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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In his Clinical Crossroads article, Dr Stillman¹ discusses a patient with infertility who desires a twin pregnancy. He details the medical concerns for the patient and for future offspring. On a population level, multiple gestations associated with assisted reproductive technologies (ARTs) have also become a significant public health concern.

Although ARTs account for about 1% of US births, they account for a disproportionate share of twins (12%) and higher-order multiples (42.5%),² with these proportions even higher with increasing maternal age. The absolute number of twin births has doubled since 1980, with more than half of twin deliveries occurring before term and roughly 12% occurring before 32 weeks.³ Preterm birth is not only a persistent problem in the United States but is increasing in frequency, with an incidence of 12.5% in 2004,⁴ and ART-associated multiple births contribute to this increase.

Stillman makes recommendations for medical care and health . . . [Full Text of this Article]

Wendy Chavkin, MD, MPH
wc9@columbia.edu
Mailman School of Public Health
Columbia University
New York, NY

Blair Johnson, MD
Division of Maternal Fetal Medicine
Department of Obstetrics and Gynecology
Columbia Presbyterian Medical Center
New York, NY

RELATED LETTER

Older Age, Infertility, and Multiple Pregnancies—Reply
Robert J. Stillman
JAMA. 2007;297(22):2480.
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RELATED ARTICLE

A 47-Year-Old Woman With Fertility Problems Who Desires a Multiple Pregnancy
Robert J. Stillman
JAMA. 2007;297(8):858-867.
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