Non-selective fetal reduction is malpractice.

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• In Vitro Fertilization (IVF)

Background:

• Non-selective multifetal pregnancy reduction is performed to decrease the number of fetuses in higher-order multiples to one or two.
• Current medical literature and expert reviews reveal no documented benefits supporting this practice.
• This procedure is considered non-evidence-based and deviates from established good clinical practice guidelines.

Purpose of the Study:

• To critically evaluate the medical justification and clinical practice of non-selective multifetal pregnancy reduction.
• To advocate for the abandonment of practices that lead to multifetal pregnancies, particularly those driven by commercial interests.
• To emphasize the importance of evidence-based reproductive medicine protocols.

Main Methods:

• Review of existing literature, including Cochrane reviews and expert investigations, on multifetal pregnancy reduction.
• Analysis of current clinical practices in assisted reproductive technologies, specifically in vitro fertilization (IVF) and ovarian stimulation.
• Assessment of the evidence base for the safety and efficacy of multifetal pregnancy reduction versus alternative strategies.

Main Results:

• No studies demonstrate any benefit derived from non-selective multifetal pregnancy reduction.
• Investigative bodies and systematic reviews have found no justification for the routine practice of multifetal pregnancy reduction.
• The practice is deemed contrary to good clinical practice due to its non-evidence-based nature.

Conclusions:

• Multifetal pregnancies can largely be prevented by transferring a maximum of two fertilized eggs during in vitro fertilization (IVF).
• Ovarian stimulation programs must strictly adhere to protocols designed to achieve mono-ovulation.
• The international medical community should cease practices that result in unnecessary multifetal pregnancies, especially when driven by commercial factors.