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The influence of assisted reproductive technologies on obstetric and perinatal outcomes: the chicken, the egg, or both?

      Safety and efficacy have been the overriding concerns for the assisted reproductive technologies (ART) since their inception over 40 years ago. Adverse obstetric and perinatal outcomes were recognized as inherent risks early on, but much of this excess risk stemmed from the high multiple pregnancy rates attributed to ART. With the advent of successful single embryo transfer (SET), that risk was substantially mitigated, and with significant improvements in pregnancy rates with SET, largely due to advances in the laboratory, it now is feasible to contemporaneously assess the true risk of ART more precisely with smaller populations of patients in a shorter timeframe. An unresolved question is how much of the recognized additional maternal and neonatal risk is due to the technology itself vs. the underlying risk conferred with the diagnosis of infertility.
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