Infertility: The desire for multiple births in couples with infertility problems contradicts present practice patterns

Paradoxically, the attitude of infertility patients towardsmultiple births has never been investigated. We therefore generateda survey by questionnaire, which was sent to 3800 consecutiveunselected couples with infertility problems: 582 responseswere received (15% response rate) and analysed. The percentagedistribution of the responses to 21 questions, addressing attitudestowards 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 aboutmultiple conceptions was rejected by a large majority (64%).The risk of a twin birth was not strongly perceived, but theperception 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 equallyexpressed and rejected, and for a multiple gestation beyondtriplets was rejected by 73–82% of couples. Patients wereeducated about the risks of selective embryo reduction and respondedin 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 largermultiples. The length of infertility was correlated with a positiveattitude towards multiples beyond triplets (P = 0.029) but wasnot correlated with a desire for twins or triplets. Prior paritydid not affect the attitude towards multiples at all. The lengthof infertility was also correlated significantly to an understandingof risk (twins, P = 0.034; triplets, P = 0.001; quadrupletsand more, P = 0.05), while age and parity was not. The considerationof selective embryo reduction as a treatment option was correlatedsignificantly with age (P = 0.0001), while the understandingof associated risks was evenly distributed, independent of patientcharacteristics. We conclude that infertility patients appearto be educated about the risks of multiple births. A strongdesire for multiple births, as long as this can be limited totriplets or less, increases with advancing female age. Increasinglength of infertility, however, increases the willingness formultiples beyond triplets. Increasing female age increases thereadiness to consider selective embryo reduction as a treatmentoption. Attitudes do not differ between couples with primaryand secondary infertility. Patient attitudes are thus not inagreement with the existing practice patterns in infertilitytherapy. A re-evaluation of some of these practice patternsmay therefore be indicated.