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Legal Challenges of Multiple Pregnancy: Exploring Selective Reduction, Medical Liability, and Parental Rights

On Behalf of | Nov 13, 2023 | Reproductive Law

If Multiple Pregnancies occur during Assisted Reproductive Technology(ART), what’s next?

In the field of assisted reproductive technology (ART), multiple pregnancies are a common occurrence but come with legal complexities. In some cases, they acquire national media attention due to the complex and surprising nature of these types of cases.

This article delves into the legal issues surrounding multiple pregnancies, including selective reduction, medical liability, and parental rights, to provide our clients with a better understanding of the legal considerations associated with multiple pregnancies.

Over 3% of live births in the United States involve twins, triplets, or other multiple pregnancies. As Assisted Reproductive Technology (ART) becomes an increasingly popular way for couples and individuals to start families, the chances of multiple pregnancy rates cannot be understated. In fact, with certain IVF procedures, the risk of multiple pregnancies can be exorbitantly high compared to traditional pregnancies.

At Law Offices of Lei, we are well-versed in the legal risks involved in ART. This article will help you better understand how we deal with multiple pregnancies ethically and some of the considerations involved.

Naturally, the goal of ART is to maximize the potential pregnancy rate. However, the challenge for clinics is to balance the goal of fertility with the risk of a multiple pregnancy occurring.

Since 1978, over 1 million children have been conceived with In Vitro Fertilization (IVF). It is an ART treatment that empowers couples who have a poor chance of pregnancy to conceive. While there are many benefits to IVF, the nature of the procedure leads to a higher chance of multiple pregnancies.

In fact, oocyte recoveries, a type of IVF procedure, produce twin deliveries 27.3% of the time. and 3.4% of deliveries using the oocyte method return triplets or more. For a couple planning on having only a single child, you can see how this can present some interesting problems. For other methods, such as ovarian stimulation, the multiple pregnancy rates are unknown.

So, what exactly makes multiple pregnancies so likely in these scenarios. The answer lies perhaps in the number of leading follicles and medium-sized follicles that are heavily related to multiplicity. In IVF, several embryos are transferred to the uterus to increase the chances of pregnancy. However, that could mean that more than one embryo gets fertilized, producing twins or more.

The Legal Complexity of Selective Reduction

Multiple pregnancies often come with ethical and legal complexities, one of which is selective reduction. Selective reduction involves the selective termination of a portion of fetuses in a multiple pregnancy to mitigate health risks to the mother and fetuses. However, it raises a series of legal issues:

  • Ethical Conflicts: Physicians and parents may face ethical conflicts and moral dilemmas when deciding whether to proceed with selective reduction. The law must balance the interests of protecting the mother and the fetuses.
  • Legal Permissibility: Different countries and regions have varying legal permissibility regarding selective reduction. Some places allow it under specific circumstances, while others prohibit it.
  • Medical Decision-making: Physicians performing selective reduction must strictly adhere to legal regulations to ensure that their decisions are based on medical necessity and ethical principles.

Medical Liability and Risks

Multiple pregnancies entail greater medical liability and risks, which also involve legal considerations:

  • Healthcare Standards: Healthcare professionals must adhere to high standards of medical care to ensure the health of the mother and each fetus.
  • Medical Errors: If physicians or healthcare institutions are negligent or make errors during a multiple pregnancy, they may face medical liability lawsuits.
  • Informed Consent: Physicians must fully inform parents about the risks associated with multiple pregnancies to enable them to make informed decisions.

Parental Rights Issues

Parental rights issues arise in the context of multiple pregnancies and require legal consideration:

  • Parental Rights: The law must clearly define the parental rights of each fetus in a multiple pregnancy, including custody and legal parentage.
  • Legal Guardianship: In cases of multiple pregnancies, parents must designate legal guardians for each fetus to ensure that their legal rights are protected.
  • Parental Disputes: If parental rights become a source of dispute, the legal system must be able to resolve these disputes to protect the interests of each child.

5 Ethical Issues Of Multiple Pregnancies in ART

Multiple pregnancies can completely overturn someone’s life plans. For that reason, in an intentional procedure like ART, multiple pregnancies are quite controversial.

In the United States, individuals and couples are given a significant degree of choice regarding the nature of the pregnancy, to the extent that they can choose the gender of their child. In theory, some might want to select twins, which of course, brings up an entirely new ethical debate.

There are a wide range of ethical issues with multiple pregnancies that can arise in ART, whether you’re intentionally targeting a multiple pregnancy outcome or not. Here are the most important ones:

The Impact On The Mother

The first thing you should know is that multiple pregnancies come with a higher risk of maternal complications. Hence, it’s ideal for many mothers to avoid it. Furthermore, the future child might risk complications like pre-term birth, low birth weight, and higher morbidity and mortality rates. ART practitioners often aim to minimize harm to the mother and the offspring, which is why they might prefer to intervene on their behalf and prevent them from having multiple pregnancies if they feel they or their child are at a higher risk.

Financial Fairness

ART procedures are expensive, and they do not come with a 100% success rate. To maximize their chances of pregnancy on the first try, many patients will ask to transfer multiple embryos to substantially increase the chance of a successful pregnancy. The caveat is, that multiple embryos also increase the chance of multiple pregnancies. Those who cannot afford to take multiple tries at a pregnancy are unlikely to afford an extra child. This can be a major dilemma for some couples.

In countries where the healthcare system subsidizes assisted reproductive technologies, the incidence of multiple pregnancies is lower. Meaning that couples can afford to try again with a single embryo transfer rather than trying to rush things by transferring extra embryos.

Regulatory Gaps

As we mentioned earlier, many parents have the autonomy in the US to decide the nature of their pregnancy. That said, if a physician can perceive that an individual cannot handle a multiple pregnancy, they might want to have more authoritative means to discourage it from happening. After all, the welfare of the future children could be in question.

Hence, certain sanctions could be permissible to intervene in favor of future children, who are vulnerable to the decisions of their parents. It is commonly thought that legislation must be brought in to help oversee this since it seems that codes of conduct have no bearing over the incidence of multiple pregnancies in such instances.

The Ethics Of Ovarian Stimulation

Ovarian stimulation is a type of infertility treatment that can also cause multiple births. However, some less scrupulous practitioners offer this service despite not having any training in the field. Adequate monitoring can entail hormonal assays and ultrasound, which help stabilize the process.

The Ethics Of MFPR

These dilemmas are closely connected to the ones we consider in abortion. The issue is, that MFPR is a process where, amongst several fetuses, certain fetuses are terminated to increase the likelihood of one of the remaining fetuses developing. However, there is a possibility that more than one fetus develops, and in that case, the act of reducing fetuses can actually lead to twins or triplets. Once again, the practitioner must not only consider the wellbeing of the child but also the fact that they are reducing the fetuses intentionally.

Generally speaking, the literature recommends that it is better to prevent multiple pregnancies. However, fetus reduction can be a critical and overwhelming decision. Notably, you must consider that some individuals have been trying to become pregnant for so long, that they assign an extremely high value to each fetus.

Hence, it’s thought that it is preferable to not put people in the position of deciding whether to reduce fetuses.

How To Handle Multiple Pregnancies In ART Ethically

So, after raising just a few of the many potential ethical dilemmas that can arise with multiple pregnancies in ART, let’s cover some of the ways we can handle these dilemmas more ethically.

Adjusting Parental Capacity

In ordinary scenarios, parents and doctors come to an agreement regarding the reproductive medicine and remedies that are deployed. The aim is to strike a balance between reproductive autonomy for the parents and professional autonomy for the practitioner. However, there are times when these two modes of autonomy can be incongruent with one another:

  • Determining the number of embryos transferred.
  • Determining whether to embark on a multifetal pregnancy reduction.

For the first case, it has been proven by several surveys that parents consider multiple pregnancies to be an unilaterally positive outcome. This means that parents do not consider the risks to their own health, the health of their future children, and the potential lifestyle and financial ramifications that having an extra child would cause.

A compromise between parents and doctors must occur. For instance, the doctor can designate a set amount of embryos to be transferred from the beginning, based on their assessment of the patient’s health risks. Then, parents could be allowed to choose to transfer embryos up to that amount. This should be seen as the doctor having a responsibility to their vulnerable patients rather than taking up a paternalistic attitude.

So long as practitioners accurately inform their patients of the consequences of their actions, patients can be further guided to make the most appropriate choice. We should emphasize that it is the responsibility of a physician to not cause unnecessary harm to the children or the prospective parents.

Resolving The Ethical Dilemma In MFPR

First and foremost, if a doctor working with a patient has any ethical concerns about reducing fetuses, they should mention this to patients upfront to avoid any issues down the road. Having been informed of this, the patient can weigh whether they want to work with this doctor from the beginning accurately so long as they are fully informed of the risks involved with multiple pregnancies, from medical to psychological and financial ones.


Multiple pregnancies involve complex legal issues, including selective reduction, medical liability, and parental rights. Understanding and addressing these legal challenges are crucial to ensuring the proper legal protection of both the mother and each fetus in multiple pregnancies. Our legal team specializes in handling legal issues related to ART, providing support and guidance to clients to make informed decisions and safeguard their legal rights in multiple pregnancies.

To Smooth The Assisted Reproduction Process, Hire A Lawyer

You can imagine that if such financial, psychological, and medical risks are involved with multiple pregnancies and ART, there are all sorts of legal pitfalls.

To help you manage these pitfalls, you need a lawyer experienced in handling all matters related to ART. As an intended parent, you should be well-informed of your rights, and have a contract drawn up that protects your autonomy in starting your own family.

For more details on how you should proceed in your case, reach out to us for a consultation.