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The more the merrier

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By Mirjam Schaap

My parents couldn’t be happier when they discovered they were expecting triplets. I can hear you think – triplets? Yes, you’ve heard me right. Some might shiver by the thought of thousands of diapers, others might be charmed by the thought of three toddlers hopping around (surrounded by pink clouds, a rainbow and some unicorns). Anyway, I’m very grateful that me and my siblings were born blurred of health. This is not usual in higher multiple pregnancies, since there’s a greater risk of fetal and maternal complications. That’s why nowadays, embryo reduction(ER) is offered in multiple pregnancies.

Due to the rise of fertility treatments as in-vitro fertilization and ovarian stimulation in the ’80, the number of higher multiple pregnancies increased1. The fact that women tend to have children at an older age played a role as well, since older women have a higher “risk” of a multiple pregnancy. In the Netherlands, the largest number of multiple pregnancies (three or more embryos) was in 1991, with an incidence of 1241. This number decreased to 40-50 pregnancies a year, because of a more restrictive policy in fertility treatment. As a response, the method of ER was developed. The idea behind this is limiting the risk of complications and perinatal death by reducing, in this case triplets, to a twin or even singleton pregnancy2.

ER in the early pregnancy can either be done by fetal intracardiac injection of potassium chloride or radiofrequency ablation of the umbilical cord. The dead embryo will be absorbed by the body of the mother2. ER is not without a risk: there’s a 4% chance of miscarriage3. This is even a higher price if you consider that a lot of women offered ER are pregnant after fertility treatment. A tough choice to make: chorionicity, number of embryos and psychosocial factors all play a role. Quite some studies have tried to quantify the pros and cons of ER, but in practice the psychosocial factor is often decisive3. As a biased person myself, my choice would be easy: the more the merrier!

 

  1. Centraal Bureau voor de Statistiek. (2016). Minder tweelingen geboren. Retrieved from https://www.cbs.nl/nl-nl/nieuws/2016/39/minder-tweelingen-geboren.
  2. Stone J, Kohari K. High order multiples. Clin Obstet Gynecol. September 2015. 58(3): 668-675.
  3. NVOG Richtlijn meerlingzwangerschap versie 3.0. Maart 2011.