Safety versus success in elective single embryo transfer: women’s preferences for outcomes of in vitro fertilisation

Abstract

Objective To assess whether women waiting to undergo in vitro fertilisation (IVF) view adverse outcomes associated with twin pregnancy as more desirable than having no pregnancy at all.Design Women's preference values for five adverse birth outcomes associated with twin pregnancy were compared with their preference value for treatment failure (TF), i.e. no pregnancy at all.Setting Aberdeen Fertility Centre, University of Aberdeen, UK.Population A total of 74 women waiting to undergo IVF.Methods The standard gamble method was used to elicit women's preference values for giving birth to a child with physical impairments (PI), cognitive impairments (CI), or visual impairments (VI), perinatal death (PD) without a subsequent pregnancy, premature delivery (PremD), and TF (no pregnancy).Main outcome measures Preference values were elicited on a scale where 1 represents giving birth to a healthy child and 0 represents immediate death.Results The median preference values for having a child with PI, CI, or VI were 0.940, 0.970, and 0.975, respectively. The median values for PremD, PD, and TF were 0.955, 0.725, and 0.815, respectively. Having no child at all was valued significantly lower than having a child with PI, CI, or VI (P < 0.01) but significantly higher than PD (P < 0.01).Conclusions Some women waiting for IVF treatment view severe child disability outcomes associated with double embryo transfer as being more desirable than having no child at all. Women embarking on IVF may be influenced more strongly by considerations of 'treatment success' rather than future risks to their offspring.

Live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers: Hong Kong experience

“…Child et al 21 found that 41% of women having assisted reproductive technology were actually inclined to prefer a twin pregnancy, and some women waiting for IVF treatment viewed severe child disability outcomes more desirable than having no child at all. 22 This barrier might be overcome by providing educational material to women so as to improve their knowledge on outcomes and risks of multiple pregnancies. 23 The feasibility of eSET also relies on improving outcomes with cryopreserved embryos and the technique on vitrification.…”

Congenital anomalies and other perinatal outcomes in ICSI vs. naturally conceived pregnancies: a comparative study

“…Furthermore, there is evidence to support that infertile women weigh treatment success more than the chances of future risks [17]. In a recent literature search noted that twin gestations following IVF represent both a favorable treatment outcome that should be encouraged, in contrast to the current medical consensus [18].…”

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

“…40 We assumed that a successful healthy birth outcome would return women to the age-specific UK population norm, whereas giving birth to a child with a disability would be associated with an EQ-5D utility decrement of 0.07. 41 For women suffering a stillbirth or neonatal/infant death followed by no subsequent pregnancy, we applied a utility weight of 0.543 elicited directly from infertile women in Grampian, 42 because no general population preference weights were available for this outcome.…”

“…42 In this previous study, standard gamble utility weights were elicited for: 'premature delivery/neonatal admission'; 'giving birth to a child with disability'; 'experiencing a neonatal death followed by no subsequent pregnancy'; and 'treatment failure' followed by life-long childlessness.…”

“…Given the low absolute probability of this event, this change also had little impact on findings. When women's life-years were quality adjusted using standard gamble utility weights previously elicited from women waiting to undergo IVF treatment in Aberdeen, 42 the apparent costeffectiveness of DET improved substantially in women of all ages; the ICERs for DET versus eSET being £9400, £7300 and £5700 per additional QALY in the 32-, 36-and 39-year-old cohorts respectively.…”