title: The influence of IVF, multiple gestation and miscarriage on the acceptance of genetic amniocentesis.
abstract: OBJECTIVE
  To determine the effect of in vitro fertilization (IVF), multiple gestation, and history of unkaryotyped miscarriage on the acceptance of genetic amniocentesis.
  
  
  METHODS
  We studied women expected to be at least 35 years of age at the estimated date of delivery without family history of chromosomal abnormalities or fetal structural anomalies. The influence of IVF, multiple gestation, and history of miscarriage on the acceptance rate of genetic amniocentesis was evaluated. Chi-square test and logistic regression were used for analysis.
  
  
  RESULTS
  In singleton pregnancies, the acceptance rate of genetic amniocentesis was 70.7% (58/82) in the IVF group compared to 77.9% (1837/2356) (P = 0.14) in the women who conceived spontaneously. The corresponding values in multiple gestation pregnancies were 71.1% (37/52) and 62.9% (34/54) respectively (P = 0.41). There was no difference in the acceptance rate of amniocentesis between singletons (70.7%) and multiple gestations (71.1%) after IVF (P = 0.96), while in women who conceived spontaneously, the acceptance rate of 78% in singletons was significantly higher than the acceptance rate of 63% in multiple gestations (P = 0.008). Adjusting for confounding variables, women with multiple gestations were about 40% less likely to accept genetic amniocentesis (OR = 0.63, 95% CI = 0.39-1.00, P = 0.05), while women with a history of miscarriage were about 17% less likely to accept genetic amniocentesis (OR = 0.83, 95% CI = 0.68-1.00, P = 0.05). Adjusting for multiple gestation and previous miscarriage, IVF was not independently associated with acceptance of genetic amniocentesis (OR = 0.84, 95% CI = 0.54-1.29, P = 0.42).
  
  
  CONCLUSIONS
  There is no difference in the acceptance rate of genetic amniocentesis among women with IVF pregnancies compared with those who conceive spontaneously, after adjusting for multiple gestation and previous miscarriage. Unlike women who conceive spontaneously, the decision to accept amniocentesis appears not to be influenced by the presence of multiple gestation in women with IVF pregnancies.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook, Stony Brook, New York 11794-8091, USA. aelimian@notes.cc.sunysb.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Elimian
authors.forename: Marcy
authors.initials: M
authors.lastname: Demsky
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Figueroa
authors.forename: Paul
authors.initials: P
authors.lastname: Ogburn
authors.forename: Alan R
authors.initials: AR
authors.lastname: Spitzer
authors.forename: J
authors.initials: J
authors.lastname: Gerald Quirk
mesh_terms: D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D000649:Amniocentesis / Q000523:psychology*; D002755:Choice Behavior; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D005820:Genetic Testing / Q000379:methods / Q000523:psychology*; D006801:Humans; D008423:Maternal Age; D009099:Multiple Birth Offspring / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies