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Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

Get the facts

Your options

  • Carry a pregnancy with three or more fetuses.
  • Have multifetal pregnancy reduction. This procedure reduces the number of fetuses.

This information is for women who are pregnant with three or more fetuses. It's also for their partners.

Key points to remember

  • Having fewer fetuses lowers all risks. This makes it more likely that you will have a healthy pregnancy and a healthy baby or babies.
  • The risk of premature birth is higher when you are carrying multiple fetuses, which increases an infant's chances of having severe health problems.
  • This procedure to reduce the number of fetuses has a risk of miscarriage of the remaining fetuses.
  • Early genetic testing (chorionic villus sampling) and fetal ultrasound can help you find out if any of the fetuses has a problem. This information may help you decide about reducing the number of fetuses.
  • This decision may be emotional and complex. For some people, it raises ethical and spiritual concerns.
FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a pregnancy—usually from three, four, or five fetuses to two. This may help the two fetuses survive and help you have a healthy pregnancy.

This procedure is most often done early in a pregnancy, between the 9th and 12th weeks. It's often done after genetic testing to find out if the fetuses have any problems.

It's usually done through the belly. Using ultrasound as a guide, the doctor puts a needle into the uterus to the selected fetus or the umbilical cord. The doctor injects the fetus or the cord with a medicine that stops the heart.

Sometimes vaginal bleeding happens afterward. This is normal.

The dead embryo or fetus is absorbed by the mother's body. This is similar to what happens with vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Reduced risk for mother. The procedure reduces the mother's risk of problems. These risks include gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care. Caring for three or more babies can be stressful, especially if any of them has health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive. Because multiple babies have an increased chance of premature birth and illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring for the babies at home also could be costly. After they come home, premature babies often need medicines, medical equipment and supplies, and extra doctor visits.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

  • Miscarriage of the other fetuses. About 4 out of 100 triplet-to-twin procedures and about 7 out of 100 quadruplet-to-twin procedures lead to miscarriage. This means that 96 out of 100 triplet-to-twin procedures and 93 out of 100 quadruplet-to-twin procedures don't cause a miscarriage.1 The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.1
  • Emotional risks for you, especially if the pregnancy miscarries. Some parents who go on to have a healthy pregnancy view the reduction as sad but medically needed. Others who have had a reduction followed by a healthy pregnancy say they felt grief, guilt, and depression about their decision. But for many women these feelings usually are reduced with time.2
  • Infection of the belly or uterus. This is rare.

Some couples choose to implant fewer embryos to reduce the chance of a pregnancy of triplets or more, rather than consider having this procedure.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have fetal reduction Have fetal reduction
  • You will have an ultrasound test to make sure that the fetus or fetuses to be reduced are in their own amniotic sac. Separate sacs reduce the chance of miscarriage. A different procedure may be done if the fetuses are in the same sac.
  • It's done in the doctor's office. It takes only a few minutes.
  • You will be watched at the doctor's office afterward to make sure that the remaining fetuses are doing well.
  • Having fewer fetuses reduces the risk of miscarriage, stillbirth, premature birth, and disability.
  • You have a lower chance of problems in your pregnancy, such as gestational diabetes, preeclampsia, or anemia. These risks increase with each added fetus.
  • It may reduce the stress related to caring for more infants.
  • It reduces the cost of caring for multiple infants.
  • You could miscarry the remaining fetuses. When reducing from a triplet to a twin pregnancy, the miscarriage rate is about 4 out of 100 pregnancies. And when reducing from a quadruplet to a twin pregnancy, the miscarriage rate is about 7 out of 100. This means that a miscarriage doesn't happen in 96 out of 100 triplet-to-twin procedures and in 93 out of 100 quadruplet-to-twin procedures.1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.1
  • You could have an infection in your belly or uterus. This is rare.
  • Some parents have grief, guilt, and depression about reducing the number of fetuses. But these feelings may decrease with time.2
Carry three or more fetuses Carry three or more fetuses
  • You will see your doctor more often during your pregnancy.
  • You will likely see a perinatologist. This doctor takes care of women who may have a problem in their pregnancy.
  • You may have more tests than you would in a pregnancy with one fetus.
  • You may avoid the emotional stress that some people feel about reducing the number of fetuses.
  • You have a lower risk of infection.
  • Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.
  • Multiple pregnancy increases the mother's risk of problems such as gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

When my husband and I learned we were expecting three babies, we were thrilled. But along with that news we heard about the risks for them and me. I'm already at risk for pregnancy problems, since I've had gestational diabetes before. So we decided to have a multifetal pregnancy reduction. What convinced me was the knowledge that the miscarriage rate is higher for triplet pregnancy than it is for the twins after the procedure. And it went well for us. We took the risk, and the babies and I are doing well.

Pam, age 37

Because of my age, our fertility doctor encouraged us to have four embryos transferred for my in vitro. We were surprised that all of them took and were worried about the risks. After talking for a few days about having a multifetal pregnancy reduction, my husband and I decided not to have one. We were more comfortable with letting nature take its course. And it did—by the second trimester, two were gone, and I was carrying twins.

Maya, age 43

We knew right away that carrying five babies was not going to work for them or me. So I had a multifetal pregnancy reduction. Then I miscarried. Even though it seemed like the obvious course to take, I'll never stop feeling terrible about it.

Jenny, age 39

I just couldn't bring myself to have a multifetal pregnancy reduction, even though my doctor told me that my pregnancy was high-risk. I'll never know whether it would have gone better if I'd had the procedure, but trying to carry the four babies didn't go well. One died after birth, and now we have the challenge of raising triplets, one of which is disabled.

Joelle, age 35

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

More important
Equally important
More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

More important
Equally important
More important

My ethical and spiritual values would allow me to have fetal reduction.

My ethical and spiritual values wouldn't allow me to have fetal reduction.

More important
Equally important
More important

I don't think I can take care of a child with a disability.

I can take care of a child with a disability.

More important
Equally important
More important

I can't afford to raise three or more children.

I have the resources to raise several children.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?

  • YesYou're right. A fetal reduction lowers the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.
  • NoSorry, that's not right. A fetal reduction does lower the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.
  • I'm not sureIt might help to go back and read "What are the benefits of a multifetal pregnancy reduction?" A fetal reduction does lower the chance that the remaining babies will have a disability.
2.

Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?

  • YesSorry, that's not right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.
  • NoYou're right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.
  • I'm not sureIt may help to go back and read "What are the risks of multifetal pregnancy reduction?" The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.
3.

Do both choices have emotional side effects?

  • YesYou're right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.
  • NoSorry, that's not right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.
  • I'm not sureIt may help to go back and read "Compare your options." You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

References
Citations
  1. Malone FD, D'Alton ME (2009). Multiple gestation: Clinical characteristics and management. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 453–476. Philadelphia: Saunders Elsevier.
  2. Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Multiple Pregnancy: Should I Consider a Multifetal Pregnancy Reduction?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Carry a pregnancy with three or more fetuses.
  • Have multifetal pregnancy reduction. This procedure reduces the number of fetuses.

This information is for women who are pregnant with three or more fetuses. It's also for their partners.

Key points to remember

  • Having fewer fetuses lowers all risks. This makes it more likely that you will have a healthy pregnancy and a healthy baby or babies.
  • The risk of premature birth is higher when you are carrying multiple fetuses, which increases an infant's chances of having severe health problems.
  • This procedure to reduce the number of fetuses has a risk of miscarriage of the remaining fetuses.
  • Early genetic testing (chorionic villus sampling) and fetal ultrasound can help you find out if any of the fetuses has a problem. This information may help you decide about reducing the number of fetuses.
  • This decision may be emotional and complex. For some people, it raises ethical and spiritual concerns.
FAQs

What is multifetal pregnancy reduction?

Multifetal pregnancy reduction is a procedure to reduce the number of fetuses in a pregnancy—usually from three, four, or five fetuses to two. This may help the two fetuses survive and help you have a healthy pregnancy.

This procedure is most often done early in a pregnancy, between the 9th and 12th weeks. It's often done after genetic testing to find out if the fetuses have any problems.

It's usually done through the belly. Using ultrasound as a guide, the doctor puts a needle into the uterus to the selected fetus or the umbilical cord. The doctor injects the fetus or the cord with a medicine that stops the heart.

Sometimes vaginal bleeding happens afterward. This is normal.

The dead embryo or fetus is absorbed by the mother's body. This is similar to what happens with vanishing twin syndrome.

What are the benefits of a multifetal pregnancy reduction?

Reduced risk for mother. The procedure reduces the mother's risk of problems. These risks include gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus.

Reduced risk for infants. The procedure may improve your chances of carrying your pregnancy longer and your chances of delivering one or more healthy babies.

Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.

Reduced stress related to infant care. Caring for three or more babies can be stressful, especially if any of them has health problems.

Reduced cost of caring for multiples. The hospital care for three or more infants can be expensive. Because multiple babies have an increased chance of premature birth and illnesses, they are cared for in a neonatal intensive care unit (NICU). Caring for the babies at home also could be costly. After they come home, premature babies often need medicines, medical equipment and supplies, and extra doctor visits.

What are the risks of multifetal pregnancy reduction?

The risks of reducing the number of fetuses include:

  • Miscarriage of the other fetuses. About 4 out of 100 triplet-to-twin procedures and about 7 out of 100 quadruplet-to-twin procedures lead to miscarriage. This means that 96 out of 100 triplet-to-twin procedures and 93 out of 100 quadruplet-to-twin procedures don't cause a miscarriage.1 The miscarriage rate is highest when reducing from 6 or more fetuses. The miscarriage rate is lower if there are fewer fetuses at the start of the procedure.1
  • Emotional risks for you, especially if the pregnancy miscarries. Some parents who go on to have a healthy pregnancy view the reduction as sad but medically needed. Others who have had a reduction followed by a healthy pregnancy say they felt grief, guilt, and depression about their decision. But for many women these feelings usually are reduced with time.2
  • Infection of the belly or uterus. This is rare.

Some couples choose to implant fewer embryos to reduce the chance of a pregnancy of triplets or more, rather than consider having this procedure.

2. Compare your options

  Have fetal reduction Carry three or more fetuses
What is usually involved?
  • You will have an ultrasound test to make sure that the fetus or fetuses to be reduced are in their own amniotic sac. Separate sacs reduce the chance of miscarriage. A different procedure may be done if the fetuses are in the same sac.
  • It's done in the doctor's office. It takes only a few minutes.
  • You will be watched at the doctor's office afterward to make sure that the remaining fetuses are doing well.
  • You will see your doctor more often during your pregnancy.
  • You will likely see a perinatologist. This doctor takes care of women who may have a problem in their pregnancy.
  • You may have more tests than you would in a pregnancy with one fetus.
What are the benefits?
  • Having fewer fetuses reduces the risk of miscarriage, stillbirth, premature birth, and disability.
  • You have a lower chance of problems in your pregnancy, such as gestational diabetes, preeclampsia, or anemia. These risks increase with each added fetus.
  • It may reduce the stress related to caring for more infants.
  • It reduces the cost of caring for multiple infants.
  • You may avoid the emotional stress that some people feel about reducing the number of fetuses.
  • You have a lower risk of infection.
What are the risks and side effects?
  • You could miscarry the remaining fetuses. When reducing from a triplet to a twin pregnancy, the miscarriage rate is about 4 out of 100 pregnancies. And when reducing from a quadruplet to a twin pregnancy, the miscarriage rate is about 7 out of 100. This means that a miscarriage doesn't happen in 96 out of 100 triplet-to-twin procedures and in 93 out of 100 quadruplet-to-twin procedures.1 The risk of miscarriage from the procedure is highest when reducing from 6 or more fetuses. The risk of miscarriage is lower if there are fewer fetuses at the start of the procedure.1
  • You could have an infection in your belly or uterus. This is rare.
  • Some parents have grief, guilt, and depression about reducing the number of fetuses. But these feelings may decrease with time.2
  • Carrying triplets or more increases the risk of miscarriage, stillbirth, premature birth, and disability.
  • Multiple pregnancy increases the mother's risk of problems such as gestational diabetes, preeclampsia, and anemia. These risks increase with each added fetus.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about multifetal pregnancy reduction

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"When my husband and I learned we were expecting three babies, we were thrilled. But along with that news we heard about the risks for them and me. I'm already at risk for pregnancy problems, since I've had gestational diabetes before. So we decided to have a multifetal pregnancy reduction. What convinced me was the knowledge that the miscarriage rate is higher for triplet pregnancy than it is for the twins after the procedure. And it went well for us. We took the risk, and the babies and I are doing well."

— Pam, age 37

"Because of my age, our fertility doctor encouraged us to have four embryos transferred for my in vitro. We were surprised that all of them took and were worried about the risks. After talking for a few days about having a multifetal pregnancy reduction, my husband and I decided not to have one. We were more comfortable with letting nature take its course. And it did—by the second trimester, two were gone, and I was carrying twins."

— Maya, age 43

"We knew right away that carrying five babies was not going to work for them or me. So I had a multifetal pregnancy reduction. Then I miscarried. Even though it seemed like the obvious course to take, I'll never stop feeling terrible about it."

— Jenny, age 39

"I just couldn't bring myself to have a multifetal pregnancy reduction, even though my doctor told me that my pregnancy was high-risk. I'll never know whether it would have gone better if I'd had the procedure, but trying to carry the four babies didn't go well. One died after birth, and now we have the challenge of raising triplets, one of which is disabled."

— Joelle, age 35

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have fetal reduction

Reasons to carry triplets or more

I want to increase the chance of having two healthy babies.

I want to try to have all my babies.

             
More important
Equally important
More important

I want to lower my chance of having a problem like preeclampsia.

I may not have any problems. But if I do, my doctor and I can decide about treatment then.

             
More important
Equally important
More important

My ethical and spiritual values would allow me to have fetal reduction.

My ethical and spiritual values wouldn't allow me to have fetal reduction.

             
More important
Equally important
More important

I don't think I can take care of a child with a disability.

I can take care of a child with a disability.

             
More important
Equally important
More important

I can't afford to raise three or more children.

I have the resources to raise several children.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Fetal reduction

Having triplets or more

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does a fetal reduction lower the chance that your remaining baby or babies will have a disability?

  • Yes
  • No
  • I'm not sure
You're right. A fetal reduction lowers the chance that your remaining baby or babies will have a disability. It also lowers the chance of a fetus or infant dying or being ill.

2. Is your risk of having a miscarriage higher with a fetal reduction than it is with having triplets or more?

  • Yes
  • No
  • I'm not sure
You're right. The risk of miscarriage is higher from having triplets or more than it is from having a fetal reduction.

3. Do both choices have emotional side effects?

  • Yes
  • No
  • I'm not sure
You're right. Either choice can be emotional and complex. You may feel guilty if you reduce the number of fetuses. But you may have a hard time raising multiples.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

References
Citations
  1. Malone FD, D'Alton ME (2009). Multiple gestation: Clinical characteristics and management. In RK Creasy et al., eds., Creasy and Resnik's Maternal-Fetal Medicine, 6th ed., pp. 453–476. Philadelphia: Saunders Elsevier.
  2. Cunningham FG, et al. (2010). Multifetal gestation. In Williams Obstetrics, 23rd ed., pp. 859–889. New York: McGraw-Hill.

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