Funding and public reporting strategies for reducing multiple pregnancy from fertility treatments

Single-embryo transfer is preferable on clinical and cost-effectiveness grounds. However, multiple birth rates remain unacceptably high owing to inadequate funding and simplistic focus on birth rate as a best measure of clinic quality.

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VOLUME 114, ISSUE 4, P715-721


Georgina M. Chambers, Ph.D., Elena Keller, M.H.Econ., Stephanie Choi, Ph.D., Yakoub Khalaf, M.D., Sara Crawford, Ph.D., Willings Botha, Ph.D., William Ledger, F.R.A.N.Z.C.O.G., C.R.E.I.


The health of children born through assisted reproductive technologies (ART) is particularly vulnerable to policy decisions and market forces that play out before they are even conceived. ART treatment is costly, and public and third-party funding varies significantly between and within countries, leading to considerable variation in consumer affordability globally. These relative cost differences affect not only who can afford to access ART treatment, but also how ART is practiced in terms of embryo transfer practices, with less affordable treatment creating a financial incentive to transfer more than one embryo to maximize the pregnancy rates in fewer cycles. One mechanism for reducing the burden of excessive multiple pregnancies is to link insurance coverage to the number of embryos that can be transferred; another is to combine supportive funding with patient and clinician education and public reporting that emphasizes a “complete” ART cycle (all embryo transfers associated with an egg retrieval) and penalizes multiple embryo transfers. Improving funding for fertility services in a way that respects clinician and patient autonomy and allows patients to undertake a sufficient number of cycles to minimize moral hazard improves outcomes for mothers and babies while reducing the long-term economic burden associated with fertility treatments.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.