To explore how the individuals within an infertile couple differ from one another in their attitudes toward the conception of twin gestations. From November 1999 through February 2000, consecutive couples undergoing treatment at a university-based infertility clinic were invited to participate in a face-to-face interview that ascertained their individual desires for singleton and twin gestations and their perception of the risks associated with these pregnancies. Of the 94 couples approached, 90 (96%) agreed to participate in the study. Patients estimated the incidence of prematurity, low birth weight, preeclampsia, and postpartum depression in twin gestations to be significantly greater than their partners did (27% versus 17%, 26% versus 17%, 22% versus 16%, and 21% versus 16%, respectively). Despite these higher estimates, the desire for a twin gestation was similar. In 19 couples (21%), the patient and partner did not agree whether a singleton or twin pregnancy was the most preferred outcome. No predictive factor for this discordance could be identified. Women undergoing infertility treatment are less risk averse than their partners. Additionally, a sizeable portion of couples do not align in their preference for a twin gestation. These differences should be recognized and addressed during the preconceptional period.