Complications during triple, even quadruple or more pregnancies are common, both at the maternal-fetal and neonatal level. The medical aspect is not the only reason for concern: multiple pregnancies also lead to disturbances within the family, which is not necessarily the case psychologically, socially and financially prepared to welcome three, four or… six babies at the same time! Faced with these difficulties, a technique can be proposed to you: embryo reduction. This medical procedure aims to ensure that only two fetuses can develop in the uterus by removing excess embryos.
Embryo Reduction: Definition and Health Code
Before August 2, 2021, there was no law on embryo reduction. The contours of this medical gesture are now determined by the law of bioethics. Its reasons differ from those of a “classic” voluntary abortion, even if it takes place within the same time limits as permitted by abortion law. As before any medical procedure, the couple will be fully briefed on this technique and will benefit from a period of reflection before giving their written consent. If the discount is generally offered to parents, you can also apply for it, whether for medical or personal reasons. To date, not all multiple pregnancies (ie more than 3 fetuses) are reduced as some parents prefer to allow them to occur spontaneously.
If there are no risks of serious medical problems for the mother or the babies, Twin pregnancies are not affected by embryonic reduction. Triple pregnancies are discussed as advances in perinatal medicine have significantly improved the vital prognosis of premature triplets.
Additional risks in IVF
The development of PMA has led to an increase in the number of multiple pregnancies. But expecting three or four children at the same time is not without risk for both the mother and the fetus.
Embryo reduction is a medical procedure that remains rare in France and has continued to decline in the last ten years thanks to the actions of the Centers for Medically Assisted Reproduction (PMA). In fact, today the number of embryos transferred after in vitro fertilization is mostly two, which makes it possible to limit the occurrence of multiple pregnancies to more than three.
Even after the stimulation of ovulation, regular hormonal tests and ultrasound increasingly prevent the appearance of an excessive number of follicles. However, from time to time nature takes over and three or even four embryos develop, leaving parents and the midwifery team in a difficult situation.
Embryo reduction: how does it work?
Two techniques, always guided by an ultrasound
The most common attitude then is to reduce the number of embryos to two. Depending on the course of pregnancy, two methods are practicedalways guided by ultrasound.
The most common is the maternal abdominal route (similar to amniocentesis), generally around 11 weeks of amenorrhea (SA). A needle is inserted all the way into the thorax of one (or more) embryos, then products are injected first to euthanize the embryo, then to stop heart activity. Rest assured, the embryos will not suffer because the heart will stop beating in a few seconds. The embryos are not selected at random, but according to different criteria. The rarest, such as the presence of a malformation or the suspicion of a chromosomal anomaly, allow an initial selection. Your doctor will then pay close attention to the number of placentas and water sacs. Finally, he or she “selects” the embryos based on their accessibility and their position in relation to the cervix.
The second technique, which is less used, is via the transvaginal route and takes place at 8 AM SA.
No long hospital stay required, since the reduction takes place in a day clinic. You don’t have to be sober either, as anesthesia is not required. The needle used, on the other hand, is very fine and you should only feel a very small puncture. The gesture is always preceded by a thorough ultrasound that allows the location of the embryos. The duration of the intervention varies depending on the technical requirements (number, position of the embryos, etc.), the patient (morphology, sensations, etc.) and the experience of your doctor.
Then antibiotic treatment is essential to avoid infection. The uterus, on the other hand, comes to rest thanks to antispasmodics. After the procedure is completed, the patient is kept under observation for an hour before returning home. Twenty-four hours later, a follow-up ultrasound is performed to check the vitality of the retained twins and the absence of cardiac activity in the reduced embryos.
What are the consequences for childbirth after embryo reduction?
However, statistics show that Preterm birth is greater than in spontaneous singleton or twin pregnancieswhich is why mothers need more rest and are often weaned throughout pregnancy.
Are you more likely to have a miscarriage?
The main complication of embryo reduction is spontaneous miscarriage, which is estimated at about 4% of cases with the most commonly used technique. Usually, Miscarriage occurs after infection in the placenta (a chorio-amnionitis) some time after the procedure. Fortunately, most expectant mothers have a normal pregnancy.
What about the psychic side?
The psychological effect of such a gesture is significant. Reduction is often experienced as a traumatic experience by the couple, who needs the support of the entire medical team and those around them to deal with it. Parents experience conflicting feelings, particularly related to the fact that reduction most commonly occurs after infertility treatment. The relief of not having experienced a risky pregnancy often gives way to the guilt of having to part with healthy embryos. It can also be difficult for future mothers to carry these “dead” embryos and live fetuses.