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  1. #16
    I have never been faced with this issue myself. But I did do some research years ago out of curiosity when a friend of a friend got pregnant with quads and my friend was sharing her struggle with this issue, she faced significant pressure from her doctors to selectively reduce (although she was morally opposed to abortion previously). I think that in the end this discussion is not really different than any other discussion of abortion.

    People who believe that life begins before birth and that a fetus is a person endowed by God with the same right to live as any other are generally going to be morally opposed to abortion for any reason (though many would make exceptions for rape or when the choice has to be made between the life of the fetus or the mother). From this perspective selective reduction hardly seems a compelling reason to consider abortion and certainly pales in comparison to the tragedy of pregnancy after rape, incest, and while the difficulty for the mother is a factor, it is hardly imminent when most selective reductions occur (nearly always during the first trimester and before any complications have ensued).

    The flip side of the issue is people who believe that any woman's decision to carry on with or end a pregnancy is a decision involves her body, personal health, well being (emotional and physical) not to mention career and future. From this perspective the decision to selectively reduce includes several compelling factors- statistically better outcomes (though I don't think this is the case when reducing from 2 to 1), with the flip side of a risk to the remaining fetus(es), and MAJOR lifestyle factors not the least of which is the cost.

    In the case of the friend of a friend she was a stay at home mom on a tight budget so that she could stay home with her one child. She had been trying for 3 or 4 years for a second and was taking clomid (that's it, no IVF- she was around 30 or 31). She didn't live near any family. She faced the reality that it is likely that one person staying home cannot provide care for 4 newborns along with a preschooler, that unlike her first baby she could not nurse 4 babies for free (so add $$$ for formula), that her old cloth diaper stash wasn't quite going to cover it (not to mention she was not going to have an extra minute to wash those cloth diapers). There was also the consideration that she wanted to be a stay at home mom and was philosophically inclined to believe that was the best thing for her children. She had to think about if caring for 4 newborns on her own was not feasible then she may have to go back to work full time in order to pay for childcare. She had to try and imagine bonding with 4 children. She had to think about how the influx of 4 babies would affect her son. It was an astronomical thing to consider. She kept her babies and her husband found a better job closer to her parents. They had family to help and hired a part time college student as a helper. All 4 babies were born healthy and she had no major complications. As far as I know that is still the case.
    Last edited by rosebyanyothername; May 22nd, 2013 at 05:13 PM. Reason: deleted a sentence
    Mama to little Ramona Mae 3/2011 and Sylvie Joy born 11/2013

  2. #18
    Join Date
    Sep 2012
    Posts
    2,667
    Pinkballerina: No offense taken. My opinion is not an educated one, just personal. I have an unsettling memory of the woman who gave birth to eight babies at once ("Octamom" they were calling the poor mother?) Yes, there are instances where implanting many fetuses is the only way someone can become pregnant. Who am I to say that such a woman shouldn't have that option? I'm sure there are IVF doctors who are brilliant at determining how many fetuses to implant. It just seems to me that it's really important to be prudent about it so the mother doesn't have to face the choice to abort seven fetuses or take on a huge medical risk/ instant baby-boom. Ethically (to me) it's such a finely-shaded area. What is necessary to achieve a pregnancy, what is too risky for mother or babies, what is abuse of technology by those seeking to profit from the desperation of people with fertility challenges, where do restrictions about how many fetuses to implant infringe on a woman's rights over her body? Hm.

  3. #20
    Join Date
    Jan 2013
    Location
    SD, CA
    Posts
    360
    I know of almost no RE's in the San Diego area that are comfortable transferring more than 3 embryos any more. In most cases, RE's limit embryos to 2 per transfer. Thankfully, the field is growing and developing and evolving. The whole ethical code in this new field was an almost blank canvas not too long ago, but over the last decade, some common sense policies have beome the norm. The fact that we even have someone in our culture called the "Octomom" is evidence that there are still some very unethical Dr.'s out there, but that is BY FAR the exception.

    Whenever I hear of a patient contemplating the number of embryos to transfer (sometimes women still think they want 3), we always talk about the potential need to selectively reduce. Once a woman really thinks about that reality, she almost always opts for 2 embryos. Even then, a woman carrying twins in her early 40's is still high risk. Twins always sound like a good idea pre-transfer, but every 40+ year old mom in her 34th week (if she makes it that far) is absolutely miserable. Still two babies have a much better outcome than three, for both babies and mom.
    Last edited by sdsurfmama; May 22nd, 2013 at 05:52 PM.
    Mama to
    Desmond Sanders, born 7/2013
    and dog son, Lambeau

  4. #22
    Join Date
    Jun 2010
    Posts
    2,356
    I agree that I don't think more than 3 embryos should be implanted, but spontaneous high-order multiples do happen (though rarely) and that wasn't really the question.

    I'm not a mother or planning to become one anytime soon, so my opinion may change if I have that experience, but for now: I would not selectively reduce, but I don't think it's morally wrong at all.
    Multiple pregnancies can be extraordinarily dangerous for both mother & children. Not every multiple pregnancy ends in all babies surviving, and the more babies in there, the more dangerous it is for all involved. I think people hear about the healthy Gosselin sextuplets and octobabies and all these "miracle baby" stories about infants born prematurely, so they underestimate how incredibly dangerous pregnancy and premature birth can be. In some cases, it could be sacrificing one or more fetus to save the others and their mother. I'd never want to be in a situation where I have to make that kind of choice, and I would never criticize anyone who had to. There really isn't a "right" choice, so every family should be able to make the decision they feel is best without fear of judgment.
    Also as a note: I'm not religious, so that has nothing to do with my opinion.

  5. #24
    Join Date
    Sep 2012
    Location
    Los Angeles
    Posts
    4,514
    @sdsurfmama beat me to it. Nowadays this is much, much less of an issue than it was a decade ago. IVF survival rates for individual embryos are much higher than prior and nearly all doctors will not implant more than 3 embryos at a time (many have limits on 2/cycle). There are always disreputable hacks (see the 'God complex' I was discussing before in re: many fertility specialists) who will indulge women with clear psychopathology like Octomom, but they are thankfully in the minority (and that particular person lost his California medical license).

    And as someone else said, if a couple is in that situation they do not personally select which embryo/fetus is terminated. It's still a "Sophie's Choice" situation, but usually the smallest or most external fetus is the one selected *by the doctor.*
    Blade, MD

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