Factors affecting patients' attitudes toward single- and multiple-embryo transfer

Objective: To identify factors that influence patient decision making concerning embryo transfer. Design: Prospective analysis. Setting: In vitro fertilization unit at a tertiary-care, university-affiliated teaching hospital. Patient(s): Seventy-nine women and 53 men who were referred consecutively for IVF treatment. Intervention(s): Provision of risk information about complications of twin pregnancy. Main Outcome Measure(s): Rated desirability of different transfer options and twin pregnancy, together with standardized measures of depression and infertility stress. Result(s): Women's initial preference for two-embryo transfer (2ET) was related to beliefs that the chance of pregnancy was higher with 2ET vs. elective single-embryo transfer and that the personal chance of twins was relatively likely with 2ET but was not related to a specific desire for twins. Providing risk information increased the desirability of elective single-embryo transfer and decreased the desirability of twin pregnancy among both men and women. Conclusion(s): Cautious patients, preferring transfer of fewer embryos, balance desires to maximize the chance of pregnancy with acceptance of risks associated with twins. Less-cautious patients may be motivated by beliefs about the influence of age, desires for, and likelihood of twin pregnancy. Information about risks may affect these groups differently and diverse patient motivations may require tailored information to ensure informed consent.