JESS Seminar: IVF, multiple births and birth quality: analysis of a reform in Sweden

The use of in vitro fertilization (IVF) has rapidly increased worldwide with rates exceeding 4% of all births in several industrialized countries. IVF has the advantages of assisting involuntary infertility and enabling women to postpone childbearing. However IVF children tend to exhibit poorer health at birth, resulting in large costs for individuals as well as health care systems. An important reason for this is that IVF births are massively more likely to be multiple births because common practice has involved multiple embryo transfers, thought to enhance the rate of successful pregnancies. However, following recent technological advances, success rates appear to no longer rely on multiple embryo transfers. In 2003, Sweden mandated that single embryo transfers (SET) become the default IVF procedure. We analyse birth outcomes as a function of this reform. Using Swedish register data for 1995-2010, we find that the reform was associated with a precipitous drop in multiple births of 65 % points and significant improvements in an array of child and maternal health outcomes, which narrowed the difference between IVF and non-IVF births by between 54 and 57 % points.