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Practice Patterns Among Board-Certified Reproductive Endocrinologists Regarding High-Order Multiple Gestations: A United States National Survey

From the Reproductive Medicine Associates of New Jersey, Somerset; and Division of Reproductive Endocrinology and Infertility, and Section of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.

Address reprint requests to: David B. Seifer, MD, UMDNJ-Robert Wood Johnson Medical School, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology, and Reproductive Sciences, 303 George Street, Suite 250, New Brunswick, NJ 08901; E-mail: seiferdb{at}umdnj.edu.

OBJECTIVE: To assess current practice management, attitudes, and strategies of reproductive endocrinologists in the United States regarding high-order (at least three) multiple gestations.

METHODS: Questionnaires were mailed to 768 board-certified reproductive endocrinologists of whom 722 were eligible for the study. The questionnaires addressed topics such as practitioner demographics, management strategies, and attitudes regarding high-order multiple gestations.

RESULTS: The survey response rate was 52%. Most physicians performed 100–300 cycles of each ovulation induction with intrauterine insemination and in vitro fertilization in 1998 and 1999. The most commonly reported incidence of high-order multiple gestations resulting from each ovulation induction with intrauterine insemination and in vitro fertilization was 2–5% in 1998 and 1999. Strategies used to decrease the rate of high-order multiple gestations varied among practitioners. Informed consent regarding high-order multiple gestations was provided by 99.5% of practitioners. Information regarding selective reduction was provided by 98.3% of respondents. Over 90% of practitioners believed it is worthwhile to attempt to decrease the risk of high-order pregnancies at the risk of decreasing their group’s overall pregnancy rates.

CONCLUSION: Most reproductive endocrinologists reported concern over the rising risk of high-order multiple gestations resulting from therapies such as superovulation with intrauterine insemination or in vitro fertilization. However, the ways in which patients are counseled regarding such events, their sequelae, and methods to avoid them greatly differ among respondents. Given the inconsistent practice patterns, a multifaceted educational approach may provide an opportunity to reduce the incidence of high-order multiple gestations and their sequelae.

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