title: Assisted reproductive technology-related multiple births: Canada in an international context.
abstract: OBJECTIVE
  It has been well-documented that the use of assisted reproductive technology (ART) increases the risk for multiple births, which are associated with sub-optimal outcomes for pregnant women and their offspring. The occurrence of multiple births due to infertility treatments has been recognized as a significant problem globally, and a number of countries have developed approaches, policies, statutes, and regulations geared to decreasing the rates of multiple births as a result of ART. This review was designed to explore Canada's position in the international context of ART-related multiple births and to examine the strategies of other countries intended to decrease rates of multiple pregnancy.
  
  
  METHODS
  Data were obtained from publicly available data sources from 21 countries, including Canada, and comparisons were made between pregnancy rates, percentages of live births, percentages of multiple births, numbers of embryos transferred, and governing guidelines and policies.
  
  
  RESULTS
  Canada has one of the highest ART-related multiple-birth rates, and the number of embryos transferred per cycle plays an important role in this. Cooperation among stakeholders in the development of approaches and guidelines is essential for preventing multiple births due to infertility treatments.
  
  
  CONCLUSIONS
  In order effectively to reduce the multiple-birth rate in Canada, it is important to learn from the experiences of other countries, taking the Canadian context into consideration.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.
authors.forename: Jocelynn L
authors.initials: JL
authors.lastname: Cook
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton ON.
authors.forename: John
authors.initials: J
authors.lastname: Collins
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal QC.
authors.forename: William
authors.initials: W
authors.lastname: Buckett
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston MA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Racowsky
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton ON.
authors.forename: Edward
authors.initials: E
authors.lastname: Hughes
authors.affiliation: Department of Urology, Mount Sinai Hospital, Toronto ON.
authors.forename: Keith
authors.initials: K
authors.lastname: Jarvi
mesh_terms: D002170:Canada; D004624:Embryo Transfer / Q000706:statistics & numerical data; D005260:Female; D014943:Global Health; D006291:Health Policy; D006801:Humans; D007391:International Cooperation; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data*; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*