The desire of infertility patients for multiple gestations - Do they know the risks?

Ginny L. Ryan; Sunny Zhang; Anuja Dokras; Bradley J. Van Voorhis

doi:10.1016/S0015-0282(02)03554-9

Objective: Trends towards increasing age of childbearing and increasing use of assisted reproductive technologies has contributed to a large increase in the rate of twins and higher order multiples conceived in the United States in recent years. Considered by physicians to be an undesired outcome of infertility treatment, multiple gestations are desired by some infertile couples. The aims of this study are to determine 1) the proportion of infertile women who prefer multiple over single gestation 2) patient characteristics associated with multiple birth preference and 3) patient knowledge about multiple gestation. Design: Prospective analysis of 210 patients at their initial infertility evaluation visit to an academic center and a private practice. Materials/Methods: A 41-question survey was given to patients at their initial visit to our clinics. The questionnaire detailed demographic data, infertility history, desires about multiple gestations, knowledge of the consequenses of multiple gestations, and desires regarding their infertility visit and treatment. Data was analyzed by unpaired T-tests and Mann-Whitney-U tests for continuous variables and by Chi-square or Fisher’s exact tests for categorical variables. Multivariable logistic regression analysis was done to assess independent factors associated with desire for multiple gestation. Results: 203 of 210 (97%) patients completed the survey. The mean age of the patients was 31, the mean duration of infertility was 30 months, and 75% of patients had previously seen a physician for infertility. Seventy-one percent of patients were nulliparous and 78% were college graduates with a median family income of $50,000-$100,000. Among all couples, avoidance of multiple gestations was a less important consideration when making treatment decisions than treatment effectiveness, affordability, time to conception, and personal safety. Among all couples regarding twin gestations, 95% knew of an increased chance of premature delivery, 73% knew of increased maternal risks, 46% knew of increased cerebral palsy risk and 30% knew of increased infant mortality after twin delivery. When asked to rank preferred treatment outcomes, 23% of patients listed twins, triplets or quadruplets over a singleton gestation. By univariate analysis, the desire for multiple gestation was significantly associated with nulliparity, lower family income, longer duration of infertility and lack of knowledge about the risks of twins. Desire for multiples was not associated with patient or partner age, education or a history of previous infertility treatment. After controlling for family income and duration of infertility, nulliparity was the only factor independently associated with the desire for multiple gestation (O.R.=1.43, C.I.=1.15–2.50). Conclusions: A sizable minority (23%) of infertile couples desires what the medical community is trying to avoid- multiple gestations. Many infertile couples lack knowledge about the risks of such pregnancies. While parity, family income, and duration of infertility are difficult to impact, it is possible to improve upon the knowledge base of our patients. It is also important for clinicians to be aware of this desire so that it can be appropriately addressed in counselling.

The desire of infertility patients for multiple gestations - Do they know the risks?

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