Reduction of multiple pregnancy in ART

It has been recognized that multiple pregnancy is associated with the increase risks to both maternal and newborn compared to singleton pregnancy. High incidence of premature birth complicated in the multiple pregnancy not only result in the high neonatal morbidity and mortality rate but also consume a high financial cost for the intensive neonatal care and may end up with the long-term childhood neurological handicaps. With the modern infertility treatment including ovarian hyperstimulation and assisted reproduction, on one hand has been resulted in a successful pregnancy rate but on the other hand has been consistency reported of the high incidence of multiple pregnancy especially high-order fetal pregnancy. The only way to prevent multiple pregnancy occurring from the infertility treatment is to induce monofollicular ovulation in non-IVF cycle and to do single embryo transfer in the IVF cycle but these have to be done without compromising the pregnancy rate. To achieve this goal, optimal IVF lab has to be developed which include optimal in vitro embryo culture system, effective embryo selection from the embryo pool for transfer and the efficiency of the cryopreservation of the surplus embryo for frozen-thaw cycle to augment the cumulative pregnancy rate. The doctor's responsibility to give information of the neonatal risk and cost of the multiple pregnancy, the patient's knowledge and attitude on the risks of multi-fetal pregnancy and the guideline for the ART practice are also essential to bring down the multiple births occurring from the treatment of the infertility.