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Pregnancy Loss – When It's a Choice You Never Wanted To Make Blog Feature
Lisa Rosenthal

By: Lisa Rosenthal on October 12th, 2015

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Pregnancy Loss – When It's a Choice You Never Wanted To Make

Abortion | Fertility Treatment

PathtoFertility is officially five years old. Five years of writing, five days a week.

Five is my favorite number so I’m enjoying this month. Facebook reminds one of what you posted in the past on any given day. Below is what I posted five years ago, yesterday.

October 11, 2010 was one of the most difficult pieces of writing I ever tackled. The subject, fetal reduction, one of the hottest in the fertility field and in the national and international political landscapes. I decided not to duck it. Not even realizing that it was just a few days before National Pregnancy and Infant Loss Remembrance day and during the month of observance for these losses.

This morning, I’m stepping into the conversation again. Last week, when I wrote the blog about the history of the month of remembrance, instituted by President Ronald Reagan, there was a paragraph that I did not print on the subject of abortion.

Here it is: “Compassionate Americans are also assisting women who suffer bereavement, guilt, and emotional and physical trauma that accompany post-abortion syndrome. We can and must do a much better job of encouraging adoption as an alternative to abortion; of helping the single parents who wish to raise their babies; and of offering friendship and temporal support to the courageous women and girls who give their children the gifts of life and loving adoptive parents. We can be truly grateful for the devotion and concern provided by all of these citizens, and we should offer them our cooperation and support as well.” Read more here.

The sentence beginning “Compassionate Americans” is a remarkable statement. Assisting women who receive abortions, which is vastly different than shaming them or attacking them. Not assisting women in having abortions, but afterwards. Acknowledging the myriad of feelings that women feel after abortion. The proclamation goes on, in this paragraph, to encourage women with adoption and to support single parents.

It was omitted last week to avoid the conversation maelstrom that occurs when abortion is included in the conversation. It was omitted because when in fertility treatment, abortion is the last thing that people are considering.

And yet, there are reasons to have the conversation. One of the best reasons to have the conversation is to avoid being in a situation that feels untenable. To understand the ramifications of multiple embryo transfers via IVF or unmonitored IUI cycles.

We are reprinting the blog in it’s entirety below, including the link to the follow up piece by a mental health professional, Jane Elisofon, MSW, wrote for PathtoFertility. 

It’s easier to duck from the hard conversations. But when faced with the hard decisions, it’s so much easier when you’ve had the hard conversations so that you know what to expect. These are hard conversations and sometimes the decisions are even harder. President Reagan used a word that we would all do well to keep in mind.

Compassion. For yourselves. For others. For all of us.

In this month of remembrance, we do well to fully understand our choices. With compassion.

The subject of fetal reduction came up this weekend. An important and difficult conversation at any time when you are trying to achieve a pregnancy. After having to undergo infertility treatment and hoping that it will work in becoming pregnant, where does pregnancy reduction have a place in the conversation?

It’s almost like a ghost flitting through certain conversations, noticeable in the background, but not clear. Fetal reduction is a little talked about aspect of infertility treatment. Probably twins are a reason for many couples to feel celebratory; although even with twins there are higher risks to both mother and fetuses. Still, with twins, there is the expectation that everyone will make it through the pregnancy, healthy and sound.

When higher order multiple pregnancy occur, (triplets and higher) then there is much greater concern for the health and welfare of all involved. When elective single embryo transfer (ESET) is offered or encouraged, although not stated, the option of fetal reduction is one procedure that is trying to be avoided.

And we don’t really talk about it. There are reasons for that. It’s highly politically charged. A fetal reduction is an elective abortion. Yes, it really is, just that. There aren’t too many other medical procedures as politically, morally, ethically and emotionally charged as abortion. Not in this country, not in the world.

For some of us, it is simply not an option. When this is true, it is imperative that we understand the possibilities for complications for the babies and for ourselves. For those of us who would be able to use this option if considered necessary for health and safety, it is often a decision that is carried forward in our lives in ways that we can’t necessarily portend. (Read Jane Elisofon’s compassionate and thoughtful blog tomorrow about how we manage our feelings about an abortion that we had previous to undergoing infertility treatment.)

Multiple pregnancies are a risk of infertility treatment when we transfer more than one embryo in an In Vitro Fertilization (IVF) cycle. ESET is a way of avoiding multiples. As a patient, it is often hard for us to imagine any treatment working. We are hopeful, we are scared, we want to be pregnant and we want to do everything to ensure that fertility treatment will be successful. If putting more embryos back will increase our risks as well as increase our chances of success, than we need to know those risks. And we need to know about the procedure that we may be offered if the risk of multiples becomes a reality.

Intrauterine insemination (IUI) is the other fertility treatment that can cause high order multiples. Especially unmonitored cycles. If you are taking medications to produce more than one egg (ovum) and there are no ultrasounds being done to see how many follicles (potential eggs) are being created, than you are at risk of multiple gestations (pregnancies). If you are undergoing this type of treatment, you would do well to reconsider. Ask for an ultrasound or consider working with a physician or fertility program that monitors IUI’s as a standard of practice.

Fetal reduction is a difficult conversation at best to have while you’re trying to become pregnant and it is not coming easily.  One question that needs to be considered with infertility treatment is, “what will we do if we become pregnant with more than we expected or is safe?” The longer that fertility  treatment goes on, the longer that we don’t have a successful pregnancy, often the more risks that we patients are willing to take, as we feel that a viable pregnancy is slipping through our fingers. This is the time to listen more carefully to trusted health care providers, who are less emotionally involved, who feel less desperate and who understand the risks more completely.

If this conversation is not happening in your fertility program or in your fertility consultation, then it may be up to you to bring it up. Understand the risks of multiple pregnancies. Understand the choices that you will have, think about what you will and will not be willing to do, and make a truly informed decision before it becomes a necessity.

About Lisa Rosenthal

Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.

Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.

Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.

Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.