Fertility and Sterility
Volume 91, Issue 6 , Pages 2426-2431 , June 2009

Twin pregnancy, contrary to consensus, is a desirable outcome in infertility

  • Norbert Gleicher, M.D.

      Affiliations

    • The Center for Human Reproduction, New York, New York
    • Foundation for Reproductive Medicine, New York, New York
    • Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
    • Corresponding Author InformationReprint requests: Norbert Gleicher, M.D., The CHR 21 East 69th Street, New York, NY 10021 (FAX: 212-994 4499).
  • ,
  • David Barad, M.D., M.S.

      Affiliations

    • The Center for Human Reproduction, New York, New York
    • Foundation for Reproductive Medicine, New York, New York
    • Departments of Epidemiology and Social Medicine and Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York

Received 29 January 2008 ,Revised 26 February 2008 ,Accepted 26 February 2008.

References 

  1. Kogan MD, Alexander GR, Kotelchuk M, MacDorman MF, Buekens P, Martin JA, et al. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981–1997. JAMA. 2000;283:335–341
  2. Fauser BCJM, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet. 2005;365:1807–1816
  3. Jones HW. Iatrogenic multiple births: a 2003 checkup. Fertil Steril. 2007;87:453–455
  4. Jones HW, Schnorr JA. Multiple pregnancies: a call for action. Fertil Steril. 2001;75:11–13
  5. Dickey RP. A year of inaction on high-order multiple pregnancies due to ovulation induction. Fertil Steril. 2003;79:14–16
  6. Seoud MA, Toner JP, Kruithoff C, Muasher SJ. Outcome of twin, triplet, and quadruplet in vitro fertilization pregnancies: the Norfolk experience. Fertil Steril. 1992;57:825–834
  7. Conde-Agudelo A, Belizan JM, Lindmark G. Maternal morbidity and mortality associated with multiple gestations. Obstet Gynecol. 2000;95:899–904
  8. Gleicher N, Oleske DM, Tur-Kaspa I, Vidali A, Karande V. Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins. N Engl J Med. 2000;343:2–7
  9. Dickey RP, Taylor AN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Risk factors for high-order multiple pregnancy and multiple birth after controlled ovarian hyperstimulation: results of 4,062 intrauterine insemination cycles. Fertil Steril. 2005;83:671–683
  10. Jones HW. Multiple births: how are we doing?. Fertil Steril. 2003;79:17–21
  11. Bardis N, Maruthini D, Balen AH. Modes of conception and multiple pregnancy: a national survey of babies born during one week in 2003 in the United Kingdom. Fertil Steril. 2005;84:1727–1732
  12. Schieve LA. The promise of single-embryo-transfer. N Engl J Med. 2006;354:1190–1193
  13. Veleva Z, Vilska S, Hydėn-Granskog C, Tiitinen A, Tapanainen JS, Martikainen H. Elective single embryo transfer in women aged 36-39 years. Hum Reprod. 2006;2098–2102
  14. De Neubourg D, Gerris J. What about the remaining twins since single-embryo transfer? How far can (should) we go?. Hum Reprod. 2006;21:843–846
  15. Karlstrőm PO, Bergh C. Reducing the number of embryos transferred in Sweden-impact on delivery and multiple birth rates. Hum Reprod. 2007;22:2202–2207
  16. American Society for Reproductive Medicine . Guidelines on number of embryos transferred. Fertil Steril. 2004;82:773–774
  17. Templeton A, Morris JK. Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization. N Engl J Med. 1998;339:573–577
  18. Meldrum DR, Gardner DK. Two-embryo transfer—the future looks bright. N Engl J Med. 1998;339:624–625
  19. Pandian Z, Templeton A, Serour G, Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a Cochran review. Hum Reprod. 2005;20:2681–2687
  20. van Montfoort APA, Fiddelers AAA, Janssen JM, Derhaag JG, Dirksen CD, Dunselman GAJ, et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod. 2006;21:338–343
  21. Fiddeles AAA, van Montfoort APA, Dirksen CD, Dumoulin JCM, Land JA, Dunselman AJ, et al. Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial. Hum Reprod. 2006;21:2090–2097
  22. Gleicher N, Campbell DP, Chan CL, Karande V, Rao R, Balin M, et al. The desire for multiple births in couples with infertility problems contradicts present practice patterns. Hum Reprod. 1995;10:1079–1084
  23. BabyCenter Web site. Poll: How many children do you want? Accessed March 5, 2008. Available at: http://www.babycenter.com/4_how-many-children-do-you-want_4190.bc
  24. BabyCenter Web site. Poll: What's the ideal family size? Accessed March 5, 2008. Available at: http://www.babycenter.com/4_whats-the-ideal-family-size_74034.bc
  25. Rodis JF, Egan JF, Craffey A, Clarieglio L, Greenstein RM, Scorza WE. Calculated risk of chromosomal abnormalities in twin gestations. Obstet Gynecol. 1990;76:1037–1041
  26. MacKay AP, Berg CJ, King JC, Duran C, Chang J. Pregnancy-related mortality among women with multifetal pregnancies. Obstet Gynecol. 2006;107:563–568
  27. Fitzsimmons BP, Bebbington MW, Fluker MR. Perinatal and neonatal outcomes in multiple gestations: assisted reproduction versus spontaneous conception. Am J Obstet Gynecol. 1998;179:1162–1167
  28. Helmerhorst FM, Perquin DAM, Donker D, Keirse MJNC. Perinatal outcome of singletons and twins after assisted conception: a systemic review of controlled studies. BMJ. 2004;328:261
  29. Barros Delgadillo JC, Alvarado Mėndez LM, Gorbea Chávez V, Villalobos Acosta S, Sánchez Solis V, Gaviño Gaviño F. Perinatal results in pregnancies obtained with embryo transfer in vitro fertilization: a case-control study. [article in Spanish] Ginecol Obstet Mex. 2006;74:626–639
  30. Manoura A, Korakakie E, Hatzidaki E, Bikouvarakis S, Papageorgiou M, Giannakopoulou C. Perinatal outcome of twin pregnancies after in vitro fertilization. Acta Obstet Gynecol Scand. 2004;83:1079–1084
  31. Sibai BM, Hauth J, Caritis S, Lindheimer MD, MacPherson C, Klebanoff M. Hypertensive disorders in twin versus singleton gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 2000;182:938–942
  32. Yukobowich E, Anteby EY, Cohen SM, Lavy Y, Granat M, Yagel S. Risk of fetal loss in twin pregnancies undergoing second trimester amniocentesis. Obstet Gynecol. 2001;98:231–234
  33. Millaire M, Bujold E, Morency AM, Gauthier RJ. Mid-trimester genetic amniocentesis in twin pregnancy and the risk of fetal loss. J Obstet Gynecol Can. 2006;28:512–518
  34. Hernández-Diáz S, Werler MM, Mitchell AA. Gestational hypertension in pregnancy supported by infertility treatments: role of infertility, treatments and multiple gestations. Fertil Steril. 2007;88:438–445
  35. Ombelet W, Martens G, De Sutter P, Gerris J, Bosmans E, Russinck G, et al. Perinatal outcome of 12 021 singleton and 3108 twin births after non-IVF assisted reproduction: a cohort study. Hum Reprod. 2006;21:1025–1032
  36. van Wely M, Twisk M, Mol BW, van der Veen F. Is twin pregnancy necessarily an adverse outcome of assisted reproductive technologies?. Hum Reprod. 2006;21:2736–2738
  37. ESHRE Capri Workshop Group. Multiple gestation pregnancy. The ESHRE Capri Workshop Group. Hum Reprod. 2000;15:1856–1864
  38. Pinborg A, Loft A, Rasmussen S, Schmidt L, Langhoff-Roos J, Greisen G, et al. Neonatal outcome in a Danish national cohort of 3438 IVF/ICSI and 10,362 non-IVF/ICSI twins born between 1995 and 2000. Hum Reprod. 2004;19:435–441
  39. Pinborg A, Loft A, Schmidt L, Greisen G, Rasmussen A, Andersen AN. Neurological sequelae in twins born after assisted conception: controlled national cohort study. BMJ. 2004;329:311
  40. Pinborg A, Loft A, Nyboe Andersen A. Neonatal outcome in a Danish national cohort of 8602 children born after in vitro fertilization or intracytoplasmic sperm injection: the role of twin pregnancy. Acta Obstet Gynecol Scand. 2004;83:1071–1078
  41. Gleicher N. Strategies to improve insurance coverage for infertility services. Fertil Steril. 1998;70:1006–1008
  42. De Neubourg D, Gerris J, Mangelschots K, Van Royen E, Vercruyssen M, Steylemans A, et al. The obstetrical and neonatal outcome of babies born after single-embryo transfer in IVF/ICSI compares favourable to spontaneously conceived babies. Hum Reprod. 2006;21:1041–1046
  43. Callahan TL, Hall JE, Ettner SL, Christiansen CL, Greene MF, Crowley WF. The economic impact of multiple gestation pregnancies and the contribution of assisted-reproduction techniques on their incidence. N Engl J Med. 1994;331:244–249
  44. Kinzler WL, Ananth CV, Vintzileos AM. Medical and economic effects of twin gestations. J Soc Gynecol Invest. 2000;7:321–327
  45. Koivurova S, Hartikainen A-L, Gissler M, Hemminki E, Järvelin M-J. Post-neonatal hospitalization and health care costs among IVF children: a 7-year follow-up study. Hum Reprod. 2007;22:2136–2141
  46. Luke B, Bigger HR, Leurgans S, Sietsema D. The cost of prematurity: a case-control study of twins vs singletons. Am J Public Health. 1996;86:809–814
  47. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and cost-effectiveness analysis. Hum Reprod. 2006;21:210–216
  48. Van der Gaag N, De Jong AH. Population scenarios for the European Union: regional scenarios. Maandstat Bevolking. 1997;45:17–31
  49. Hoorens S, Gallo F, Cave JAK, Grant JC. Can assisted reproductive technologies help offset population ageing? An assessment of the demographic and economic impact of ART in Denmark and UK. Hum Reprod. 2007;22:2471–2475
  50. Ryan GL, Zhang SH, Fokras A, Syrop CH, Van Voorhis BJ. The desire of infertile patients for multiple births. Fertil Steril. 2004;81:500–504
  51. Newton CR, McBride J, Feyles V, Tekpetey F, Power S. Factors affecting patients' attitudes toward single- and multiple-embryo transfer. Fertil Steril. 2007;87:269–278
  52. Stillman RJ. A 47-year-old woman with fertility problems who desires a multiple pregnancy. JAMA. 2007;297:858–867
  53. Scotland GS, McNamee P, Peddie VL, Bhattacharya S. Safety versus success in elective single embryo transfer: women's preferences for outcomes of in vitro fertilization. BJOG. 2007;114:977–983
  54. Belaisch-Allart J. Is twin pregnancy necessarily an adverse outcome of assisted reproductive technologies?. Hum Reprod. 2007;22:1495
  55. Gleicher N, Barad D. The relative myth of elective single embryo transfer. Hum Reprod. 2006;21:1337–1344
  56. Ellison MA, Hotamisligil S, Lee H, Rich-Edwards JW, Pang SC, Hall JE. Psychological risks associated with multiple births resulting from assisted reproduction. Fertil Steril. 2005;83:1422–1428
  57. Karla SK, Milad MP, Klock SC, Grobman WA. Infertility patients and their partners: Differences in the desire for twin gestation. Obstet Gynecol. 2003;102:152–155
  58. Martin JA, Park MM. Trends in twin and triplet births: 1980–97. Natl Vital Stat Rep. 1999;14(47):1–16
  59. Fiddelers AA, van Montfoort AP, Dirksen CD, Domoulin JC, Land JA, Dunselman GA, et al. Single versus double embryo transfer: cost effectiveness analysis alongside a randomized clinical trial. Hum Reprod. 2006;21:2090–2097
  60. van Moontfoort APA, Fiddeleres AAA, Land JA, Dirksen CD, Severens JL, Geraedts JPM, et al. eSET irrespective of the availability of a good-quality embryo in the first cycle only is not effective in reducing overall twin pregnancy rates. Hum Reprod. 2007;22:1669–1674
  61. Mastenbroek S, Twisk M, van Echten-Arends J, Sikkema-Raddatz B, Korevaar JC, Verhoeve HR, et al. In vitro fertilization with preimplantation genetic screening. N Engl J Med. 2007;357:9–17

 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.

PII: S0015-0282(08)00520-7

doi: 10.1016/j.fertnstert.2008.02.160

Fertility and Sterility
Volume 91, Issue 6 , Pages 2426-2431 , June 2009