fertility news

Multiple studies have documented the desire of many patients for a multiple pregnancy. A recent Canadian study of 801 male and female infertility patients suggests that 41% of those who participated desired multiple pregnancy. These results were not affected by age or gender however the longer the duration of infertility and previous assisted reproductive treatment increased the desire, while having a child and recognition of the increased fetal risks decreased the desire.

In a smaller US study 20.3% of the 459 participants ranked twin, triplet, and quadruplet pregnancies as preferable to a singleton pregnancy. Among all women, avoidance of multiple births was a less important consideration at this stage of their infertility evaluation than were treatment efficacy, safety, affordability, and time to conception. With regard to twins, most women knew of the increased risk of preterm delivery and increased maternal risks during pregnancy and delivery. Less than half of the women knew of the increased risk of cerebral palsy and infant mortality. Knowledge of risks associated with triplet gestation was somewhat better, although only half of the women surveyed knew of the increase in infant mortality after a triplet pregnancy.

The results of these studies underscore the intense desire of patients to have a child and the risks they are willing to take in order to fulfill this desire. Bridging the knowledge gap between physicians and their patients regarding the risks of multiple gestation is a high priority so patients can make informed decisions about cycle cancellations or the number of embryos to transfer. Counseling patients before beginning treatment, during treatment and at the time of embryo transfer is highly recommended.

If patients do conceive a high-order multiple gestation the option of multifetal pregnancy reduction exists. The technique of multifetal pregnancy reduction (MFR) was developed in the mid 1980s in an attempt to decrease the perinatal complications associated with high-order multiple pregnancies. This procedure is done by a perinatologist usually around the 10th week of pregnancy. It is not without risk and complete loss rates of around 6% have been reported. Counseling by both a physician, to weigh the benefits and risks of the procedure, and a mental health professional, to explore the emotional aspects of their decision, is recommended.

References:
Child T, Henderson A, Tan S. The desire for multiple pregnancy in male and female infertility patients. Human Reproduction 2004; 19: 558-561.

Gleicher N et al. The desire for multiple births in couples with infertility problems contradicts present practice patterns. Human Reproduction 1995; 10: 1079-1084.

Ryan G, Zhang S, Dokras A, Syrop C, Van Voorhis B. The desire of infertile patients for multiple births. Fertility Sterility 2004; 81: 500-504.

Stone JA. Physiology and consequences of multiple fetal pregnancies. Paper presented at Smart Art: From Physiology to Clinical Success; August 24-26, 2000; Chicago, Illinois.