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Physician influence and IVF: how much do patients rely on physician opinion when choosing elective single embryo transfer?


While some patients desire twins from IVF, most are interested in their physician’s opinion regarding the optimal number of embryos to transfer. Our objective was to determine how physician influence relates to the likelihood of a patient undergoing elective single embryo transfer (eSET) or multifetal reduction.


Descriptive analysis of online survey results from a cross-sectional sample of U.S. community women.


An online survey advertised through RESOLVE, the National Infertility Association, was conducted over 5 weeks in 2014. Interested respondents were screened for gender and cycle eligibility and gave consent by acknowledging an online privacy statement. Inclusion criteria for this study were age < 40 and the completion of at least one IVF cycle with embryo transfer. The outcomes of interest were elective single embryo transfer (eSET) versus multiple embryo transfer (MET) in 1st cycle, as well as attitudes related to multifetal reduction as queried on a Likert scale. Responses were analyzed using descriptive statistics, with X2 used to compare proportions among groups.


Of 888 participants, 654 met age and cycle criteria. Compared to those receiving MET, participants who underwent eSET were more likely to report that the decision was made between her and her partner and less likely to report it was solely the doctor’s decision (p<0.001). There was no association between perceived physician opinion on number of embryos to transfer and whether a patient actually received MET vs eSET (p=0.402). Forty-two percent of participants who underwent eSET stated the most important reason for doing so was potential health risks to offspring, while 23% stated the doctor’s opinion was most important. Compared to those undergoing MET, participants who underwent eSET reported being more likely to consider selective reduction if ever recommended by their physician (p=0.001).


Physician opinion may not be a highly critical factor when patients are deciding on eSET, as more study participants reported making this decision on their own and influenced mostly by risks to offspring. This suggests that efforts should be focused on educating patients on the risks of multiple gestations as a means of improving eSET rates and reducing the need to consider selective reduction.

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