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nancy rates did not differ. Twin pregnancies were reduced from 19 percent to 3 percent (Gordts et al., 2005).

Stricter guidelines on the number of embryos transferred should be emphasized by a number of U.S. professional organizations and not just ASRM. Similar best-practice guidelines should be outlined for other infertility treatments that use ARTs, such as ovulation induction. Such guidelines should recommend the use of strict ultrasound guidance and abandonment of a cycle if too many follicles develop. Policy makers should mandate the more systematic collection of data on such procedures and should also consider recommending the use of medication to stimulate egg production. Professional organizations and surveillance activities should redefine success as singleton live births (rather than pregnancy rates). Efforts to reeducate ART consumers on the risks of multiple gestation and preterm birth must transpire simultaneously. Other policies regarding access to assisted reproduction should also be further explored.

Access to reproductive health care and reproductive technology may be a double-edged sword when it comes to ARTs. States with legally mandated coverage for infertility treatment, including ARTs, were the states with the highest rates of ART procedures per million population (Massachusetts, New Jersey, Maryland, the District of Columbia, and Rhode Island) (CDC, 2002b). In Massachusetts, a rise in the state’s rate of multiple births can be directly linked to mandated insurance coverage of infertility services (CDC, 1999a). Sweden and Belgium exemplify a contrasting approach, with public funding limited to the coverage of only SET cycles, thus freeing infertile couples from the financial pressure to transfer as many embryos as possible.

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