Patient perspectives on IVF success and likelihood of multiple gestations (original) (raw)

The desire for multiple pregnancy in male and female infertility patients

Human Reproduction, 2004

BACKGROUND: It is apparent that many fertility patients consider multiple birth an ideal treatment outcome. We wished to evaluate the desire for multiple birth among patients, and the effect of patient demographics and recognition of the increased fetal risks of multiple pregnancy on this desire. METHODS: This was a prospective questionnaire study completed by 801 male and female infertility patients attending a tertiary level Canadian university fertility clinic. Two logistic regression analyses were performed with desire for multiple birth with next fertility treatment and recognition of the increased fetal risks of multiple pregnancy as the dependent variables. RESULTS: 41% of patients desired a multiple birth. Increasing duration of infertility or previous assisted reproductive treatment increased, and having previous children or recognition of the increased fetal risks decreased, this desire. Patient age or sex did not affect desire for multiple birth. Previous assisted reproductive treatment was associated with increased recognition of the fetal risks of multiple pregnancy. CONCLUSIONS: A signi®cant proportion of fertility patients considers multiple birth an ideal treatment outcome. Recognition of the increased fetal risks of multiple pregnancy signi®cantly reduced this desire. Patient education may play an important role in assisting physicians in the quest to reduce the contribution of assisted reproductive treatment to multiple births and their attending complications.

The desire of infertile patients for multiple births

Fertility and Sterility, 2004

To determine the proportion of infertile women who prefer a multiple birth over a singleton, patient characteristics associated with this desire, and patient knowledge about the risks of multiple births. Design: Prospective analysis. Setting: Academic university hospital-based infertility center and private general gynecology clinic. Patient(s): Four hundred sixty-four female patients with infertility who presented for their initial visit. Main Outcome Measure(s): Demographic characteristics, infertility history, desire regarding multiple births, knowledge of the risks of multiple births, and goals of infertility evaluation and treatment were determined by using a 41-question survey. Univariate analysis was performed to assess patient characteristics associated with the desire for multiple births. Independent factors associated with this desire were assessed by multivariable logistic regression analysis. Result(s): 20.3% of women desired multiples over a singleton gestation. Nulliparity, lower family income, younger patient age, prior evaluation for infertility, longer duration of infertility, and lack of knowledge regarding risks of twin gestations were associated with this desire. Only nulliparity and lower family income were independently associated. Conclusion(s): A sizable minority of infertility patients prefers a multiple birth as their treatment outcome. Patient education may be an effective strategy to reduce the incidence of twin and higher-order multiple pregnancies. (Fertil Steril 2004;81:500 -4.

The Desire for Multiple Pregnancy among Patients with Infertility and Their Partners

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.

Judicious Fertility Treatment to Minimise the Risk of Multiple Pregnancy

Multiple Pregnancy - New Challenges, 2019

Pregnancies resulting from fertility treatment are associated with higher rates of multiple pregnancy and have higher rates of pregnancy complications than spontaneously conceived pregnancies. Methods exist to make fertility treatment safer and less likely to result in multiple pregnancy and practitioners should be practicing fertility treatment with the aim to produce a healthy, term, singleton pregnancy. Approaches to minimising the risk of multiple pregnancy include carefully monitoring ovulation induction (OI) cycles to produce mono-follicular ovulation. Identifying patients at risk of excessive response to ovulation induction and treating them with low dose therapies and close monitoring is a critical step in practicing safe OI treatment. Performing single embryo transfer in all but exceptional cases of in-vitro fertilisation (IVF), and never transferring more than two embryos, is the single, most successful way to reduce the multiple pregnancy rate with IVF. An appreciation of the increased risk of mono-chorionic twinning with IVF is also important. This chapter will explore ways to minimise the risk of multiple pregnancy with a variety of fertility treatments.

A conceptual framework for patient-centered fertility treatment

Reproductive Health

Background: Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. Methods: In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Results: Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Conclusions: Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for infertility, this revised conceptual framework can be used to inform patientcentered treatment and research on infertility and to develop decision support tools for patients and providers.

Resolution of infertility and number of children: 1386 couples followed for a median of 13 years

Human Reproduction, 2017

How common were children among infertile couples? SUMMARY ANSWER: A total of 61.7% of infertile couples presenting for care subsequently had live born children 13.1 years after first being clinically assessed, with a mean of 1.7 children among those who had at least one. WHAT IS KNOWN ALREADY: While the prognoses for infertile couples undertaking specific treatments have been well described, less is known about those not undergoing these treatments or the total number of children. This information is necessary for decision-making in many individual cases; not knowing this has been cited by patients and clinicians as impeding implementation of care. STUDY DESIGN, SIZE, DURATION: The sole provider of specialist fertility care for the two southern-most regions in New Zealand enroled 1386 infertile couples from 1998 to 2005 in a longitudinal study with follow-up on all births until the end of 2014. Couples were followed in care for a median of 1.1 years and median follow-up for births was 13.1 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Clinic-collected data were linked to national maternity data to extend followup past the end of clinical contact. The primary outcome was the total number of live born children. Hurdle regression was used to investigate factors associated with resolving infertility and the total number of children. MAIN RESULTS AND THE ROLE OF CHANCE: Infertility was resolved with a live birth by 61.7% (95% CI 59.1-64.2%) of couples; just over half of all first births were treatment-dependent. Among couples who resolved their infertility, 55.6% (52.2-58.9%) had at least one additional child and the mean number of children was 1.7. While female age strongly influenced outcomes, one-third of women aged 40-41 years had a child, not significantly less than those in their late 30s. The lowest levels of resolution occurred in women aged ≥42 years, couples who were infertile for >4 years and women with a BMI ≥ 35 kg/m 2. Moderate obesity did not affect outcomes. LIMITATIONS, REASONS FOR CAUTION: The main limitation of this study was insufficient data to investigate male factor infertility outcomes. It is also possible that treatment-dependent resolution could be higher in more recent cohorts with the increased use of ART. WIDER IMPLICATIONS OF THE FINDINGS: Outcomes in these couples are comparable to those seen in other studies in highincome countries despite the relatively low contribution of ART. The prognosis for most infertile couples is positive and suggests many will not require treatment. Further research is needed to inform best practice for women in their early forties or with moderate obesity, and to develop prediction models that are more relevant for the initial management of infertility.

Factors predicting IVF treatment outcome: a multivariate analysis of 5310 cycles

Reproductive BioMedicine Online, 2005

The objective of this study was to analyse factors predicting live birth rate following IVF. A computerized database of 1928 women who underwent 5310 consecutive IVF cycles in a single IVF unit was evaluated. Data on the women's age, number of retrieved oocytes, performance of intracytoplasmic sperm injection (ICSI), aetiology of infertility, number of transferred embryos and option of choosing embryos for transfer were evaluated. There were 1126 pregnancies that resulted in 689 live births. Transferring two embryos doubled the chances of delivery compared with one embryo, but transferring three embryos was not significantly superior to two embryos. Moreover, following a three-embryo transfer, the multiple delivery rates were significantly higher (P < 0.01) compared with transferring two embryos. Optimal delivery rates were observed in women aged 26-30 years, with gradual decline with advanced age. The performance of ICSI resulted in higher delivery rates compared with conventional insemination. According to these data, the best live birth results following IVF treatment were achieved when the maternal age was 26-30 years, in couples with male factor infertility undergoing ICSI, and when two embryos were transferred.