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

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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.

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