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In vitro pregnancies and the ethical dilemma of 'selective reduction'

A 33-week pregnant woman is seen by a midwife in a routine checkup.
A 33-week pregnant woman is seen by a midwife in a routine checkup.
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With the increased use of in vitro fertilization methods to conceive, more couples increase their chances of getting pregnant with multiple embryos.  Couples may end up with the unexpected challenge of twins or triplets or higher multiples.

This challenge may be too much for some couples to handle financially or emotionally.

One way out of the challenge is selective reduction. In the case of high multiple pregnancies, doctors often will recommend selective reduction for the safety of the mother and the other babies in her womb. The procedure can also be done with fraternal twins. In the case of identical twins they are not as easily separated.

In recent years more doctors and patients use selective reductions in the case of twins and not always for medical reasons.  

According to ABC News, a leading New York City obstetrician said twins to single fetus reductions make up nearly 10 percent of the reductions performed and the number is increasing. On the popular parenting website Babble, an expecting mom and dad wrote essays about their in vitro fertilization struggles and now their pregnancy with twins. In their essays they write about being “terrified” and “pissed” about having twins, sparking a strong reaction from readers.

As Ruth Padawaer pointed out in 2011 New York Times Magazine piece explains, all reducing twins aren’t seen as risky enough for parents to justify medically, and becomes a controversial choice.

Are there moral issues with selecting reduction if the babies do not pose a health risk to the mother?


Arthur Caplan, professor of Medical Ethics at New York University Langone Medical Center

Bonnie Steinbock, Professor of Philosophy at the University at Albany, and a founding faculty member of the Union-Mount Sinai Bioethics Program.