The one-in-eight American couples who face fertility problems are, if they pursue reproductive technologies like artificial insemination or in-vitro fertilization, inevitably confronted with the possibility of "selective reduction," where they will need to abort one or more fetuses in order to make a pregnancy viable. For some, the decision is hypothetical and never needed. For others, it is medically mandated.
But for yet others, it is a choice, and like any reproductive choice, it is complex, deeply personal, and ethically controversial. The New York Times has published an in-depth, thought-provoking piece about the rising number of women who are choosing to reduce twin pregnancies to singletons:
For all its successes, reproductive medicine has produced a paradox: in creating life where none seemed possible, doctors often generate more fetuses than they intend. In the mid-1980s, they devised an escape hatch to deal with these megapregnancies, terminating all but two or three fetuses to lower the risks to women and the babies they took home. But what began as an intervention for extreme medical circumstances has quietly become an option for women carrying twins. With that, pregnancy reduction shifted from a medical decision to an ethical dilemma. As science allows us to intervene more than ever at the beginning and the end of life, it outruns our ability to reach a new moral equilibrium. We still have to work out just how far we're willing to go to construct the lives we want.
What is it about terminating half a twin pregnancy that seems more controversial than reducing triplets to twins or aborting a single fetus? After all, the math's the same either way: one fewer fetus. Perhaps it's because twin reduction (unlike abortion) involves selecting one fetus over another, when either one is equally wanted. Perhaps it's our culture's idealized notion of twins as lifelong soul mates, two halves of one whole. Or perhaps it's because the desire for more choices conflicts with our discomfort about meddling with ever more aspects of reproduction.
Firm numbers on twin reductions are not available, but the number is reportedly rising:
No agency tracks how many reductions occur in the United States, but those who offer the procedure report that demand for reduction to a singleton, while still fairly rare, is rising. Mount Sinai Medical Center in New York, one of the largest providers of the procedure, reported that by 1997, 15 percent of reductions were to a singleton. Last year, by comparison, 61 of the center's 101 reductions were to a singleton, and 38 of those pregnancies started as twins.