Aborting one twin, sparing the other, when IVF goes 'wrong'

Pregnant woman CNA US Catholic News 8 25 11

Dr. Anthony Caruso, who performed in vitro fertilizations before his pro-life turn, isn't surprised by the recent increase in “two-minus-one” pregnancies, where women abort one of their two artificially-conceived children for personal reasons. It's a logical result, he says, of the mentality behind IVF.

“It's something that was developing over the course of time that I was in the field,” said Dr. Anthony Caruso in an August 25 interview with CNA. “People want to do 'A, B, and C' to have their one child and be fine with it. They don't want to have more than one child, because their plan was to have one child and be done with it.”

Caruso says pregnancy “has become a commodity. As such, you can do with it as you will, to make sure you have the 'best' outcome you can. Selective reduction is one of those options.”

“Selective reduction” involves aborting one or more children in a multiple pregnancy while leaving others alive, through a chemical injection that stops the baby's heart. It began as a way for IVF doctors to manage the sometimes risky multiple pregnancies resulting from their embryo implantation practices.

For decades, most doctors would not even discuss “reducing” twins down to a single child, an option with almost no conceivable medical basis. In recent years, however, what was once unthinkable has become increasingly popular, according to a recent New York Times article about IVF recipients opting for “two-minus-one pregnancies.”

That August 14 article cited figures from Mount Sinai Medical Center, a major provider of fetal reduction. Out of the 101 selective abortions the center performed in 2010, 38 involved a reduction from one twin to a single child. 

A woman named Jenny, who felt personally unable to care for more than one additional child, told the Times that she knew her “selective reduction” of twins to one baby was “bad, but … not anywhere near as bad as neglecting your child or not giving everything you can to the children you have.” Jenny told the Times about the decision she and her husband made, but she plans never to tell anyone else.

Shelby, who aborted two out of three children (conceived through artificial insemination rather than IVF), told the Times she couldn't bear the thought of raising more than one child while her husband was fighting in Iraq: “My number one priority was to be the best mom I could be, but how was I supposed to juggle two newborns or two screaming infants while my husband was away being shot at?”

Columbia Reproductive Genetics Professor Dr. Ronald Wapner even described for the Times how he was threatened by a patient who told him: “Either reduce me to a singleton, or I'll end the (entire) pregnancy.” He did so – and soon became a sought-after reductionist among women unwilling to bear twins, before later deciding he personally opposed the practice.

Dr. Caruso, who was reconciled to the Catholic Church after quitting his IVF practice in 2010, was never involved with a purely elective reduction. He says that patients who end up with twins “very rarely – if ever – entertain the thought of reduction.”

But the advent of the “two-minus-one pregnancy” is the result of trends he noticed for many years. “Children have become less the fruit of a marriage, and more of a commodity,” he told CNA.

Because of this consumer approach to new life, he said, “people walk into this (in vitro) process having a certain expectation – and no matter what you tell them, that is their expectation. But there's no way to make that expectation guaranteed.”

“There's no way to tell them, 'I can make and create a program for you that guarantees that at the end of the day, you will have just one child.'”

“Because we want 'a baby,' we'll do whatever it takes to have that baby. And if we happen to overdo it, and wind up with more than one baby, we'll just kill it.”

Caruso was involved with five cases in which individuals considered selective reduction to increase their odds of a healthy pregnancy. “Four of them went for selective reduction,” he recalled. “All four of them against my advice. But four of the five did.”

The fifth kept all of her artificially-conceived children, “because I convinced her that it was okay to have triplets.”

Most of Caruso's patients, over the course of 10 years, never faced a situation in which they might have considered a selective abortion. But all of them, he noted, were told that artificial reproduction might lead to a situation in which a physician could recommend reduction.

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“It is discussed every single time the patient gives consent for in vitro fertilization – whether was done by myself as a practitioner, or by a nurse, or by a psychological professional, or by a social worker. They have to, as a means of fulfilling informed consent. They must discuss this substantively, including the risks to the pregnancy.”

In Caruso's experience, couples often wanted twins, considering it a bargain of sorts. “As a matter of fact, the euphemistic joke – that's only a half joke – is that maybe they'll get two for the price of one.”

But those who only wanted one child often got more than they bargained for. “In those cases, when they have twins … that changes their world terrifically,” Caruso said. “You see marriages break down, relationships break down, people have all kinds of problems – because they didn't plan on having more than one child.”

For some couples, the status quo that's threatened by a second child becomes more precious than that child's life.

In one case documented by the Times, two women in a same-sex partnership both underwent IVF, and both became pregnant with twins. They were already caring for a 14-month-old child, and found the stresses overwhelming. Just before one of the women lost both her children in a miscarriage, the other chose to abort one of her twins selectively.

That woman told the Times she was “very grateful that we had this option at our disposal, that it can be done safely and in a legal way, but it was very difficult for both of us. I still wonder, did we choose the right one? That idea, that one's gone and one's here, it's almost like playing God.”

“There are those people out there who will do everything in their power to only have one child,” Caruso reflected.

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“Pregnancy is a commodity for them – and when you think about it from that perspective, all the other possibilities that come through, on what you might call the 'slippery slope' – why wouldn't they happen? Why wouldn't you have a situation where a person gets pregnant with triplets and has an abortion to a singleton because they only wanted one baby?”