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Christian couples with high-risk pregnancies, often due to biotech fertility treatments or a fetal illness, may find themselves facing an agonizing decision, not just an eagerly awaited birth.

When their physicians intensively use fertility drugs and in vitro fertilization, the chance of a multiple conception increases dramatically. In facing the complexities of gestating and birthing triplets or even octuplets, physicians often advise would-be parents to "selectively reduce" the number of living embryos in order to give the others a better chance at life. And even in the more common instance of twins, some physicians recommend aborting one of the fetuses when medical complications arise.

For Scot and Patty Shier of Los Angeles, who faced the question of selective reduction, the promise of having their own baby became a perilous journey through high-tech bioethics.

After more than four years of infertility, the Shiers sought help at a fertility clinic. Because Patty had scarring from a ruptured appendix in childhood, in vitro fertilization—in which eggs and sperm are mixed in a petri dish and the resulting embryos are implanted in the womb—was their only hope for having their own children.

The Shiers, members of the 2,000-member Hope Chapel in Hermosa Beach, say they prayed for God's will in the situation. But not only did several in vitro attempts fail, two adoption attempts also fell through. So they decided for one last attempt. Concerned that job stress might be part of the problem, Patty, a software support technician, took a leave of absence and waited for a call from the clinic. When the phone rang on July 4, 1995, she quickly sensed a different result. The disappointing news of a negative pregnancy test had always been administered by the clinic's sympathetic nurses. This time the doctor was on the line. Yes, she was pregnant. But the doctor did not sound happy, saying Patty should prepare for multiple births.

Twins! Patty thought. Maybe triplets. That would be a lot of work, but after all, she and Scot really wanted a family, and families are work.

The couple went for the first ultrasound examination at six weeks in utero. Nurses crowded into the room, and the doctor started counting.

One. The nurses smiled. Two. The nurses were still happy. At three, the nurses' beaming dissipated. By four, they quietly filed out of the room. At the five count, the doctor blurted, "We have to talk about selective reduction."

ROOM FOR WOMB MATES: Selective reduction, or multifetal pregnancy reduction, would mean that at around 11 weeks' gestation, a specialist would insert a needle into a fetal heart and inject potassium chloride, causing immediate death.

The stakes for multiple birth are high. There are many genuine risks for infants who have numerous womb mates, mostly resulting from premature birth. The at-risk group has a higher percentage of problems ranging from respiratory infections to cerebral palsy.

Statistically, larger women do better with higher-order multiple births, such as quintuplets. But Patty was only 5 foot 4 inches and weighed 115 pounds.

The doctor told the Shiers he did not believe in abortion, but they had no other choice. If the Shiers did not selectively reduce, the physician said, not all the babies would survive birth. Nevertheless, Patty refused to allow such a procedure. The doctor rejected the Shiers' request for a referral to a physician who would try to deliver all the babies—unless they also agreed to see two doctors who practiced selective reduction.

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December 6 1999, Vol. 43, No. 14