Multiple pregnancies after assisted reproduction--international comparison

Area of Science:

• Reproductive Medicine
• Public Health

Background:

• High incidence of multiple pregnancies is a global concern, particularly high-order multiples, considered adverse events.
• Assisted reproductive technology (ART) contributes significantly to multiple births worldwide.

Purpose of the Study:

• To analyze trends in multiple births resulting from ART in Europe and the US.
• To evaluate the impact of new strategies and regulations on multiple pregnancy rates.

Main Methods:

• Comparative analysis of multiple birth rates across different countries and regions.
• Review of data on the effectiveness of elective single embryo transfer (eSET).
• Assessment of the influence of legal and financial regulations on ART practices.

Main Results:

• Multiple births, especially triplets from ART, are declining in Europe, with countries like Finland and Sweden pioneering eSET.
• Elective single embryo transfer significantly reduces high-order multiples while maintaining high pregnancy rates.
• The US has a higher incidence of multiple births post-ART (54%) compared to Europe's declining rates (33%).
• In Germany, legal and financial regulations led to fewer ART treatments but did not increase multiple birth rates.

Conclusions:

• Elective single embryo transfer is an effective strategy to reduce high-order multiple births in ART.
• Regulatory frameworks can influence ART utilization and outcomes, but careful implementation is needed to manage multiple pregnancy rates.
• Continued monitoring and adoption of safer ART practices are crucial globally to mitigate risks associated with multiple pregnancies.