ABSTRACT
The first successful pregnancy after in vitro fertilization (IVF)1 initiated an unforeseen increase in both private and public clinics treating fertility. The ability to stimulate women so that a greater number of eggs could be obtained led to a second major breakthrough in the field of IVF.2 This second achievement however, generated a further problem in IVF as it meant that each couple was more likely to have more embryos at their disposal. Although freezing the embryos was a viable option,3 the preferred choice in many clinics was to transfer an increased number of embryos, hence increasing the chances of infertile couples to achieve pregnancy. This has led to one of the major criticisms of IVF treatment in that it leads to a recognized increase in multiple pregnancy.4 The dangers of multiple pregnancy for the mother and children are extremely high. In a number of countries these dangers have been allayed by legally restricting the number of embryos that it is possible to transfer. For example, in the United Kingdom (UK) the Human Fertilisation and Embryology Authority (HFEA) has restricted the number of transferred embryos to a maximum of three. In the UK and in some other countries there is already discussion to restrict the number of embryos transferred to two, and the transfer of only a single embryo is already being attempted by some clinics.5 In many other countries no legal restriction is in place, and the onus is on individual clinics to decrease the number of embryos transferred so that they achieve a balance between the dangers of multiple pregnancy with a perceived decline in overall pregnancy rates. Further pressures have now come into play in that health insurance companies have realized that the financial costs of supporting infants born from multiple pregnancies after IVF are in many cases higher than the cost of supporting IVF.6 In this case the health insurers may choose not to support clinics that maintain a high multiple pregnancy rate and will only support clinics transferring low numbers of embryos. The current indications are that in the future we will be compelled by a legal, financial, or moral
obligation to restrict the number of embryos transferred to minimize the risk of multiple pregnancy. This situation leads to fears that there will be a concurrent decline in pregnancy rates for many clinics.
