Demand Still High for Fetal Reduction Procedure.

VAIL, COLO. -- High-order multifetal pregnancies continue to be a common side effect of assisted reproductive technologies--and demand remains high for multifetal pregnancy reduction.

"There are a lot of women out there who are conceiving triplets or more even though there has been so much hoopla about trying to get the infertility doctors to reduce the number of these patients that are created," said Dr. Richard L. Berkowitz, professor and chairman of ob.gyn. at Mount Sinai School of Medicine, New York.

Indeed, in the past 2 years physicians at Mount Sinai have performed an average of 165 multifetal pregnancy reductions annually, nearly all in infertility patients, he said at a conference on obstetrics and gynecology sponsored by the University of Colorado.

The procedure's goal is to increase the potential for good quality of life for those fetuses left behind by getting them to be born at a later gestational age.

"The problem is that the human uterus was designed to have one fetus in it. The more you put in there, the earlier the patient is likely to deliver," Dr. Berkowitz explained.

The multifetal pregnancy reduction procedure is effective in achieving its goal. In the first 400 cases at Mount Sinai, the majority of which involved reduction of triplets or quadruplets to twins, the gestational age at delivery averaged 35.5 weeks. Overall, 88% delivered after 32 weeks.

Only 3% delivered at 24-28 weeks' gestation, the time that obstetricians and patients dread most because of the high rate of associated profound and irreversible damage that is compatible with a long but severely impaired life.