title: Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI twins and 634 IVF/ICSI singletons: health-related and social implications for the children and their families.
abstract: BACKGROUND
  There is a lack of knowledge on child health as well as family well-being in IVF/ICSI twins.
  
  
  METHODS
  These data originated from questionnaires completed by mothers taking part in a national cohort study of twin and singleton births occurring in Denmark in 1997. The overall response rate was 83%. The three cohorts consisted of all IVF/ICSI twin children (n = 472), all IVF/ICSI singletons (n = 634) and all non-IVF/ICSI twin children (n = 1132) born in Denmark in 1997.
  
  
  RESULTS
  No major differences in physical health were observed between IVF/ICSI twins and non-IVF/ICSI twins. Compared with IVF/ICSI singletons, more IVF/ICSI twins were admitted to a neonatal intensive care unit (NICU) (P < 0.01) and more had surgical interventions (P = 0.03) and special needs (P = 0.02), moreover they had poorer speech development (P < 0.01). Correspondingly, IVF/ICSI twin mothers rated their infant's general health poorer than IVF/ICSI singleton mothers did. All discrepancies between IVF/ICSI twins and singletons disappeared after stratification for birthweight except for NICU admissions and speech development. Multiple logistic regression analyses showed that both IVF/ICSI and non-IVF/ICSI twin parents experienced more marital stress [odds ratio (OR) 2.9, 95% CI 2.2-3.8] and that twins had more impact on the mother's life (OR 1.7, 95% CI 1.2-2.4) compared with singletons. Nevertheless, the only predictor of low divorce/separation risk was IVF/ICSI treatment.
  
  
  CONCLUSIONS
  Our study indicates that physical health of IVF/ICSI twins is comparable with that of non-IVF/ICSI twins. However, physical health of IVF/ICSI twins is poorer and the implications for the families stronger compared with IVF/ICSI singletons.
authors.affiliation: The Fertility Clinic, University of Copenhagen, Rigshospitalet, Denmark. apinborg@rh.dk
authors.forename: Anja
authors.initials: A
authors.lastname: Pinborg
authors.forename: Anne
authors.initials: A
authors.lastname: Loft
authors.forename: Lone
authors.initials: L
authors.lastname: Schmidt
authors.forename: Anders Nyboe
authors.initials: AN
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000367:Age Factors; D001724:Birth Weight; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000601:surgery; D003718:Denmark; D002658:Developmental Disabilities; D019988:Children with Disabilities; D004200:Diseases in Twins; D005190:Family; D005260:Female; D005307:Fertilization in Vitro; D006304:Health Status; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D008423:Maternal Age; D009017:Morbidity; D009422:Nervous System Diseases / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D012919:Social Behavior; D012923:Social Class; D020554:Sperm Injections, Intracytoplasmic; D011795:Surveys and Questionnaires; D014427:Twins