Assisted reproductive technologies are expensive. One IVF procedure costs an average of $12,000 and up to $15,000, and more than one attempt is often needed. Donor eggs or sperm, ICSI, and any other additional procedures add to the cost (Gurevich, 2011).

Preliminary research on single births has found a twofold increase in heart prob­lems, cleft lip and palate, and abnormalities in the esophagus or rectum in infants con­ceived with IVF compared to infants conceived naturally. However, since these birth defects are rare to begin with, this increase is small. For example, in the United States cleft lip typically occurs in one out of 950 births, whereas the risk for infants conceived with IVF is one in 425 (Reefhuis et al., 2008).

Multiple embryos are usually implanted during IVF to increase the chances of con­ception (Roberts et al., 2011). Consequently, the twin birth rate rose by 76% from 1980 to 2009. In 1980, one in every 53 babies was a twin, compared to one in every 30 in 2009. One third of the increase is attributed to more women having babies later in life instead of IVF (Martin et al., 2012). The triplet-or-more birth rate increased by 380% during a similar period (Martin et al., 2009). Any multiple pregnancy increases the danger to babies, with greater incidence of prenatal and postnatal death, prematurity, low birth weight, and birth defects (Wadhawan et al., 2011). For mothers the risks of cesarean deliveries, high blood pressure, and other birth complications, including death, increase with multiple births (MacKay et al., 2006). In some cases one or more fetuses are removed during the pregnancy to increase the likelihood that at least one or two others will survive and be healthy (Stone et al., 2008).

The rate of multiple births following IVF decreased in the late 1990s after the American Society for Reproductive Medicine published guidelines for reducing the number of multiple births (Martin et al., 2009). Other countries have strict regulations: Some European countries have laws instead of guidelines limiting IVF to one or two embryos (Gibbs, 2008).