The Bitter Cost

By Denise Grady

The brave new science of reproductive technology has been a mixed blessing for childless couples. Women who were once told they might never conceive are now able to become pregnant. But fertility drugs or surgery can produce three or four, sometimes even eight or nine, fetuses. Not only does such a pregnancy threaten the mother's health, but each extra fetus increases the risk of miscarriage or premature birth, which can cause an infant's death or irreparable brain damage. In a widely publicized 1985 case, Californian Patti Frustaci gave birth prematurely to septuplets; only three survived.

Now doctors are offering an alternative: aborting some of the fetuses in order to save the others. So far, fewer than 100 women have undergone the procedure, called fetal reduction, at a handful of U.S. hospitals. Usually performed before the twelfth week of pregnancy, it requires that the doctor pierce the mother's abdomen with a needle and, guided by an ultrasound image, inject a lethal drug into the fetus. It dies within minutes. The remaining infants, usually two, then have a much improved chance of developing normally.

Last week in the New England Journal of Medicine a team from New York's Mount Sinai School of Medicine warned that the procedure can lead to miscarriage of all the fetuses. Four of twelve pregnancies analyzed in the study were lost entirely, though the technique was clearly to blame in only one. Others have fared better: Dr. Ronald Wapner of Jefferson Medical College in Philadelphia has treated 18 women with no complications so far.

Those results have not dampened the ethical debate over the practice. Says Dr. John Willke of the National Right to Life Committee: "Fetal reduction is the thinly veiled killing of unwanted babies." But both Wapner and Dr. Richard Berkowitz, head of the Mt. Sinai team, insist that the vast majority of patients come to them for medical reasons, not social ones.

"The most important thing is that this procedure is preventable," says George Annas of the Boston University School of Medicine. Multiple fetuses often result from in vitro fertilization, in which numerous embryos are transferred into the uterus in the hope that one will "take." As a result, some clinics now use fewer embryos. Multiple conceptions have also occurred in women taking fertility drugs; many could be avoided, say obstetricians, if dosages were prescribed more carefully. Such measures would probably lengthen the time that it takes couples to conceive, but that seems a small price to pay for avoiding what must be one of the most painful decisions that parents- to-be are ever forced to make.

With reporting by Andrea Dorfman/New York