Responsible Surrogacy

Information regarding the ethical aspects of the process

One of the common practices in some countries and agencies is the use of selective reduction early on in the process. To begin with, a relatively large number of embryos is transfered to increase the likelihood that at least one will be carried to term. In case of a multifetal pregnancy (commonly with more than two fetuses), the number is reduced using a medical procedure in early pregnancy. This process has implications for the health of the surrogate and of the remaining embryos, and is therefore rarely used. However, as mentioned, parents may enter the surrogacy process knowing fetal reduction is an option in the case of multifetal pregnancy. In some cases the decision on reduction is made by the intended parents and the agency and clinic, and the surrogate’s position on the subject is not taken into account.


Like all pregnancy-related medical procedure, it is recommended to discuss the issue of selective reduction and the circumstances under which it will be done with the surrogate early on (preferably before signing the agreement). This issue should also affect the number of embryos which are transferred. Also, it is worthwhile noting that not all countries allow fetal reduction. It is important to understand the different options before the beginning of the process and take into account the implications of using selective reduction if such an option isn’t easily available.


Fetal reduction is sometimes required for medical reasons which are unrelated to the number of embryos transferred (such as a problem in the development of the embryos). The considerations in this case are different and more like those described in the page addressing unplanned medical procedures.

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