Background: Although multiple births are associated with poorer clinical and psychological outcomes, there isa perception that couples choose multiple embryo transfer because they would prefer a multiple IVF birth. Objective :To review literature concerning the attitudes of infertile couples to a multiple birth and to explore factorsinfluencing couples decisions about embryo transfer. Methods: Thirteen research articles were identified in the medical literature that examined womens choices concerningmultiple IVF pregnancies. A cross-sectional survey was conducted at one centre for the treatment of infertility in the EastMidlands, UK. Sixty-eight couples undergoing in-vitro fertilisation (IVF) with at least two embryos available for transferwere recruited to the study. Outcome measures were couples ratings of factors influencing the number of embryostransferred. Results: Eight of the 13 studies found couples favouring a multiple birth to be in the majority. Most studies, however, hadrequired hypothetical or retrospective judgments. In the present survey no patient had chosen single embryo transfer(SET), 56 (76%) had had 2 embryos transferred and 16 (24%) had 3 embryos transferred. Patients strongly perceived thatSET would reduce the chances of having a child. Only 13 women (19.1%) considered that a desire for twins hadinfluenced their decision. Of more importance was the desire to increase the chance of pregnancy (92.7%), the medicaladvice received (91%) and a desire to avoid further treatment (57.3%). The majority of couples found the decisionregarding embryo transfer easy but a third would have liked more information. Participants with children were less likelyto report a desire for twins (p < 0.06) but other demographic factors had no influence. Conclusions: Although the literature has suggested that infertile couples have strongly positive attitudes to multiplepregnancies, most patients are not seeking a twin birth when they choose multiple embryo transfer and physicians have animportant role to play in helping patients make informed decisions.