Iranian Journal of Medical Ethics and History of Medicine

Science considers using technologies for treatment of infertility as the important cause of multifetal pregnancies. Fetal reduction is a clinical procedure developed for reducing the number of fetuses in multifetal pregnancies in order to avoid their common complications. Three aims may be offered for fetal reduction: (1) pregnancy preservation, and prevention of and decreasing risks of multifetal pregnancy to the mother and the remaining fetuses (high-end multifetal reduction); (2) eliminating fetuses bearing certain kind of illnesses (selective reduction); and (3) just preventing multiple birth where no considerable risk threatens the mother or the fetuses (elective reduction). Moral evaluation on fetal reduction techniques varies depending on which of the mentioned aims is followed. However, in many cases this is “medical necessity” that morally justifies the reduction. Nevertheless, given the difficulty of reaching a decision on this issue, risks involved in fetal reduction procedure, and its psychological implications for the mother and the father, it is seriously recommended to avoid such an action by methods that prevent multifetal pregnancy.

Modern infertility treatment methods, along with favorable results, sometimes bring about unfavorable consequences. Multiple pregnancy is one of those consequences that puts the health of mother and life of fetus in danger. Fetal reduction, namely removing one or more fetuses with aim of preserving pregnancy and also certain preventive measures such as transfer of fewer fetuses into uterus of mother in each cycle of In Vitro Fertilizations (IVF), is one of solutions to tackle this unfavorable consequence. In a number of legal systems, along with a permission to conduct fetal reduction, precise provisions on the number of transferable fetuses are enacted. A comparative study of fetal reduction in countries in which there is an experience of legal encounter with this issue shall open a horizon for the legislator and policy makers in the field of health in Iran, where there is no consistent laws or regulations in this context, so that they adopt an appropriate approach to the problem. It seems that a fetal reduction permission, limiting regulations on the number of transferable fetuses, and proper insurance coverage embody an appropriate legal system in the context of fetal reduction.