For thousands of couples suffering from infertility, the advances in reproductive health have given many new hope--and, in some cases, new life.

However, with progress comes the burden of ethical responsibility--a burden many in the field seem unwilling to shoulder. The Washington Post published an emotionally-charged article, "Too Much to Carry," that did an admirable job portraying the wave of selective reduction that often accompanies modern fertility treatments.

Doing her best to put a human face on the inhumane procedure, author Liza Mundy visited the offices of Dr. Mark Evans to observe the dark side of in-vitro fertilization (IVF) for herself.

The experience, as she tells it, was an eye-opening one. If IVF were as simple as fertilizing one egg with one sperm, the process would be less troubling. Yet for several of these at-risk women, doctors insist that to make the pregnancies more "viable" there must be less competition in the womb.

This often means that "excess embryos" are created, implanted, and destroyed after tests are performed to determine which of the fetuses are healthiest. In some instances, Mundy was present for the "reductions" and describes the horror of seeing tiny lives, once active on the ultrasound screen, quickly silenced by a lethal injection to the heart. The "selection process" is also used to single out small victims that doctors suspect have Down syndrome or other maladies, which, 85% of the time is used to justify an abortion.

In one visit, Mundy describes the patient crying, "Oh, my gosh, I can really see it! I can see the fingers!" and then sobbing uncontrollably as the small baby goes still. Another woman says, "It's killing me that we're going to do this. I never thought I would feel that... I'm vehemently pro-choice."

Yet the sight of seeing the needle, as one nurse puts it, "chasing the babies" who try to get away, overwhelms mothers. This same nurse, a new mom herself, has trouble with the procedure because she feels like they are "playing God." "Some of these people tried to get pregnant...and prayed to God. And now that they're pregnant, they're telling God, 'You gave me too many.'" Rather than using IVF as an end to create life, the process is all too often a means that destroys it. This article serves as a timely call to conscience in an era when couples consider it a "right" to have children but seek freedom from the unintended consequences.

[Family Research Council, 21May07]

Too Much to Carry? http://www.washingtonpost.com/wp-dyn/content/article/2007/05/15/AR2007051501730.html?hpid=smartliving

Too Much to Carry?
Women pregnant with multiple fetuses face one of the toughest choices imaginable: Risk the health of all, or take the lives of some

By Liza Mundy
Sunday, May 20, 2007; Page W14

THE MEDICAL PRACTICE OF MARK EVANS IS LOCATED ON THE GROUND FLOOR OF A MANHATTAN TOWNHOUSE, nestled discreetly among the restaurants and nail salons of the Upper East Side. To be admitted, patients must ring a buzzer and wait for the door to open before taking a seat inside the crowded waiting room.

Down the hall in a tiny examining room one morning, a sonographer named Rachel Greenbaum was sitting on a high stool next to an ultrasound machine. "Do you want to see the screen?" she asked one of Evans's patients, who was lying unhappily on an examining table. The woman, pale-skinned, fine-featured, tall, in her 30s, was wearing a hospital gown. Beside the woman was her husband, sitting in a chair, holding his wife's hand. He too was pale, and, like his wife, he looked miserable. "Yes, I'd like to see them," the woman on the table said firmly.

"I'll just take a few pictures, and I'll show them to you," Greenbaum said.

"Them" referred to the three fetuses in the woman's belly, a long sought pregnancy achieved by in vitro fertilization. The woman and her husband were about to turn their triplets into twins in a procedure known as selective reduction.

Selective reduction is one of the most unpleasant facts of fertility medicine which has helped hundreds of thousands of couples have children but has also produced a sharp rise in high-risk multiple pregnancies. There is no way to know how many pregnancies achieved by fertility treatment start out as triplets or quadruplets and are quietly reduced to something more manageable.

The U.S. Centers for Disease Control and Prevention, which publishes an annual report on fertility clinic outcomes, does not include selective-reduction figures because of the reluctance to report them.

The industry doesn't publish them, either. "This is a very sensitive topic," says David Grainger, president of the Society for Assisted Reproductive Technology, the membership group for IVF clinics. It's sensitive, personally, for patients, but also politically, for doctors.

Mark Evans is one of the few doctors in the country who not only performs reductions but also is willing to discuss all qualms, ethics, issues, outcomes. Evans, who describes himself as an obstetrician-geneticist, is a pioneer in fetal therapy. Using stem-cell transplants, he developed the first in-utero correction of SCID, a genetic disorder that severely compromises the immune system. He has also pioneered fetal surgeries, including bladder shunts for fetuses with urological obstructions. The goal of his practice is the delivery of a healthy baby. In some cases, this can be achieved by treating a fetus in utero. In some cases, it is achieved by sacrificing a fetus in utero.

In 2005, I spent two days with Evans, where the first reduction patient was the distressed woman who had become pregnant with triplets. Triplets pregnancies are far riskier than most people realize: Carrying three babies to term would more than double the woman's risk of developing the most severe diseases of pregnancy, such as preeclampsia. The average triplet is born two months premature, significantly raising the risk of disabilities such as cerebral palsy and of lifelong damage to the infant's lungs, eyes, brain and other organs. By reducing the pregnancy to twins, the woman and her husband would decrease the risk of severe prematurity. And the risk of losing her entire pregnancy would fall from 15 percent to 4 percent.

As she was having her sonogram, the patient told Greenbaum how she'd ended up there. After suffering a series of miscarriages, she and her husband had IVF performed, producing three embryos. To maximize the chances of a successful pregnancy, all three embryos were put into her uterus. All three took.

"Triplets," Greenbaum said.

"So they tell me," the woman said, her voice hollow.

And, sure enough, on Greenbaum's screen were three little honeycombed chambers with three fetuses growing in them. The fetuses were moving and waving their limbs; even at this point, approaching 12 weeks of gestation, they were clearly human, at that big-headed-could-be-an-alien-but-definitely-not-a-kitten stage of development. Evans has found this to be the best window of time in which to perform a reduction. Waiting that long provides time to see whether the pregnancy might reduce itself naturally through miscarriage, and lets the fetuses develop to the point where genetic testing can be done to see which are chromosomally normal.

Greenbaum periodically magnified one fetus and brought it into focus. She would then freeze the frame and do two things: measure the fetuses to assess their growth and see if any one is lagging; and take a "nuchal translucency," measuring the fluid behind each fetus's neck. An excess of nuchal fluid suggests a possible problem: Down syndrome, for example. They are all measuring at 11 weeks and 6 days," Greenbaum said.

"That's right," the woman said, wonderingly. "It is 12 weeks tomorrow."

So far, there was nothing anomalous about any of the fetuses. Greenbaum turned the screen toward the patient. "That's the little heartbeat," she said, pointing to the area where a tiny organ was clearly pulsing. "And there are the little hands. There's the head. The body."

"Oh, my God, I can really see it!" the patient cried. "Oh, my God! I can see the fingers!"

"Okay!" she said, abruptly, gesturing for the screen to be turned away. She began sobbing. There were no tissues in the room, so her husband gave her a paper towel, which she crumpled to her face. The patient spent the rest of the procedure with her hospital gown over her face, so she would not see any more of what was happening.

WHAT WAS HAPPENING WAS DAY ONE OF A TWO-DAY PROCESS, in which one of the woman's three fetuses would be eliminated through an injection of potassium chloride, which stops the fetal heart. This process was developed by a select group of doctors including Evans, a large man with the occasional impatience of someone smarter than most of the people around him.

Evans, now 54, was in high school when he became interested in genetics, and he soon realized that the action, genetic therapy-wise, was going to be in prenatal. He became known as an adept practitioner of fetal therapy -- somebody with the know-how