Fetal reduction in a nontuplet pregnancy: technical and ethical considerations.

A case of a nontuplet pregnancy that was successfully reduced to twins resulting in a good neonatal outcome is described. A 37-year-old woman achieved a nontuplet pregnancy after ovarian stimulation with GnRH-analogues and gonadotrophins in the short protocol and artificial insemination. Reduction of the nontuplet pregnancy to twins was successfully performed in three attempts and delivery by caesarian section was followed on the 32nd week of pregnancy. Two alive and healthy neonates with birth weights 1235 g and 1515 g were born. Multifetal pregnancy reduction is medically justified in the very high order pregnancies. The first approach, though, to the problem of multiple gestation should be prevention through carefully monitored infertility treatment, as the elective embryo reduction procedure carries with it medical, ethical and psychological issues for both the parents and the physicians involved.