Hum. Reprod. Advance Access originally published online on March 13, 2008
Human Reproduction 2008 23(5):1233-1234; doi:10.1093/humrep/den077
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LETTERS TO THE EDITOR |
Reply: Patient attitudes towards twin pregnancies and SET: a questionnaire study
1 The Fertility Clinic, Department of Obstetrics and Gynaecology, Aarhus University Hospital, Skejby Sygehus, Brendstrupgaardsvej, DK-8000 Aarhus N, Denmark 2 Institute of Public Health, Department of Epidemiology, University of Aarhus, DK-8000 Aarhus C, Denmark
3 Correspondence address. Tel: +45-89102509; Fax +45-86402811; E-mail: astrid.hoejgaard{at}webspeed.dk
We are grateful to Garel et al. (2008)
for their interest in our article (Højgaard et al., 2007). It is true that self-administered questionnaires may mask more complex opinions.
In order to address this, we therefore conducted a qualitative study prior to the questionnaire study in order to elucidate the views on which topics are relevant for the reproductive decisions made by the infertile couples treated (Ingerslev et al., 2005). Semi-structured interviews were conducted with 18 couples by an independent anthropologist outside the clinic. All interviews were audio-recorded and transcribed. An analytical framework based on narrative theory was used to understand patterns of decision-making (Seeberg, 2005). The couple
reasoning for and against twin pregnancy provided the basis for a preliminary questionnaire which was tested in the pilot test mentioned in the article (Højgaard et al., 2007). In accordance with the results of the quantitative questionnaire study, it was concluded from the qualitative study that childlessness was considered a greater risk than twinning and that the couples were willing to accept twins in order to ensure siblings.
All the couples in our study were infertile couples who have decided to seek help. It is not possible to make conclusions from the study on the motives for not seeking treatment. Therefore, we cannot conclude that the reason why some infertile couples reject ART is due to the wish to avoid multiple pregnancies. In 2005, 6.5% of all Danish newborn were the result of infertility treatment (http://fertilitetsselskab.dk). As so many Danish couples accept ART makes it difficult to believe that large subgroups of infertile couples avoid treatment due to a risk of multiple pregnancies. However, this can of course not be out ruled as it has not been investigated.
We are not sure that improvement of the results of single embryo transfer (SET) is sufficient to result in a higher demand for singleton pregnancies. The main reason for wanting twins in our study was to ensure that the child had a sibling. The zero-child risk constituted the most important risk for the respondents. One of the main reasons for choosing double embryo transfer (DET) was that ‘age plays a role’. As the age of primiparas in Denmark is steadily increasing, it might be that socio-economic factors have to be taken into consideration if a reduction in the percentage of DET is to be achieved in the absence of obligatory SET. According to our qualitative study, the couples found statistical information negatively emotionally charged and information that questions the success of the project tends to be seen as unwelcome. The wording of information is thus highly important which was also seen in the questionnaire study. It may therefore be a challenge to inform couples to choose SET at their own accord even if the results are substantially improved.
References
Højgaard A, Ottosen LD, Kesmodel U, Ingerslev HJ. Patient attitudes towards twin pregnancies and single embryo transfer—a questionnaire study. Hum Reprod (2007) 22:2673–2678.
Ingerslev HJ, Poulsen PB, Kesmodel U, Højgaard A, Pinborg A, Henriksen TB, Seeberg J, Ottosen LD. Should one or two embryos be transferred in IVF? A health technology assessment. Danish Health Technology Assessment. (2005) 7(2). Copenhagen: National Board of Health, Danish Centre for Evaluation and Health Technology Assessment 2005. http://www.sst.dk/publ/Publ2005/CEMTV/IVF_1_2/IVF_1_or_2.pdf.
Garel M, Blondel B, Karpel L, Blanchet V, Breart G, Frydman R, Olivennes F. Letters to the Editor. Hum Reprod (2008) this issue.
Seeberg J. Barnløshedsbehandling og det uønskedes non-narrativitet. Tidsskrift for forskning i Sygdom og Samfund (2005) 2:77–101.
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