Most pregnancies with three early gestation sacs (each sac usually contains one embryo) reduce spontaneously. In one study, there were 38 pregnancies with three gestation sacs between three and four weeks after IVF/embryo transfer. At delivery there were seven single babies, twelve twins and eighteen sets of triplets.

Selective termination is a procedure usually employed when one fetus is found to have a significant abnormality with the objective of allowing the pregnancy to continue with the expectation of delivery of the remaining healthy infant(s). Multifetal pregnancy reduction is the termination of one or more seemingly healthy fetuses with the objective of reducing the risks of higher order multiple pregnancies. Recent analysis of data from North East London showed that the neonatal death rate (babies dying in the first four weeks per 1000 live births) for a singleton pregnancy is 3.4, for twins 25.4 and for higher order it is 93.8. Multifetal pregnancy reduction has been shown to improve the perinatal outcome for pregnancy with four or more fetuses, although there is a 9% risk of losing the entire pregnancy.

The ethical issues associated with selective termination of a fetus with significant abnormality are identical to those pertaining when there is only one fetus. The ethical issues relating to multifetal pregnancy reduction are far more complex as it involves the sacrifice of one or more normal fetuses for the benefit of the remainder. Interestingly, a psychological assessment of surviving offspring and their parents in Holland found no adverse effects.

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