Infertility clinics are doing a better job helping couples have children, and overcoming some of the problems that accompanied the creation of so-called test-tube babies. Doctor Alan Munson says Iowa has three facilities that offer “assisted reproduction,” the University of Iowa, McFarland Clinic in Ames, and its branch clinic in West Des Moines.The initial impetus was that they achieve the highest possible pregnancy rate, and early on when that rate tended to be low the doctors would use one, two or more embryos. Often the process failed and doctors and their patients were happy if even one implanted embryo produced a successful pregnancy. And then as science and the quality of embryos improved, the number increased, and there were more twins, triplets, even quads and the occasional quintuplet. While we see multiple pregnancies in the news, Dr. Munson says the successful ones are rare and many involve serious complications. When you go beyond twins, the neonatal mortality rate goes much higher, and even if they don’t die before or after birth, premature birth is common in triplets or more, requiring long hospitals stays and bills of 150- to 100-thousand dollars. But improving technology has brought doctors another benefit — fertilized test-tube embryos more likely to implant, survive and grow, which means they can use fewer for each case. Dr. Munson says that’s meant fewer multiple pregnancies.His estimate that there hasn’t been more than twins born to a couple in a couple of years, out of perhaps 100 IVF or in-vitro fertilization pregnancies in that time, though he says the perfect case would be to have zero sets of triplets, and all pregnancies a “singleton” — just one baby per mother at a time. When there are too many to successfully carry to term, parents must make a heartbreaking choice to risk miscarriage of them all, or to use “selective reduction” to remove some of the developing embryos from the womb. The new national report on I-V-F, and Iowa’s clinic results, mean that choice does not have to be made.