title: Patient attitudes towards twin pregnancies and single embryo transfer - a questionnaire study.
abstract: BACKGROUND
  The present trend towards selective single embryo transfer (SET) calls for evaluation of patient attitudes towards twins and how the patients balance advantages and disadvantages of one or two embryos in IVF/ICSI treatment.
  
  
  METHODS
  The study was conducted in a Danish public fertility clinic, where the common practice was double embryo transfer (DET), and the number of reimbursed treatments was limited to three. Referred patients were given oral and written information about the IVF/ICSI treatment including twin probability following DET and the risk of preterm delivery and neonatal complications associated with twins. In order to evaluate patients and partners attitudes towards twins and SET, an anonymous survey was conducted, and 588 couples were invited to participate.
  
  
  RESULTS
  Four hundred and fourteen women (70.4%) and 404 men (68.7%) answered the questionnaire adequately for analysis. About 58.7% preferred having twins to having one child at a time (37.9%). Primary reasons for preferring twins were desire for siblings (23.3%), a positive attitude towards twins (22.5%), and a wish to minimize physical and psychological stress through having as few IVF treatments as possible (19.3%). Economic considerations were not important.
  
  
  CONCLUSIONS
  Obligatory single embryo policy would be in conflict with patient interests and wishes. More carefully prepared information seems to be needed. The challenge consists in balancing clinical considerations with unbiased information on twin pregnancy, respecting patient autonomy and enabling informed decision-making.
authors.affiliation: The Fertility Clinic, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, DK-8000 Arhus N, Denmark. astrid.hoejgaard@webspeed.dk
authors.forename: Astrid
authors.initials: A
authors.lastname: Højgaard
authors.forename: Lars D M
authors.initials: LD
authors.lastname: Ottosen
authors.forename: Ulrik
authors.initials: U
authors.lastname: Kesmodel
authors.forename: Hans Jakob
authors.initials: HJ
authors.lastname: Ingerslev
mesh_terms: D000328:Adult; D001290:Attitude; D004624:Embryo Transfer / Q000379:methods / Q000523:psychology*; D005260:Female; D005307:Fertilization in Vitro; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D026684:Personal Autonomy; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000523:psychology*; D020554:Sperm Injections, Intracytoplasmic; D011795:Surveys and Questionnaires; D014427:Twins