[Embryo reduction in twin pregnancy on maternal request: A French practice study.]

In France, embryo reduction is controversial in twin pregnancy, especially when there is no underlying pathology. The objective of this study was to establish the status of this practice in France and to depict the ethical issues around this problematic. A questionnaire drafted by Maternal and Fetal Medicine physicians and family planning teams of the University Hospital from Strasbourg was distributed to the 48 French Multidisciplinary Prenatal Diagnosis Centers, among which 28 answered (58,3%). Embryo reduction in twin pregnancy on maternal request has already challenged 71% of the centers; 29% have performed such a reduction. The overall position of the centers to these requests is negative (3.1/10), with very mixed levels of in-team agreement. The main arguments against this practice are that twin pregnancy is not a pathology, that embryo reduction exposes to the risk of loosing the entire pregnancy, the feeling of being held hostage with the alternative of abortion of the whole pregnancy, and the lack of legal framing. On the contrary, the arguments in favor of the reduction are : that the reduction can avoid an abortion, that this type of reduction can be related to a partial abortion, that it responds to women's rights and that mental health is an integral part of women's health. There is no consensus about how to respond to patients requesting for embryo reduction in twin pregnancy. However, the majority of Centers have been confronted with it and it would be necessary to open the debate on this problem and the ethical questions it raises.

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