Twin pregnancy, contrary to consensus, is a desirable outcome in infertility
Received 29 January 2008; received in revised form 26 February 2008; accepted 26 February 2008. published online 25 April 2008.
Objective
To determine whether the worldwide consensus that twin pregnancy after fertility treatment represents an adverse outcome to be avoided is correct.
Design
Literature search via PubMed and MEDLINE, going back to 1990.
Setting
Academically affiliated private fertility center.
Patient(s)
Mothers and offspring in singleton and twin pregnancies.
Intervention(s)
None.
Main Outcome Measure(s)
Maternal and perinatal/neonatal risks as well as cost considerations for singleton versus twin pregnancies.
Result(s)
Most risk assessments of twin pregnancies after fertility treatment have used spontaneous conceptions data, which reflect different treatment paradigms and outcome benefits from pregnancies after fertility treatments. In vitro fertilization (IVF) twins demonstrate approximately 40% lower outcome risks than spontaneous twin conceptions. Most risk assessments in the literature are calculated with pregnancy as the primary outcome, but in a fertility-treatment paradigm where patients want more than one child the statistically correct risk assessment should refer to born children as the primary reference. If published data are corrected accordingly to achieve statistical commonality of outcome (i.e., one child in singleton versus two children in twins), twin pregnancies no longer demonstrate a significantly increased risk profile and/or cost for mothers or individual offspring.
Conclusion(s)
For infertile patients who want more than one child, twin deliveries represent a favorable and cost-effective treatment outcome that should be encouraged, in contrast to the current medical consensus.
aThe Center for Human Reproduction, New York, New York
bFoundation for Reproductive Medicine, New York, New York
cDepartment of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
dDepartments of Epidemiology and Social Medicine and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
Reprint requests: Norbert Gleicher, M.D., The CHR 21 East 69th Street, New York, NY 10021 (FAX: 212-994 4499).
N.G. has nothing to disclose. D.B. has nothing to disclose.
Supported by the Center for Human Reproduction, New York and the Foundation for Reproductive Medicine.
Presented in part by invitation in form of a debate (Twins in ART Is a Desirable Outcome?) at the 14th World Congress on In Vitro Fertilization and 3rd World Congress on In Vitro Maturation, Montreal, Canada, September 15–19, 2007.
ABSTRACT