Objective. To study the predictors for desire for multiple pregnancies and the influence of providing information regarding the maternal and fetal complications associated with multiple pregnancies on their preference for multiple pregnancies. Methods. Couples attending an infertility clinic were offered to fill up a questionnaire separately. Following this, they were handed a pamphlet with information regarding the risks associated with multiple pregnancies. The patients will then be required to answer the question on the number of pregnancies desired again. Results. Two hundred fifty three out of 300 respondents completed the questionnaires adequately. A higher proportion of respondents, 60.3% of females and 57.9% of males, prefer singleton pregnancy. Patients who are younger than 35 years, with preexisting knowledge of risks associated with multiple pregnancies and previous treatment for infertility, have decreased desire for multiple pregnancies. However, for patients who are older than 35, with longer duration of infertility, and those patients who have preexisting knowledge of the increased risk, providing further information regarding the risks did not change their initial preferences. Conclusion. Providing and reinforcing knowledge on the risks to mother and fetus associated with multiple pregnancies did not decrease the preference for multiple pregnancies in patients. 1. Introduction Assisted reproductive techniques (ART) have enabled many childless couples to achieve their dream of having a child of their own. The number of women undergoing ART treatment has increased tremendously over the past three decades, leading to more than 5 million children conceived by this treatment [1]. However, as ART traditionally involved ovarian stimulation and replacement of more than one embryo, it had contributed to a significantly higher number of multiple births. The multiple birth rate from 376,971 European IVF treatment cycles in 2007 was reported as 22.3% (21.3% twins and 1% triplets), similar to rates in 2005 and 2006 (21.8 and 20.8%, resp.) [2]. The data from the Society for Assisted Reproduction Technology (SART) registry in the USA, based on 108,130 ART cycles, revealed a multiple birth rate of 35.4, of which 31.8% were twins, 3.5% were triplets, and 0.1% were higher order multiple [3]. As compared to singleton, twin and higher order pregnancies have contributed significantly to preterm deliveries. Prematurity, which is a main cause of neonatal morbidity and mortality, occurs in nearly one-half of all multiple pregnancies. It was reported that 42% of
References
[1]
S. D. McDonald, K. Murphy, J. Beyene, and A. Ohlsson, “Perinatel outcomes of singleton pregnancies achieved by in vitro fertilization: a systematic review and meta-analysis,” Journal of Obstetrics and Gynaecology Canada, vol. 27, no. 5, pp. 449–459, 2005.
[2]
J. de Mouzon, V. Goossens, S. Bhattacharya et al., “Assisted reproductive technology in Europe, 2007: results generated from European registers by ESHRE,” Human Reproduction, vol. 27, no. 4, pp. 954–966, 2012.
[3]
Society for Assisted Reproductive Technology and American Society for Reproductive Medicine, “Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry,” Fertility and Sterility, vol. 87, pp. 1253–1266, 2001.
[4]
J. Moise, A. Laor, Y. Armon, I. Gur, and R. Gale, “The outcome of twin pregnancies after IVF,” Human Reproduction, vol. 13, no. 6, pp. 1702–1705, 1998.
[5]
W. N. Spellacy, A. Handler, and C. D. Ferre, “A case-control study of 1253 twin pregnancies from a 1982–1987 perinatal data base,” Obstetrics and Gynecology, vol. 75, no. 2, pp. 168–171, 1990.
[6]
O. Ozturk and A. Templeton, “Multiple pregnancy in assisted reproduction techniques,” in Current Practices and Controversies in Assisted Reproduction, E. Vayena, P. J. Rowe, and P. D. Griffin, Eds., pp. 220–234, WHO, Geneva, Switzerland, 2002.
[7]
M. Dhont, P. De Sutter, G. Ruyssinck, G. Martens, and A. Bekaert, “Perinatal outcome of pregnancies after assisted reproduction: A case-control study,” American Journal of Obstetrics and Gynecology, vol. 181, no. 3, pp. 688–695, 1999.
[8]
FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health, “Ethical guidelines in the prevention of iatrogenic multiple pregnancy,” European Journal of Obstetrics & Gynecology and Reproductive Biology, vol. 96, pp. 209–210, 2001.
[9]
K. Thorpe, J. Golding, I. MacGillivray, and R. Greenwood, “Comparison of prevalence of depression in mothers of twins and mothers of singletons,” British Medical Journal, vol. 302, no. 6781, pp. 875–878, 1991.
[10]
W. L. Kinzler, C. V. Ananth, and A. M. Vintzileos, “Medical and economic effects of twin gestations,” Journal of the Society for Gynecologic Investigation, vol. 7, no. 6, pp. 321–327, 2000.
[11]
“ASRM Guidelines on number of embryos transferred. A Practice Committee Report,” pp. 1-2, November 1999.
[12]
American Society for Reproductive Medicine, “Elective single embryo transfer,” Fertility and Sterility, vol. 97, pp. 835–842, 2012.
[13]
Z. Pandian, S. Bhattacharya, O. Ozturk, G. I. Serour, and A. Templeton, “Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection,” Cochrane Database of Systematic Reviews, vol. 15, no. 2, 2004.
[14]
C. Bergh, A. T. Kjellberg, and P. O. Karlstrom, “Single-embryo fertilization in vitro. Maintained birth rate in spite of dramatically reduced multiple birth frequency,” L？kartidningen, vol. 102, pp. 3444–3447, 2005.
[15]
B. Urman and K. Yakin, “New Turkish legislation on assisted reproductive techniques and centres: a step in the right direction?” Reproductive BioMedicine Online, vol. 21, no. 6, pp. 729–731, 2010.
[16]
P. Kutlu, O. Atvar, O. F. Vanlioglu et al., “Effect of the new legislation and single embryo transfer policy in Turkey on assisted reproduction outcomes: preliminary results,” Reproductive BioMedicine Online, vol. 22, no. 2, pp. 208–214, 2011.
[17]
G. L. Ryan, S. H. Zhang, A. Dokras, C. H. Syrop, and B. J. Van Voorhis, “The desire of infertile patients for multiple births,” Fertility and Sterility, vol. 81, no. 3, pp. 500–504, 2004.
[18]
N. Gleicher and D. Barad, “Twin pregnancy, contrary to consensus, is a desirable outcome in infertility,” Fertility and Sterility, vol. 91, no. 6, pp. 2426–2431, 2009.
[19]
N. Gleicher, D. P. Campbell, C. L. Chan et al., “The desire for multiple births in couples with infertility problems contradicts present practice patterns,” Human Reproduction, vol. 10, no. 5, pp. 1079–1084, 1995.
[20]
M. D'Alton, “Infertility and the desire for multiple births,” Fertility and Sterility, vol. 81, no. 3, pp. 523–525, 2004.
[21]
G. L. Ryan, A. E. T. Sparks, C. S. Sipe, C. H. Syrop, A. Dokras, and B. J. van Voorhis, “A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates,” Fertility and Sterility, vol. 88, no. 2, pp. 354–360, 2007.
[22]
T. J. Child, A. M. Henderson, and S. L. Tan, “The desire for mulitple pregnancy in male and female infertility patients,” Human Reproduction, vol. 19, no. 3, pp. 558–561, 2004.
[23]
C. R. Newton, J. McBride, V. Feyles, F. Tekpetey, and S. Power, “Factors affecting patients' attitudes toward single- and multiple-embryo transfer,” Fertility and Sterility, vol. 87, no. 2, pp. 269–278, 2007.
[24]
S. K. Kalra, M. P. Milad, S. C. Klock, and W. A. Grobman, “Infertility patients and their partners: differences in the desire for twin gestations,” Obstetrics and Gynecology, vol. 102, no. 1, pp. 152–155, 2003.
[25]
A. H？jgaard, L. D. M. Ottosen, U. Kesmodel, and H. J. Ingerslev, “Patient attitudes towards twin pregnancies and single embryo transfer—a questionnaire study,” Human Reproduction, vol. 22, no. 10, pp. 2673–2678, 2007.
[26]
S. Murray, A. Shetty, A. Rattray, V. Taylor, and S. Bhattacharya, “A randomized comparison of alternative methods of information provision on the acceptability of elective single embryo transfer,” Human Reproduction, vol. 19, no. 4, pp. 911–916, 2004.
[27]
O. B. A. Van Den Akker and S. Purewal, “Elective single-embryo transfer: Persuasive communication strategies can affect choice in a young British population,” Reproductive BioMedicine Online, vol. 23, no. 7, pp. 838–850, 2011.
[28]
A. van Peperstraten, W. Nelen, R. Grol et al., “The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial,” British Medical Journal, vol. 341, article c2501, 2010.
[29]
B. Leese and J. Denton, “Attitudes towards single embryo transfer, twin and higher order pregnancies in patients undergoing infertility treatment: A review,” Human Fertility, vol. 13, no. 1, pp. 28–34, 2010.
