title: During IVF treatment patient preference shifts from singletons towards twins but only a few patients show an actual reversal of preference.
abstract: BACKGROUND
  Knowledge of patients' preferences for elective single embryo transfer (eSET) or double embryo transfer (DET) and for singletons or twins is of great importance in counselling for embryo transfer (ET) strategies. In this study, the stability of IVF patients' preferences over time for either a healthy single child or healthy twins was measured and we investigated which factors could explain preference shifts.
  
  
  METHODS
  Infertile women (n = 177) who participated in an RCT comparing one cycle eSET with one cycle DET were included. A satisfaction questionnaire was developed to measure patient preferences and attitudes at two moments in time, i.e. at 2 weeks before ET and at 2 weeks following ET, after the results of the pregnancy test. Regression analysis examined the effect of several variables on preference shifts.
  
  
  RESULTS
  Before ET, most patients expressed a preference for a singleton, whereas most patients were indifferent 2 weeks after ET, resulting in an overall preference shift towards twins (P = 0.002; n = 145). Overall, 62% of patients showed a preference shift. Preference shifts were explained by patients' global satisfaction of the information given by the fertility clinic staff received by the fertility clinic staff, and an interaction between the occurrence of pregnancy and transfer policy (eSET or DET).
  
  
  CONCLUSIONS
  In general, patients' preferences for a singleton or twins are not stable during IVF treatment. Possible explanations of a shift in preference are that pregnant patients attuned their preferences to what they expect their pregnancy to result in, whereas non-pregnant patients shifted towards a preference for twins in order to be able to fulfil their ultimate child wish.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Research Institute Grow and Development, and Care and Public Health Research Institute, PO Box 5800, 6202 AZ Maastricht, The Netherlands. audrey.fiddelers@mumc.nl
authors.forename: Audrey A A
authors.initials: AA
authors.lastname: Fiddelers
authors.forename: Fred H M
authors.initials: FH
authors.lastname: Nieman
authors.forename: John C M
authors.initials: JC
authors.lastname: Dumoulin
authors.forename: Aafke P A
authors.initials: AP
authors.lastname: van Montfoort
authors.forename: Jolande A
authors.initials: JA
authors.lastname: Land
authors.forename: Johannes L H
authors.initials: JL
authors.lastname: Evers
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D057240:Patient Preference; D017060:Patient Satisfaction; D011247:Pregnancy; D011272:Pregnancy, Multiple; D056826:Single Embryo Transfer; D011795:Surveys and Questionnaires; D014427:Twins