Evolution of gender options in multiple pregnancy management

Objective: Fetal reduction (FR) in multiples dramatically improves outcomes. We prioritize FR decisions for health and historically declined to factor gender. As male preferences apparently diminished, our bioethicist encouraged a re-evaluation. Methods: Three hundred ninety-six patients reducing triplets or twins were categorized as 3→2, 3→1, and 2→1, Major (M) anomaly or minor (m) anomaly, same gender (SG), and those for whom gender preference (GP) was possible. Higher order and non chorionic villus sampling were excluded. FR decisions were prioritized by M anomaly, Suspicious, or m anomaly. If neither, we considered GP. Results: Of 319, 214 (67%) had either M/m or SG. Of those, 3→2 with gender option: 71/79 chose male and female or had no preferences, one chose male/male, and seven chose female/female. We reduced monochorionic twins in 33/35 3→1 cases. Of 20 with GP choice, 10 chose male and 10 chose female. Of 162 2→1, 54 had M or m, 50 were SG, but of the 44 M/F twins, 20 chose male and 24 chose female. Conclusions: There has been a cultural shift mostly preferring one of each or having no preference. When reducing to one, >50% prefer a girl. In addition to identifying abnormalities, chorionic villus sampling before FR expands patient autonomy.