Selective reduction is a weighty decision to make early in your surrogacy journey. Intended Parents and surrogates alike should fully understand what selective reduction is and how it may play a role in their surrogacy.

What is Selective Reduction?

Selective reduction—also referred to as multifetal pregnancy reduction (MFPR) or selective termination—is a medical procedure in which one or more fetuses in a multiples pregnancy are terminated. Selective reduction typically occurs between 10-12 weeks of the pregnancy and is a minimally invasive procedure for the surrogate.

Selective reduction may be recommended to increase the chances of one or two of the fetuses surviving the pregnancy. Pregnancy with multiples (three or more fetuses) increases risks of premature birth, and health concerns for the children. Carrying a pregnancy with multiples also increases health risks for the surrogate.

Why Transfer Multiple Embryos?

Every case in assisted reproductive technology is unique. IVF doctors typically recommend at least two embryos be transferred to the surrogate's uterus at a time to increase the chance for pregnancy.

Sometimes none of the embryos take. The hope is that one or two do implant and the surrogate becomes pregnant. It is possible that multiple (three or more) transferred embryos implant and the surrogate becomes pregnant with multiples. While the idea of having a big family at one time sounds hopeful, the risk of complications for the fetuses and surrogate increase with multiples.

How Can Selective Reduction Impact Me?

Depending on how many eggs/embryos IPs have and how many IVF cycles they can commit to, they may be advised to transfer several embryos at one time. If the IPs and the surrogate do not engage in a preemptive discussion regarding selective reduction, their views on the procedure may impede their surrogacy.
 

How to Discuss Selective Reduction

Initiating a conversation about selective reduction with your prospective IPs or surrogate may sound intimidating but it is an important topic to discuss. While there is hope that you will be matched to someone with similar beliefs and opinions, you cannot be sure unless you discuss where you each stand. Once you've established a level of comfort, ask the other party what their thoughts are regarding selective reduction.

Make sure they know exactly what selective reduction is, what the procedure involves, and when it may be recommended. Inquire when they would be open to selective reduction and when they would be opposed to considering it. As uncomfortable as it may seem to initiate this topic, the alternative could set the stage for an otherwise avoidable obstacle that can be stressful and painful to everyone involved.

If the IPs and surrogate enter the surrogacy agreement with shared opinions regarding selective reduction, then they are on a good path. Arguments can be posed to support or disagree with the procedure, they are matters of opinions. It is important for the surrogate and her IP(s) to understand that selective reduction may play a critical role during their journey, and to agree on an ultimate course of action should the situation arise.