Effect of mood states and infertility stress on patients' attitudes toward embryo transfer and multiple pregnancy

ObjectiveTo examine whether mood state or infertility stress influences perceptions of risk, preferences for embryo transfer, or views on multiple pregnancy.DesignObservational cohort study.SettingHospital-based fertility clinic.Patient(s)One hundred seventy-six women participating in IVF treatment.Intervention(s)None.Main Outcome Measure(s)Mood scores, ratings of risk, preference for multiple embryo transfer, and attitudes toward multiple pregnancy.Result(s)Growing feelings of tension across the cycle corresponded with increases in the perceived riskiness of double-embryo transfer, but there was no change in strength of transfer preferences. Women experiencing negative moods, such as depression, viewed twin and triplet pregnancy as less likely, whereas increasing positive feelings across the cycle were associated with increasing desire for twin pregnancy. Overall, women perceived double- and triple-embryo transfer as less risky by cycle end than at cycle beginning and felt more certain about multiple-embryo transfer.Conclusion(s)The dyssynchrony observed among changes in mood, perceptions of risk, and transfer preferences challenges assumptions about the way medical risk information influences transfer preferences, and the findings suggest that mood states experienced during an IVF cycle might affect transfer preferences by influencing attitudes toward multiple pregnancy. Additional considerations beyond providing risk information are needed to facilitate effective patient decision making.