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ART, assisted reproductive technolgy, infertility, multiple gestation, pregnancy, costs


Please note that the copyright in the Harvard Journal of Law & Gender is held by the President and Fellows of Harvard College, and that the copyright in the article is held by the author.


The United States, unlike most developed countries, does not regulate its fertility industry. Rather, it vests control over the industry to professional organizations and to market forces. While lack of regulation has produced a vibrant market for fertility services, it has also produced an undesirable consequence: a high rate of multiple gestation pregnancies, including twin pregnancies. This Article summarizes the data on the medical, psychological, and financial costs associated with multiple pregnancies to the parents, the children, and American society. It suggests that the current U.S. regulatory regime has not only failed to address these costs as they surfaced but may also have aggravated the problem. It compares the U.S. regime to approaches taken in Europe to reduce the rate of multiple gestation pregnancies and suggests that governmental intervention may be necessary. Finally, the Article proposes that regulation to improve reporting, disclosure, and clinic supervision, combined with more strictly enforced embryo transfer practices would reduce the costs of multiple births without impermissibly burdening the freedom to procreate. This proposed regulation is not only desirable, but it would also likely pass constitutional muster.

Publication Citation

32 Harvard Journal of Law and Gender, 463 (2009).


Health Law and Policy | Law and Gender