THE DESIRE FOR MULTIPLE BIRTHS IN COUPLES WITH INFERTILITY PROBLEMS CONTRADICTS PRESENT PRACTICE PATTERNS

Paradoxically, the attitude of infertility patients towards multiple births has never been investigated. We therefore generated a survey by questionnaire, which was sent to 3800 consecutive unselected couples with infertility problems: 582 responses were received (15% response rate) and analysed. The percentage distribution of the responses to 21 questions, addressing attitudes towards and knowledge about the risk of multiple gestations, was the main outcome. Worry about multiple births was expressed, independent of the number of multiples, although fear about multiple conceptions was rejected by a large majority (64%). The risk of a twin birth was not strongly perceived, but the perception of risk increased with increasing numbers of multiples: triplets (50-62%), quadruplets or more (71-72%). A desire for the conception of twins was expressed by 67-90% of couples, a desire for the conception of triplets was equally expressed and rejected, and for a multiple gestation beyond triplets was rejected by 73-82% of couples. Patients were educated about the risks of selective embryo reduction and responded in a bimodal fashion to the option of utilizing this procedure, with equal numbers being willing to consider or reject it. Age, parity and length of infertility did not affect the couples' worry or fear about multiples. The desire for twins and triplets, however, was correlated significantly with age (twins, P = 0.032; triplets, P = 0.03); there was no such correlation for larger multiples. The length of infertility was correlated with a positive attitude towards multiples beyond triplets (P = 0.029) but was not correlated with a desire for twins or triplets. Prior parity did not affect the attitude towards multiples at all. The length of infertility was also correlated significantly to an understanding of risk (twins, P = 0.034; triplets, P = 0.001; quadruplets and more, P = 0.05), while age and parity was not. The consideration of selective embryo reduction as a treatment option was correlated significantly with age (P = 0.0001), while the understanding of associated risks was evenly distributed, independent of patient characteristics. We conclude that infertility patients appear to be educated about the risks of multiple births. A strong desire for multiple births, as long as this can be limited to triplets or less, increases with advancing female age. Increasing length of infertility; however, increases the willingness for multiples beyond triplets. Increasing female age increases the readiness to consider selective embryo reduction as a treatment option. Attitudes do not differ between couples with primary and secondary infertility. Patient attitudes are thus not in agreement with the existing practice patterns in infertility therapy. A re-evaluation of some of these practice patterns may therefore be indicated.