When fertility treatments become frightening

‘I was sad but relieved’
As she approached her 12-week mark — when her doctor had told her he needed to do the reduction — Kristina knew she couldn’t put off the decision any longer. Every ultrasound showed that her babies were still alive; every week that passed felt like torture. She scheduled an appointment for the reduction, tearfully conceding that she had no other choice: She couldn’t possibly carry six babies, risking her health just when she needed it most. They couldn’t possibly all be healthy. And she couldn’t possibly care for them. “I was in denial the whole time,” Kristina says. “But I realized it would be much worse to get halfway through and then lose all or some of the babies, or for that to happen after they were born. This was bad, but that was something I couldn’t face.”

Kristina was still hesitant when she and her husband arrived at her doctor’s office the September morning of the procedure. As she lay down on the table, the anxiety of the previous weeks flooded over her again. She started crying, softly at first, as the technician again swirled the ultrasound paddle over her belly to locate the embryos. Even now, Kristina hoped that one or more of the hearts would have stopped on its own. Instead, she gazed one last time at six pulsing blobs onscreen before the technician printed a picture — a bittersweet memento that would torment Kristina for months. As the technician turned the monitor away, she watched the doctor fill a syringe with potassium chloride, a clear metal chemical that stops the heart when inserted directly into it. He put his empty hand on Kristina’s belly and poised the 3-inch needle over her. Then he studied the ultrasound monitor, which served as a guide to where to insert the tip. Because Kristina’s age put her at lower risk, the couple had not had genetic testing, so she knew the doctor was deciding which babies to reduce based on size of the fetus and location in her uterus; if all fetuses appear equally well-developed with no abnormalities, doctors typically select ones easiest to reach, usually those highest in the uterus.

Kristina’s doctor took only a few moments to locate the first embryo he planned to reduce. But as he touched the needle to her skin, she suddenly started sobbing. Her uterus tightened, preventing the needle from going through. “I was freaking out, still questioning if we should do it,” she recalls. “It’s not that it hurt so much. I was just at my wit’s end by that point.” After a few minutes, Kristina calmed down enough for the doctor to insert the needle. He pushed it all the way into the first baby’s heart, then injected the potassium chloride, a process that took only a few seconds. By the time he’d removed the needle, Kristina was sobbing again. And again her uterus became so tense he wasn’t able to continue. As she tried to relax, the technician put the ultrasound paddle over the first baby, expecting to see its heart had stopped. But it hadn’t. Somehow, the fetus had survived the injection, a rare anomaly. Michael, who was facing the monitor, gasped. For Kristina, the news was too much. She leaped off the table, inconsolable.

“Stop!” she shouted, in hysterics. “I can’t do this! It’s not meant to be!”

Kristina rushed from the room and spent the rest of the day at home, in tears, avoiding talk about the morning’s events. But when she woke up the next day, nothing had changed. She felt a reduction was her only option, regardless of how excruciating. “By now, Michael and I were both so drained, we just needed to get on with it,” she says. So again, they drove to the doctor’s office, and she lay on the table. This time, she remained calm while the doctor inserted the needle, three separate times, injecting the potassium chloride into the three embryos easiest to reach. In total, the procedure took 20 minutes. When the technician checked, all three hearts had stopped. “I couldn’t look at them,” Kristina says. “And I couldn’t look at the other three, either. I was sad but relieved that it was behind me.”

Still, Kristina couldn’t completely relax yet. She knew that every reduction bears the risk of infection or premature labor, which can end the entire pregnancy — an added insult that she couldn’t bear to think about. Patients like her, who have the reduction between 12 and 14 weeks, have a 2 to 3 percent risk of losing the whole pregnancy if the body misreads the loss as miscarriage and tries to abort the remaining fetuses; after 15 to 20 weeks, the risk inches up to about 5 percent, Dr. Sehdev notes. The fear of losing everything meant Kristina wouldn’t let herself truly connect with the three small lives growing inside her. “Only when I felt them move at 18 weeks was I able to bond with my babies,” she recalls. “That’s when I finally thought it might be OK.”

Kristina delivered her triplets 10 weeks early, after ultrasounds determined one had stopped growing, which isn’t unusual for triplets or even twins. That baby, Nathan, was almost 2 pounds; siblings Evan and Makena each weighed more than 3 pounds. Nathan spent nearly four months in neonatal intensive care and the next year in and out of the hospital. He’s still slightly developmentally behind his siblings — who came home after seven weeks — but is expected to catch up and have no permanent disability.

Three years later, Kristina still wonders what could have been. She never knew if her other babies were girls or boys, never had the chance to name them. But the grueling months spent at the hospital with Nathan finally made one thing clear to her: She did the right thing. “To this day, if I knew I could have six healthy babies, I’d have carried them,” she says. “But seeing how sick Nathan was made me realize how tough it could be. I have no regrets.”

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