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Gangs of New York


We’d never heard the term reduction, but as we looked into it, we discovered that it’s become a major feature of the techno-fertility process. When women come out of IUI or IVF more pregnant than they want to be, they see a practitioner like Mark I. Evans, a 54-year-old obstetrician and geneticist who works out of a townhouse in the East Sixties. Though he’s been doing this for more than twenty years, he still has a cowboy mentality. “We do some pretty bizarre shit,” he says. “I’ve seen women pregnant with septuplets, octuplets. My record is twelve.”

In the midst of telling another twins war story, Elizabeth nudges Alice. “Remember, we were going to try not to scare them,” she says, referring to us. Too late.

Back in the early eighties, when Evans was a young professor at the Wayne State Medical School in Detroit, he thought he knew how to stop the heart of a single fetus without harming any others in the womb. It involved an injection of highly concentrated potassium chloride. He didn’t use it on a human patient until he received a call from a physician treating a four-foot-ten woman pregnant with quadruplets. The doctor had recommended to her that she get an abortion, but having spent seven years trying to get pregnant, she asked if there was such a thing as “half an abortion.” Evans thought he could do that for her, and when he did, his medical career began its strange odyssey to the present day. “I turned those four into two, and they’re out of college already,” he says. “Then I got a call from a lady in Alaska who had octuplets. She was a little taller, but even King Kong couldn’t carry octuplets. So we turned her into two, and those kids are in college. By now, I’ve done thousands of patients.”

On the day we went to his office, Evans was wearing aqua-green scrubs and a nice gold watch. On the wall, he had pictures of himself with Phil Donahue, Diane Sawyer, and, of all people, Pope John Paul II. Evans sees himself as a crusader for the cause of rational family planning. “Our goal—and here’s your sound bite—is healthy families,” he says. “It doesn’t matter how many. When I first started this thing, nobody except for the most fundamentalist of folks had a problem reducing four or more, because the outcomes were so horrible.” he says. “So the ethical debate was triplets. People were claiming, ‘Oh, you don’t reduce triplets, they do so great.’ But the data doesn’t support that. The average gestational age is three weeks earlier than twins, and the perinatal mortality rate is considerably higher.”

Over the years, as three-to-two reductions became routine for Evans, he slowly approached a new threshold. What about going all the way down to one? He’d done it, of course, but only out of medical necessity. Now, he admits, it had become “more a matter of lifestyle. The typical story is, second marriage for both, he’s got two kids from his marriage, she’s got two from hers, they just want one of their own.”

Two years ago, the feminist Amy Richards told The New York Times Magazine about her decision to reduce the triplets she was carrying. She rejected the option of twins as still too much of an imposition and health risk and had her doctor reduce her pregnancy to a single fetus. Predictably, she was excoriated by right-to-lifers. What was more surprising was the relatively conflicted reaction she received from the pro-choice side. A decision like hers made people uncomfortable, like a kind of yuppie eugenics.

Even the freewheeling Evans tones down his rhetoric when he explains his decision to do the two-to-one procedure. “When you start doing anything radically new, you start with the life-and-death situations,” he says. “You start with the nothing-to-lose cases. As with every technology, as the risks and benefits get better known, those indications liberalize. I came to the ethical conclusion that if you believe that one-to-zero is ever acceptable—i.e., that a woman should be allowed to have an abortion—then why not two-to-one? I came to believe it was a valid choice.”

Fewer and fewer are likely to be put in that position, though. IVF technology is improving to the point where doctors can better identify the hardier embryos so they don’t have to stack the deck by implanting more than one. “We’re almost at the point where we can consider single-embryo transfers,” says Jamie Grifo, head of the reproductive-medicine program at NYU Medical Center. “The Europeans are already doing that. But you can’t always control the process even then. I had a patient who was terrified of having twins. So I said fine, and we put in one embryo. Guess what? They split. She got twins.”

As for us, reduction ceased to be a consideration as soon as we did an amniocentesis test and it came back clean. But the brutal little detour had an unintended benefit. The fear of losing one brought us to terms with how intensely we wanted both of our little girls.


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