“I couldn't think that far”: Infertile women's decision making about multifetal reduction
Corresponding Author
Kate Sullivan Collopy
University of New Hampshire, Durham, NH
Assistant Professor.
Department of Nursing, University of New Hampshire, 257 Hewitt Hall, Durham, NH 03824.Search for more papers by this authorCorresponding Author
Kate Sullivan Collopy
University of New Hampshire, Durham, NH
Assistant Professor.
Department of Nursing, University of New Hampshire, 257 Hewitt Hall, Durham, NH 03824.Search for more papers by this authorAbstract
In this phenomenological study women's experiences regarding their decisions to undergo or forgo multifetal reduction of their higher-order multiple pregnancies were explored. Seven women who had conceived higher-order multiple pregnancies as the result of in vitro fertilization were interviewed. Four participants accepted reduction, whereas three participants declined. Three themes were discerned: (a) the presence of infertility as a barrier to contemplating hyperfertility; (b) multiple-birth pregnancy as yet another form of loss for infertile women; and (c) the lasting effects of having made the decision. © 2004 Wiley Periodicals, Inc. Res Nurs Health 27:75–86, 2004
REFERENCES
- Albrecht, J.L., & Tomich, P.G. (1996). The maternal and neonatal outcome of triplet gestations. American Journal of Obstetrics and Gynecology, 174, 1551–1556.
- Alexander, G.R., Kogan, M., Martin, J., & Papiernik, E. (1998). What are the fetal growth patterns of singletons, twins, and triplets in the United States? Clinical Obstetrics and Gynecology, 41, 115–125.
- American Society for Reproductive Medicine. (1997). Patient's fact sheet: Infertility. Birmingham, AL: Author.
- Becker, G., & Nachtigall, R.D. (1994). ‘Born to be a mother’: The cultural construction of risk in infertility treatment in the U.S. Social Science & Medicine, 39, 507–518.
- Bergh, C., Moller, A., Nilsson, L., & Wikland, M. (1999). Obstetric outcome and psychological follow-up of pregnancies after embryo reduction. Human Reproduction, 14, 2170–2175.
- Blickstein, I. (2002). Spontaneous and induced triplets. In L.G. Keith, & I. Blickstein (Eds.), Triplet pregnancies and their consequences (pp. 9–16). London: Parthenon.
- Blickstein, I., & Keith, L.G. (2001). The spectrum of iatrogenic multiple pregnancy. In I. Blickstein, & L.G. Keith (Eds.), Iatrogenic multiple pregnancy: Clinical implications (pp. 1–8). London: Parthenon.
- Britt, D.W., Mans, M., Risinger, S.T., & Evans, M.I. (2001). Bonding and coping with loss: Examining the construction of an intervention for multifetal pregnancy reduction procedures. Fetal Diagnosis and Therapy, 16, 158–165.
- Brkovich, A.M., & Fisher, W.A. (1998). Psychological distress and infertility: Forty years of research. Journal of Psychosomatic Obstetrics and Gynaecology, 19, 218–228.
- Bryan, E. (2002). Loss in higher multiple pregnancy and multifetal pregnancy reduction. Twin Research, 5, 169–174.
- Centers for Disease Control and Prevention. (2002). Use of Assisted Reproductive Technology—United States, 1996 and 1998. MMWR Weekly, 51(5), 97–101.
-
Daniluk, J.C.
(2001).
“If we had it to do over again …”: Couples' reflections on their experiences of infertility treatments.
The Family Journal: Counseling & Therapy for Couples & Families,
9,
122–133.
10.1177/1066480701092006 Google Scholar
- Domar, A.D., Clapp, D., Slawsby, E.A., Dusek, J., Kessel, B., & Freizinger, M. (2000). Impact of group psychological interventions on pregnancy rates in infertile women. Fertility & Sterility, 73, 805–812.
- Domar, A.D., Friedman, R., & Zuttermeister, P.C. (1999). Distress and conception in infertile women: A complementary approach. Journal of the American Medical Women's Association, 54, 196–198.
- Elster, N. (2000). Less is more: The risks of multiple births. Fertility & Sterility, 74, 617–623.
- Evans, M.I., Littmann, L., St Louis, L., LeBlanc, L., Addis, J., Johnson, M.P., et al. (1995). Evolving patterns of iatrogenic multifetal pregnancy generation: implications for aggressiveness of infertility treatments. American Journal of Obstetrics and Gynecology, 172, 1750–1753; discussion 1753–1755.
- Evans, M.I., May, M., Drugan, A., Fletcher, J.C., Johnson, M.P., & Sokol, R.J. (1990). Selective termination: Clinical experience and residual risks. American Journal of Obstetrics and Gynecology, 162, 1568–1572; discussion 1572–1575.
- Garel, M., Stark, C., Blondel, B., Lefebvre, G., Vauthier-Brouzes, D., & Zorn, J.R. (1997). Psychological reactions after multifetal pregnancy reduction: A 2-year follow-up study. Human Reproduction, 12, 617–622.
- Gleicher, N., Campbell, D.P., Chan, C.L., Karande, V., Rao, R., Balin, M., et al. ( 1995). The desire for multiple births in couples with infertility problems contradicts present practice patterns. Human Reproduction, 10, 1079–1084.
- Godwin, Y. (2000). Do they listen? A review of information retained by patients following consent for reduction mammoplasty. British Journal of Plastic Surgery, 53, 121–125.
- Goldfarb, J., Kinzer, D.J., Boyle, M., & Kurit, D. (1996). Attitudes of in vitro fertilization and intrauterine insemination couples toward multiple gestation pregnancy and multifetal pregnancy reduction. Fertility & Sterility, 65, 815–820.
- Greil, A.L. (1997). Infertility and psychological distress: A critical review of the literature. Social Science & Medicine, 45, 1679–1704.
- Grobman, W.A., Milad, M.P., Stout, J., & Klock, S.C. (2001). Patient perceptions of multiple gestations: an assessment of knowledge and risk aversion. American Journal of Obstetrics and Gynecology, 185, 920–924.
- Harris, B.G., Sandelowski, M., & Holditch-Davis, D. (1991). Infertility … and new interpretations of pregnancy loss. MCN: The American Journal of Maternal Child Nursing, 16, 217–220.
- Hart, V.A. (2002). Infertility and the role of psychotherapy. Issues in Mental Health Nursing, 23(1), 31–41.
- Imeson, M., & McMurray, A. (1996). Couples' experiences of infertility: A phenomenological study. Journal of Advanced Nursing, 24, 1014–1022.
- Jones, H.W., & Schnorr, J.A. (2001). Risks of multiple pregnancy—The decision belongs to whom? Fertility & Sterility, 76, 424–425.
- Kanhai, H.H., de Haan, M., van Zanten, L.A., Geerinck-Vercammen, C., van der Ploeg, H.M., & Gravenhorst, J.B. (1994). Follow-up of pregnancies, infants, and families after multifetal pregnancy reduction. Fertility & Sterility, 62, 955–959.
- Keith, L.G., & Oleszczuk, J.J. (2002). Triplet births in the United States: An epidemic of high-risk pregnancies. Journal of Reproductive Medicine, 47, 259–265.
-
Kelly-Powell, M.L.
(1997).
Personalizing choices: Patients' experiences with making treatment decisions.
Research in Nursing & Health,
20,
219–227.
10.1002/(SICI)1098-240X(199706)20:3<219::AID-NUR5>3.0.CO;2-L CAS PubMed Web of Science® Google Scholar
-
Krueger, N.,
Zakowski, S.G.,
Kwak-Kim, J.,
Beer, A.E., &
Halverson, G.
(2000).
Distress and social constraints on emotional expression in women diagnosed with fertility problems.
Fertility & Sterility,
74(3[Suppl1]),
S23.
10.1016/S0015-0282(00)00787-1 Google Scholar
- Lembet, A., Selam, B., Gaddipati, S., Berkowitz, R.L., & Salafia, C.M. (2001). Shortened gestational age following multifetal pregnancy reduction: can chronic placental inflammation be the explanation? Journal of Maternal-Fetal Medicine, 10, 149–154.
-
Lincoln, Y.S., &
Guba, E.G.
(1985).
Naturalistic inquiry.
Beverly Hills, CA: Sage.
10.1016/0147-1767(85)90062-8 Google Scholar
- Lukse, M.P., & Vacc, N.A. (1999). Grief, depression, and coping in women undergoing infertility treatment. Obstetrics and Gynecology, 93, 245–251.
- Madsen, P. (2001). Risks of multiple pregnancy—The decision belongs to whom? [Letter]. Fertility & Sterility, 76, 424.
- Maifeld, M., Hahn, S., Titler, M.G., & Mullen, M. (2003). Decision-making regarding multifetal pregnancy reduction. JOGNN: Journal of Obstetrical, Gynecologic, Neonatal Nursing, 32, 357–369.
- Martin, J.A., MacDorman, M.F., & Mathews, T.J. (1997). Triplet births: Trends and outcomes, 1971–94. Vital Health Statistics 21(55), 1–20.
- Maxwell, V.A. (1992). Understanding and validity in qualitative research. Harvard Educational Review, 62, 279–300.
- McKinney, M., Downey, J., & Timor-Tritsch, I. (1995). The psychological effects of multifetal pregnancy reduction. Fertility & Sterility, 64, 51–61.
- McKinney, M., & Leary, K. (1999). Integrating quantitative and qualitative methods to study multifetal pregnancy reduction. Journal of Women's Health, 8, 259–268.
- McKinney, M.K., Tuber, S.B., & Downey, J.I. (1996). Multifetal pregnancy reduction: Psychodynamic implications. Psychiatry, 59, 393–407.
- McNeil, B.J., Pauker, S.G., Sox, H.C., & Tversky, A. (1982). On the elicitation of preferences for alternative therapies. New England Journal of Medicine, 306, 1259–1262.
- Miller, V.L., Ransom, S.B., Shalhoub, A., Sokol, R.J., & Evans, M.I. (2000). Multifetal pregnancy reduction: Perinatal and fiscal outcomes. American Journal of Obstetrics and Gynecology, 182, 1575–1580.
- Millstein, S.G., Katz, P., & Pasch, L. (2002). Deciding about IVF: What's important to infertile couples? Fertility & Sterility 78, S27.
- Munhall, P.L. (1994). Revisioning phenomenology: Nursing and health science research. New York: National League for Nursing Press.
- Nachtigall, R.D., Becker, G., & Wozny, M. (1992). The effects of gender-specific diagnosis on men's and women's response to infertility. Fertility & Sterility, 57, 113–121.
- Norwitz, E.R., & Vidaeff, A.C. (1997). Controversies in multiple gestation. Contemporary OB/GYN, 42(12), 54–88.
- Olshansky, E.F. (1990). Psychosocial implications of pregnancy after infertility. NAACOG's Clinical Issues in Perinatal and Women's Health Nursing, 1, 342–347.
- Sandelowski, M. (1988). A case of conflicting paradigms: Nursing and reproductive technology. ANS: Advances in Nursing Science, 10(3), 35–45.
- Sandelowski, M. (1993a). Rigor or rigor mortis: The problem of rigor in qualitative research revisited. ANS: Advances in Nursing Science, 16(2), 1–8.
-
Sandelowski, M.
(1993b).
With child in mind: Studies of the personal encounter with infertility.
Philadelphia: University of Pennsylvania Press.
10.9783/9781512806779 Google Scholar
- Schreiner-Engel, P., Walther, V.N., Mindes, J., Lynch, L., & Berkowitz, R.L. (1995). First-trimester multifetal pregnancy reduction: Acute and persistent psychologic reactions. American Journal of Obstetrics and Gynecology, 172, 541–547.
- Seifer, D.B., Dodson, W.C., Reindollar, R.H., & Santoro, N.F. (2001). Strategies to prevent multiple pregnancy during infertility treatment. Contemporary OB/GYN 46(2), 57–58, 61–62, 64 passim.
- Senat, M.V., Ancel, P.Y., Bouvier-Colle, M.H., & Breart, G. (1998). How does multiple pregnancy affect maternal mortality and morbidity? Clinical Obstetrics and Gynecology, 41, 79–83.
- Souter, I., & Goodwin, T.M. (1998). Decision making in multifetal pregnancy reduction for triplets. American Journal of Perinatology, 15, 63–71.
- Suri, K., Bhandari, V., Lerer, T., Rosenkrantz, T.S., & Hussain, N. (2001). Morbidity and mortality of preterm twins and higher-order multiple births. Journal of Perinatology, 21, 293–299.
- Tabsh, K.M. (1993). A report of 131 cases of multifetal pregnancy reduction. Obstetrics and Gynecology, 82(1), 57–60.
- Van Manen, M. (1990). Researching lived experience: Human science for an action sensitive pedagogy. New York: State University of New York Press.
- Vauthier-Brouzes, D., & Lefebvre, G. (1992). Selective reduction in multifetal pregnancies: technical and psychological aspects. Fertility & Sterility, 57, 1012–1016.
- Zoldbrod, A.P. (1993). Men, women, and infertility: Intervention and treatment strategies. Lexington, MA: Lexington Books.