Selective Reduction and Abortion for Genetic Defects

Amongst some of the hot topics in the world of commercial surrogacy, two that pop up often are selective reduction and abortion. Although these are not very common occurrences, I firmly believe that these two issues should be brought up, discussed, and worked into the commercial surrogacy contract BEFORE the surrogacy pregnancy has begun.

Unfortunately, this does not always happen and messiness ensues.

I want to take a minute now to make a note that the surrogate mother is, 100% of the time, 100% in control of her own body. If, for whatever reason (moral, religious, etc.), a surrogate mother is opposed to selective reduction or abortion, that is absolutely her right.

With that being said, she should NEVER enter into an agreement with intended parents who would pressure her to have these processes done. In the same vein, intended parents who would not want to have these processes done should enter into a commercial surrogacy contract with someone who would.

The fact of the matter is that multiples are very common in gestational surrogacy, so it needs to be very clear that all parties involved are on the same page regarding what could happen should a multiple pregnancy occur. That is why these issues need to be addressed sooner rather than later.

In situations where the intended parents desire for a selective reduction or abortion to take place, but the surrogate mother does not, the surrogate is legally able to refuse. However, if the contractual agreement addresses this issue and she breaches those terms she may find herself facing a civil suit (as occurred recently in the news).

Essentially, surrogate mothers should be matched with intended parents who are on the same as concerning selective reduction and abortion issues.

The goal is to make sure that everyone is on the same page regarding the possibility of a selective reduction.

What is selective reduction?

Selective reduction is a procedure by which the number of embryos in a pregnancy are reduced. Sometimes, when too many embryos implant during a commercial surrogacy, it lowers the chances of the surrogate mother carrying the pregnancy to term by a significant amount. It is generally used when there are more than three fetuses. It is typically done to prevent pregnancy complications as well as to prevent the loss of all of the fetuses. Generally, it is believed that it is safer for the surrogate pregnancy overall if the number of fetuses is reduced to two, so if a selective reduction is decided upon, the doctor would choose two babies to survive and abort the remaining fetuses. Other times selective reduction is used when fetuses are considered to be at a great risk for having a birth defect.

What is the procedure for selective reduction?

If it is decided that a selective reduction is necessary, it would have to be done during the first trimester. At that point, if no genetic abnormalities have been detected, the doctor will typically abort the ones that are the easiest to reach. Potassium chloride would be injected into the fetuses that were selected for reduction, causing them to die. The fetuses would typically be absorbed by the mother’s body. However, there are risks involved with the procedure. In about five percent of selective reduction cases, one or all of the remaining fetuses would also die. Another possible complication could be that the surrogate mother could go into preterm labor.

Why would abortion occur during surrogacy?

Abortion is another issue that should be discussed before entering into a contract. Although it is rarer than selective reduction, the issue may very well arise. If it comes to light that a fetus has a serious medical defect, the intended parents may decide that the fetus should be aborted. As with the issue of selective reduction you will find that both surrogate mothers and intended parents may fall on different sides of the issue. Some may feel that abortion should be kept open as an option, while others may feel that abortion is not acceptable under any circumstances.

What is the procedure for abortion in surrogacy?

Some questions that should be discussed before entering a commercial surrogacy agreement include:

  • If pregnant with triplets, will the surrogate mother be required to selectively reduce to twins? Would she agree to do this?
  • If pregnant with quadruplets or more, will the surrogate mother be required to selectively reduce to twins? Would she agree to do this?
  • Are there any circumstances under which the intended parents would require a selective reduction or abortion?
  • Are there any circumstances under which the surrogate mother would refuse to undergo a selective reduction or abortion?

The commercial surrogacy contract should outline, in clear terms, what will happen if (for whatever reason) the issue of selective reduction or abortion should arise. This will help to ensure that surrogate mothers are matched with intended parents who feel the same as they do on these issues.

At the end of the day, however, the decision regarding what will actually be done is ultimately up to the surrogate mother since it is her body. At any point (within legal parameters regarding the two procedures) she is able to either continue or terminate the pregnancy. It her legal right to either agree to or refuse a selective reduction or abortion. There is nothing that the intended parents can do in that regard.

If the surrogate mother breaches the contract, however, by aborting or refusing to abort fetuses as stated in the surrogacy contract, she may have to face financial repercussions as outlined in the surrogacy agreement.

Has either of these ever happen to you? If so, what advice would you give?

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