An overview of temporal trends in multiple births after assisted reproductive technology in the USA

Abstract

Transfer of multiple embryos for IVF was an early and important advance to improve procedure effectiveness. Along with the increase in live birth rate, this advance resulted in a three-decade long battle to counteract high rates of multiple delivery that have accompanied multiple embryo transfer. This review chronicles the history of the struggle in the USA to reduce the number of embryos transferred and the multiple births that resulted from this practice while continuing to strive for high live birth delivery rates in young as well as older patients. The positive and negative influences of law, professional guidelines, inadequate medical insurance and patient preference are discussed. Recent reporting strategies and technical advances in embryo selection that can help us achieve single embryo transfer are reviewed.