Multiple pregnancies after assisted reproduction--international comparison.

The high incidence of multiple pregnancies after application of techniques for assisted reproduction is a phenomenon of major concern worldwide. High order multiples in particular have to be regarded as a serious adverse event. However, data show that in Europe, although the situation varies from country to country, multiple births, especially triplet births, as consequence of assisted reproductive technology are on the decline. New strategies such as elective single embryo transfer, emphasized especially by Finland and Sweden, open up new pathways towards safer treatments, reducing the incidence of high order multiples to almost zero while maintaining high pregnancy rates. Compared with Europe, in the US, more than half of all children delivered after assisted reproduction are multiples. While an incidence of 33% of multiple births may seem to be acceptable, an incidence of 54% of children born as multiples, moreover high order multiples, is certainly not. The enormous impact of legal and financial regulations on the attitude of physicians and patients regarding assisted reproduction can be observed at the moment in Germany, with a dramatic decline in number of treatments. However, the incidence of multiples has not increased.