Selective/Embryo Reduction or Multifetal Reduction

When you find out you're expecting triplets or more, whichever way your pregnancy was conceived - be it through a long IVF journey or an unexpected pregnancy - there's lots to process and take in.

Once your pregnancy has been confirmed, it's best practice for your care to be transferred to a Fetal Medicine Unit for an early review and initial discussion around the pregnancy. They may not need to continue your care throughout your whole pregnancy, depending on the makeup of your pregnancy and how it progresses, but you should be seen by a specialist consultant in the first trimester.

At this appointment the consultant will do all the necessary checks and scans to find out the type of triplet/quad pregnancy you have, explain the risks – both to you and the babies – with this type of pregnancy and discuss methods to potentially reduce this risk, which includes the possibility of selective reduction. This is standard practice in the NHS and so we wanted to prepare you for the discussion and so you can make the most informed decision about what you do for your family. Twins Trust will support families who make either decision.  We understand how incredibly difficult this can be.  Every family have their own unique views, circumstances and beliefs and as a charity we're here to support everyone in the decisions they make for their family.  

What is Selective Reduction?

Selective reduction is a procedure to reduce the number of embryos/fetuses in a multiple pregnancy. It can be offered in a twin pregnancy following the detection of a congenital or genetic defect in one of the twins. When offered in a triplets or higher order (four or more) pregnancy, this is usually to reduce the risks of carrying three or more fetuses to term. It can also be called MultiFetal Reduction. 

Why is it offered?

When a pregnancy involves three or more fetuses (high-order pregnancy), the risks of miscarriage, stillbirth and lifelong disability due to being born early (preterm delivery) increase. There are not only complications for the baby but also for the mother. The chance of hypertension, preeclampsia, gestational diabetes and other conditions in pregnancy can be considerably higher in triplet and higher order multiple pregnancy. It's important that the consultant has a good picture of your individual history, so they can make you aware of your specific pregnancy and the risks attached to it.

By reducing the number of fetuses, research shows that this reduces the chance of the baby (babies) being born early and therefore there's a lesser chance of developing complications connected with premature birth. The chance of miscarriage can be slightly increased in the immediate period (2-3 weeks) after the procedure.

When would the procedure be done?

The guidance is that this procedure's ideally done no later than 16 weeks to reduce the chance of miscarriage associated with this procedure. The earlier it takes place, the lower the risk of miscarriage. It would be done by your fetal medical team in a specialist unit where only the most highly trained consultants will carry out the procedure.

What support is offered to help make this decision?

Your Fetal Medicine Consultant will provide an appointment for you to attend. Here they'll discuss and provide you with all the facts about your pregnancy and the options available to you, highlighting risk factors as well as possible outcomes.

It’s really important you're open about your feelings on this matter when talking to the consultant. Ask all the questions you need to. No question is a silly question! Look ahead to the future and the impact your decisions will have on your family for the rest of your lives.

Make sure you take your time. The team will allow you to go away and think about your decision. It’s so important to take this time to do some research and be open and honest with your partner about your feelings and the choices available.

If you feel that you'd like further support on this matter please get in touch with our support team. However, please note that we're not medical professionals.

This information was written in collaboration with Fetal Medical Professionals.