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What is foetal reduction, when is it done?

Foetal reduction is the process of reducing the number of embryos by stopping the heartbeat of one or two embryos in a multiple pregnancy.

Multiple pregnancies have become more frequent due to the practice of assisted reproduction – IVF method, depending on the number of transferred embryos. In other words, while families who have been trying to conceive for years are overjoyed to have finally succeeded, they also have come to face the risks of falling pregnant with more than one baby. The most prominent problem with on-going multiple pregnancies (triplets or more) is the risk of premature birth as well as related complications in the development of the babies. Going into labour before week 37 is considered to be a premature birth. Not all ladies carrying a multiple pregnancy will not carry the pregnancy to full term so on average 36 weeks is recommended for twins and 32 weeks for triplets. Going into labour early, especially before week 34 can present serious complications.

Some problems suffered by babies due to premature birth include:

  • Serious lung problems;
  • Heart disease;
  • Brain haemorrhage;
  • Severe ocular damage;
  • Hearing problems;
  • Intestinal problems (like necrotising enterocolitis);
  • Severe infection – sepsis;
  • Anaemia;
  • Jaundice.

All these problems have the potential of affecting the baby for the rest of his-her life. In fact some problems can lead to death after birth or during infancy.

How is the procedure performed?

In recent years there is an increasing tendency to carry out a single embryo transfer. However multiple embryo transfer may be performed depending on certain conditions and the ethics of the centre you choose to under-go your treatment. When should you consider more than one embryo to be transferred?

  • When a patient’s age indicates that there egg quality has declined;
  • When patient has had a high number of past failed attempts;
  • When poor embryo quality has been shown on previous failed IVF attempts;
  • When the family’s wish to have multiple pregnancies, although it will be against our recommendations.

While twins are an acceptable condition, the option of foetal reduction is offered to families with triple or more pregnancies after explaining the risks. Reduction is performed in week 11-12 of pregnancy not sooner or later. The mother’s womb is entered with a needle, assisted by an ultrasound; potassium chloride is injected into one or two of the weakest foetus` to stop the heartbeat. The aim of this intervention is to leave one or at most two healthy babies in the womb to carry to a healthy and full term pregnancy. There are certain criteria’s that determine which baby’s heart will be stopped (baby’s development, baby’s location inside the womb, placenta location, nape thickness etc.). There is no need to remove the reduced foetus. The body will organise itself in the following term and eliminate the remains.

This is an interventional procedure so it does carry certain risks, which include:

  • Bleeding – infection at injection point;
  • Uterine bleeding (usually self-limited);
  • Perforation of the amniotic sack;
  • Intra-uterine infection (serious condition which might require termination of pregnancy);
  • Effect on all babies, miscarriage (the risk of this happening is 5-6%).

If the pregnant woman is Rh (-) and the partner/husband is Rh (+), then the mother must definitely undergo a blood incompatibility injection (Anti-D immunoglobulin) after the procedure.

Although some families have doubts even if they accept the risks related to the procedure, they still go ahead with foetal reduction because the risk of multiple pregnancies and losing all babies is much greater.

That is why we advise you choose a centre that is not only responsible to you as a patient but ethically understands the risks involved with more than one embryo being transferred. It is easy to offer a multiple embryo transfer but the end result can be more heart breaking for the couple, so making an informed and realistic decision to give you the best chance of pregnancy and to maintain this as a healthy pregnancy is important in any IVF treatment.

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