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The Effect Of Knowledge On The Desire For Multiple Pregnancies Among Patients with Subfertility

Nuguelis Razali, Ida Lilywaty LatarDepartment of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.

Objectives

Multiple births are considered a serious complication of artificial reproductive techniques. Multiple births have been shown to be associated with higher risks of fetal as well as maternal complications.

They are also associated with a higher cost for the family and the health system [1,2]. Despite these knowledge , a proportion of fertility patients still appear to favour multiple pregnancies as the ideal treatment outcome [2].

These preferences has been strongly associated with the patients’ lack of knowledge about fertility treatment, multiple pregnancy as well as the associated risks [3].

The aim of this study is to determine the influence of informing patients regarding the risks associated with multiple pregnancies to both mother and fetus and their initial desire for multiple pregnancies.

Methods

A prospective study was carried out in the Infertility clinic of University Malaya Medical Center, Kuala Lumpur, Malaysia involving patients and their spouses.

Couples attending the clinic were offered to fill up a questionnaire separately. Following this, they were handed a pamphlet with information regarding the risks associated with multiple pregnancies. The patients will then be required to answer again the question on the number of pregnancy desired that was previously asked.

Univariate and Multivariate regression analysis were performed looking at the predictors for desire for multiple pregnancy and also predictors of continuous desire for multiple pregnancies after provision of information.

Results

41% of patients desired multiple pregnancies. Patients older than 35 years old have increased while patients with preexisting knowledge of risks associated with multiple pregnancy and previous treatment for infertility have decreased desire for multiple pregnancies (Table 1).

However, for those patients who have preexisting knowledge of the increased risk, providing further information regarding the risks did not change their increased desire for multiple pregnancy. Similarly, patients who are older than 35 and with longer duration of infertility also did not change their desire after given information regarding the increased risk (Table 2).

Discussion

References

For infertile patients, twin deliveries represent a favourable and cost effective treatment outcome that should be encouraged, in contrast to the current medical consensus [4].

This desire has been attributed to lack of knowledge among the patients [2]. In our study, the provision of information regarding the increased risks associated with multiple births has not influence the patients’ decision. This is in contrast to previous data that showed that simple educational materials can improve knowledge of twin pregnancy risks and affect decision making [5] .

A possible explanation for this resistance to change might be because ART in Malaysia is still costly and not financially supported by the government or any insurance policy.

Providing and reinforcing knowledge on the risks to mother and fetus associated with multiple pregnancies did not decrease the preference for multiple pregnancies in patients.

1. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update 2005; 11:575-93

2. Ryan GL, Zhang SH, Dokras A, Syrop CH, Van Voorhis BJ. The desire if infertile patients for multiple births. Fertil and Steril 2004;80(3):500-04.

3. D’Alton M. Infertility and the desire for multiple births. Fertil and Steril 2004;81(3):523-25.

4. Gleicher N, Barad D. Twin Pregnancy, contrary to consensus, is a desirable outcome in infertility. Fertil and Steril 2009;91:2426-31. Ryan GL, Sparks AE, Sipe CS et al.

5. A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates. Fertil and Steril 2007; 88 (2): 354-59.

The Effect of Knowledge On The Desire For Multiple Pregnancies Among Patients with SubfertilityThe Effect of Knowledge On The Desire For Multiple Pregnancies Among Patients with Subfertility

Univariate analysis

Multivariate analysis

No of patients

Hazards ratio95% CI p Hazards ratio p

Total 253

Age

<35 186 1.00 1.00

≥35 672.44

(138-4.31)0.002 2.29

(1.26-4.16) 0.014

Received treatment

No 230 1.00

Yes 230.41

(0.17-0.98) 0.044

Pre-existing recognition of multiple pregnancy

No 54 1.00 1.00

Yes 187 0.30 (0.16-0.56) <0.001

0.30 (0.16-0.57) <0.001

Table 1: Univariate and multivariate analysis of predictors for multiple pregnancy outcome

Univariate analysis Multivariate

analysis

No of patients

Hazards ratio(95% CI) P Hazards ratio

(95% CI) P

Total 103

Age

< 35 years 65 1.00 1.00

≥ 35 years 38 3.33 (1.22-9.11) 0.019 3.57

(1.24-10.43) 0.019

Duration of infertility

< 5 year 70 1.00

≥ 5 years 33 3.31 (1.14-9.63) 0.028

Pre-existing recognition of risks of multiple pregnancy

No 35 1.00 0.001 1.00

Yes 66 4.32 (1.76-10.60)

4.59 (1.79-11.72) 0.001

Table 2: Univariate and multivariate analysis of predictors for a continuous desire of multiple pregnancy outcome

Conclusion