To the Editor The Chambers et al1 study recently published in JAMA Pediatrics assesses the financial burden associated with multiple births and concludes that the increased use of single-embryo transfer during in vitro fertilization (IVF) could significantly reduce health care costs, not to mention morbidity and mortality. We cannot agree more. However, as we found in our ethical and policy analysis of the relationship between fertility treatment and multiple births,2 clinicians and patients in the United States are under considerable financial pressure to eschew single-embryo transfer. These pressures are primarily the result of decisions by insurers, employers, and state governments to exclude many fertility treatments, particularly IVF, from insurance plans.
Johnston J, Gusmano MK, Patrizio P. Reducing Rate of Fertility Multiples Requires Policy Changes. JAMA Pediatr. 2015;169(3):287. doi:10.1001/jamapediatrics.2014.3219