When there are too many foetuses

From Professor Ian Craft Sir: Fergus Walsh's informative article "Two's company, five's a crowd" (31 January) on the problems associated with the reduction in the number of foetuses occurring with a multiple pregnancy following fertility treatment, poig-nantly throws up the dilemmas facing both patients and doctors alike.

Unfortunately, we are not able to know precisely whether pregnancy will occur with fertility treatment, or, indeed, whether a single or multiple conception will result. It is certainly true that careful monitoring using ultrasound and other methods, allows more precision and assists the doctor in deciding not to treat a patient in a given menstrual cycle because of the risk of multiple pregnancy. However, it is impossible to eliminate this risk altogether since even the transfer of the maximum allowed number of three embryos with IVF treatment may result in a triplet pregnancy. Such a pregnancy is of greater risk than a twin or singleton pregnancy especially if there are other factors such as previous premature birth, diabetes, etc.

The article quotes another medical opinion suggesting that it is unethical to perform selective reduction where fertility treatment has resulted in a multiple pregnancy. Others, including myself, would hold the converse view, ie, that it is unethical to withhold selective reduction if a patient, properly informed of the risk of multiple pregnancy, then requests selective reduction subsequently.

The practice will remain a dilemma for both patients and doctors who have to make agonising personal decisions concerning not only the performance of the procedure but also a decision as to which foetus should survive - after all, patients and doctors are all human.

Yours faithfully, Ian Craft Director London Gynaecology and Fertility Centre London, W1

1 February