Despite the increased risks inherent in multiple births, patients do not always share their physicians’ concerns. This prospective survey was carried out in 464 infertile women presenting for an initial visit. The goal was to determine the proportion of women who preferred a multiple to a singleton birth and how much these women knew about the attendant risks. The women were seen at an academic university hospital-based infertility center and a private general gynecology clinic. The 449 women who returned the questionnaire had a mean age of 31 years and were mostly well educated and from high-income families. Two thirds were nulliparous. The median duration of infertility was 33 months. A majority of women had previously seen another physician concerning their infertility. One in 5 women (20.3%) preferred twin, triplet, or quadruplet pregnancies to a singleton pregnancy. Nearly 95% of these women reported twins as their first choice. Effective treatment, safety, affordability, and time to conception all were viewed as more important than avoiding a multiple birth. Most women did know that preterm delivery was more likely with twin birth, but fewer than half knew of the increased risks of infant death and cerebral palsy. After adjusting for maternal age, duration of infertility, clinic site, and knowledge about the risks of twin pregnancy, the only factors independently associated with a desire for multiple births were nulliparity and lower family income. A minority, but a significant minority, of infertile women desires multiple pregnancy. Patient education could well help to lower the incidence of twin and higher-order multiple pregnancies.
University of Iowa Roy J. and Lucille A. Carver College of Medicine and University of Iowa Hospitals and Clinics, Iowa City, Iowa
Fertil Steril 2004;81:500–504