Hard Choices: Where To Draw the Line on Limiting Selection in the Selective Reduction of Multifetal Pregnancies

Imagine a hopeful mother, desperate after many failed attempts to become pregnant. She consults a fertility clinic and decides to undergo the invasive and costly process of in vitro fertilization (IVF). The procedure is more than successful—she finds herself pregnant with quadruplets. At less than five feet tall and with a petite frame, she will not be able to carry all four fetuses to term. Her doctor recommends an abortion, but she is unwilling to sacrifice the pregnancy. In 1984, such a patient came to Mark Evans, an obstetrician-geneticist who performed the first procedure now known as selective reduction— the termination of one or more fetuses in a multifetal pregnancy. As reproductive technology has become more accessible in recent years, the number of multifetal pregnancies has skyrocketed. Due to the risks inherent in multifetal pregnancies,