So as we all know that multi-fetal pregnancy is defined when more than one fetus is present. So anything more than three is actually the definition so the multi-fetal reduction is defined as a procedure when we try to reduce the number of fetuses.  It is preferably done in the first trimester or sometimes we have to do it in the second trimester also so there is another terminology called selective fetal reduction.  This is defined when we are reducing the fetus with the presence of either an anatomical defect or a genetic abnormality like sometimes we do prenatal testing for thalassemia or Duchenne muscular dystrophy so then we find there is an anomaly in one of the twins then we have to reduce it and then it is called selective fetal reduction.  The preference of all selective or multi-fetal reduction is to perform at the earliest because the earlier the procedure is done less chance that the pregnancy will be lost.

When you are giving multiple follicle development happening in ovulation induction or in supra-ovulation the dominant risk factors of both dizygotic twinning and monozygotic twinning becomes high and this is much higher than the natural conception cycles.  So if there a need for multi-fetal pregnancy reduction,

The risk of perinatal as well as maternal morbidity and mortality increases with any extra fetus which is present intrauterine so again as I said it is a precious pregnancy and you have to go for fetal reduction. You know it is not about having three babies, but whether the lady is able to bring up the three babies and give them good education and when you don’t do it, there is an increased chance of pregnancy loss due to pre-term labor and this is directly proportional to the increasing fetal number.  Cerebral palsy which is around 1 in 400 pregnancies becomes 1 in 100 twin pregnancies and 1 in 30 in triplet pregnancy and 1 in 10 in a quadruple or more.  So there is an increased chance of IUGR and NICU admissions and there is definitely high mortality.

A few other questions to be answered include:

• what does the American Society of Reproductive Medicine tell us about this?
• what is the risk as such of multiple pregnancies?
• what are the maternal complications?
• what can be done?

For detailed answers to these and other questions you might have on  Fetal reduction  enroll for live lectures by Dr. Shalini Gainder (Additional Professor – Dept. of Obstetrics and Gynaecology, PGIMER, Chandigarh ), here https://docmode.org/fetal-reduction-dr-shalini-gainder/