The main goal of this thesis is the analysis of multiple-births in Czech Republic between the years of 1950 and 2005 including the international comparison and assess of the influence of assisted reproduction on occurrence of multiple-births. The thesis is divided into five different parts. The first part is dedicated to the analysis of fertility according to a succession of births in Czech Republic while using the indicators of total fertility, the average age of mothers in the time of childbirth and the total number of new-born babies. The second part focuses on multiple-births considering both historical and contemporary point of view and on possible risks for both the mother and the foetus. Next part describes the assisted reproduction, its history, present and commonly used methods. The fourth part is dedicated to the influence of assisted reproduction on the occurrence of multiple-births and to the analysis of multiple-births with the use of absolute and relative number of mono-births and multiple-births indicators, indicators of total fertility, masculinity index, the rate of stillborn babies and the proportion of children born outside of marriage. The last part compares the development of multiple-births within the European countries according to NIDI 1999 classification.

Introdução: O Brasil está passando por uma transição demográfica e epidemiológica, com melhorias na área da saúde. Apesar desse cenário, as taxas de baixo peso ao nascer (BPN) e a mortalidade infantil permanecem altas. O objetivo deste estudo é avaliar o impacto do uso extensivo de tecnologias, como o parto cesáreo e a concepção assistida, sobre resultados perinatais, durante os últimos 16 anos. Esse objetivo foi dividido em duas partes: (1) avaliação do impacto do aumento da taxa de parto cesáreo no BPN, de acordo com tipo de hospital (privado, público ou misto) e (2) avaliação do impacto das taxas de nascimentos múltiplos nas taxas de mortalidade infantil. Métodos: Estudo observacional de todos os nascidos vivos registrados entre 1996 e 2011, em Porto Alegre (RS). Características maternas, do parto, de assistência e do recém-nascido foram obtidas através do Sistema de Informações sobre Nascidos Vivos (SINASC). Informações sobre a mortalidade foram obtidas a partir do Sistema de Informações sobre Mortalidade (SIM), apenas no período de 1996-2010. No estudo do BPN, os nascimentos múltiplos foram excluídos. A análise de tendência foi realizada através de modelos de regressão joinpoint. A Regressão de Poisson foi utilizada para calcular o risco relativo para BPN ao longo do período, ajustado pelas covariáveis. O modelo de Equações de Estimação Generalizadas foi utilizado para avaliar o risco relativo para mortalidade infantil entre gemelares e nascimentos únicos ao longo do período, ajustado pelas covariáveis. Foi calculado o risco atribuível populacional, para avaliar o impacto dos gêmeos dizigóticos sobre taxas de mortalidade infantil (TMI) e seus componentes, taxa de mortalidade neonatal (TMN) e taxa de mortalidade pósneonatal (TMPN). Resultados: No estudo sobre baixo peso ao nascer, foram incluídos 319.597 nascidos vivos durante o período. Foi observado um aumento de 43% na cobertura do setor privado, de 14,9% em 1996 para 21,3% em 2011. As taxas de cesarianas aumentaram 52%, chegando a 86,9%, 51,0% e 37,5% em 2011, nos hospitais privados, mistos e públicos, respectivamente. As taxas de baixo peso ao nascer aumentaram significativamente nos hospitais privados e mistos, independentemente do tipo de parto. Nos hospitais públicos, diminuíram no grupo de recém-nascidos por parto cesáreo e se mantiveram estáveis para os nascidos por parto normal. Houve associação entre o aumento das taxas de cesarianas com o aumento nas taxas de baixo peso ao nascer, durante o período. Em relação aos gêmeos e à mortalidade infantil, foi observado um aumento significativo na taxa de nascimentos múltiplos, de 1,97% em 1996 para 2,45% em 2010, p<0,001, entre os quais 65% eram dizigóticos (DZ) em 2010. Houve uma redução na mortalidade infantil e seus componentes para o grupo de nascimentos únicos: a TMI caiu de 15,4‰ para 8,3‰; a TMN, de 8,3‰ para 5,04‰; e a TMPN, de 7,0‰ para 2,9‰. Entre gêmeos, essas taxas permaneceram constantes, em torno de 44‰, 33‰ e 11‰ respectivamente. Em 1996, 1,7% da TMI, 2,0% da TMN e 1,4% da TMPN podem ser atribuídos aos gêmeos DZ. Em 2010, a contribuição de gêmeos DZ subiu para 8,4% (TMI), 9,8% (TMN) e 5,7% (TMPN). Conclusão: A assistência à saúde intensa e não regulamentada fornecida pelo setor privado e as melhorias na saúde, no setor público, apresentam cenários contraditórios, sugerindo abordagens diferenciadas para esses grupos, a fim de diminuir a diferença entre as taxas de baixo peso ao nascer e a mortalidade infantil no Brasil. / Introduction: Brazil is undergoing demographic and epidemiological transitions with improvements of health care standards. Despite this scenario, low birth weight (LBW) and infant mortality (IM) rates remains elevate, mainly in more developed areas of the country. The aim of this study is to evaluate the impact of extensive use of technologies, such as cesarean section (CS) and artificial insemination rates on neonatal outcomes, during the last 16 years. At first, we will investigate the impact of the increase rate of CS in LBW, considering the changes in pattern of health insurance; and second, we will investigate the impact of multiple births in infant mortality. Methods: This is an observational study of all live births registered between 1996 and 2011, in Porto Alegre (RS). Birth weight, type of delivery, type of pregnancy (single or multiple), prenatal coverage, maternal characteristics and health care insurance according to type of hospital (private, mixed, public) were obtained from the Information System on Live Births (SINASC). Information on mortality was obtained from Information System on Mortality (SIM), only in the period of 1996 to 2010. In the study of LBW, multiple births were excluded. Trends in LBW, CS and covariates were assessed using joinpoint regression models, general and according to the type of hospital. Poisson regression was used to calculate the relative risk for LBW over the period, adjusted for covariates. Generalized Estimated Equations model was used to evaluate the relative risk for infant mortality among multiple births and sigletons, adjusted for covariates. Populational Attributable Risk was calculated to evaluate the impact of multiple births on infant mortality. Results: In the study of low birth weight, there was a total of 319,597 live births included in the analysis during the period. An intense change in the pattern of health insurance was observed with an increase of 43% in private sector coverage from 14.9% (1996) to 21.3% (2011). CS rates increased 52%, reaching 86.9%, 51.0% and 37.5% in 2011, respectively, in private, mixed and public hospitals. LBW rates increased significantly in private and mixed hospitals independently of the type of delivery. In opposition, LBW rates decreased in public hospitals for babies born by CS and remained stable for those born by vaginal delivery. Increases in CS and in prenatal coverage were associated with rising of LBW rates during the period. Reduction in the number of adolescent mothers and improvements in maternal education were the main protector factors for LBW during the period. There was a significant increase in multiple births rate from 1.97% (1996) to 2.45% (2010), p<0.001, among which 65% were dizygotic in 2010. There was a reduction in IMR and its components, in singletons: IMR fell from 15.4‰ to 8.3‰, TMN, from 8.3‰ to 5.04‰ and PNMR from 7.0‰ to 2.9‰. Between twins these rates remained constant at around 44‰, 33‰ and 11‰, respectively. In 1996, 1.7% of the infant mortality rate, 2.0% of the neonatal mortality rate 1.4% and the rate of post-neonatal mortality could be attributed to DZ twins. In 2010, the contribution of DZ twins rose to 8.4% in infant mortality, neonatal mortality 9.8% and 5.7% in the post-neonatal mortality. Conclusion: Increase in LBW was related with an intense change in patterns of health insurance associated with overuse of medical technologies. In counterpart, social improvements and increase in access to prenatal care reduced this impact in public and mixed hospitals.

Introdução: O Brasil está passando por uma transição demográfica e epidemiológica, com melhorias na área da saúde. Apesar desse cenário, as taxas de baixo peso ao nascer (BPN) e a mortalidade infantil permanecem altas. O objetivo deste estudo é avaliar o impacto do uso extensivo de tecnologias, como o parto cesáreo e a concepção assistida, sobre resultados perinatais, durante os últimos 16 anos. Esse objetivo foi dividido em duas partes: (1) avaliação do impacto do aumento da taxa de parto cesáreo no BPN, de acordo com tipo de hospital (privado, público ou misto) e (2) avaliação do impacto das taxas de nascimentos múltiplos nas taxas de mortalidade infantil. Métodos: Estudo observacional de todos os nascidos vivos registrados entre 1996 e 2011, em Porto Alegre (RS). Características maternas, do parto, de assistência e do recém-nascido foram obtidas através do Sistema de Informações sobre Nascidos Vivos (SINASC). Informações sobre a mortalidade foram obtidas a partir do Sistema de Informações sobre Mortalidade (SIM), apenas no período de 1996-2010. No estudo do BPN, os nascimentos múltiplos foram excluídos. A análise de tendência foi realizada através de modelos de regressão joinpoint. A Regressão de Poisson foi utilizada para calcular o risco relativo para BPN ao longo do período, ajustado pelas covariáveis. O modelo de Equações de Estimação Generalizadas foi utilizado para avaliar o risco relativo para mortalidade infantil entre gemelares e nascimentos únicos ao longo do período, ajustado pelas covariáveis. Foi calculado o risco atribuível populacional, para avaliar o impacto dos gêmeos dizigóticos sobre taxas de mortalidade infantil (TMI) e seus componentes, taxa de mortalidade neonatal (TMN) e taxa de mortalidade pósneonatal (TMPN). Resultados: No estudo sobre baixo peso ao nascer, foram incluídos 319.597 nascidos vivos durante o período. Foi observado um aumento de 43% na cobertura do setor privado, de 14,9% em 1996 para 21,3% em 2011. As taxas de cesarianas aumentaram 52%, chegando a 86,9%, 51,0% e 37,5% em 2011, nos hospitais privados, mistos e públicos, respectivamente. As taxas de baixo peso ao nascer aumentaram significativamente nos hospitais privados e mistos, independentemente do tipo de parto. Nos hospitais públicos, diminuíram no grupo de recém-nascidos por parto cesáreo e se mantiveram estáveis para os nascidos por parto normal. Houve associação entre o aumento das taxas de cesarianas com o aumento nas taxas de baixo peso ao nascer, durante o período. Em relação aos gêmeos e à mortalidade infantil, foi observado um aumento significativo na taxa de nascimentos múltiplos, de 1,97% em 1996 para 2,45% em 2010, p<0,001, entre os quais 65% eram dizigóticos (DZ) em 2010. Houve uma redução na mortalidade infantil e seus componentes para o grupo de nascimentos únicos: a TMI caiu de 15,4‰ para 8,3‰; a TMN, de 8,3‰ para 5,04‰; e a TMPN, de 7,0‰ para 2,9‰. Entre gêmeos, essas taxas permaneceram constantes, em torno de 44‰, 33‰ e 11‰ respectivamente. Em 1996, 1,7% da TMI, 2,0% da TMN e 1,4% da TMPN podem ser atribuídos aos gêmeos DZ. Em 2010, a contribuição de gêmeos DZ subiu para 8,4% (TMI), 9,8% (TMN) e 5,7% (TMPN). Conclusão: A assistência à saúde intensa e não regulamentada fornecida pelo setor privado e as melhorias na saúde, no setor público, apresentam cenários contraditórios, sugerindo abordagens diferenciadas para esses grupos, a fim de diminuir a diferença entre as taxas de baixo peso ao nascer e a mortalidade infantil no Brasil. / Introduction: Brazil is undergoing demographic and epidemiological transitions with improvements of health care standards. Despite this scenario, low birth weight (LBW) and infant mortality (IM) rates remains elevate, mainly in more developed areas of the country. The aim of this study is to evaluate the impact of extensive use of technologies, such as cesarean section (CS) and artificial insemination rates on neonatal outcomes, during the last 16 years. At first, we will investigate the impact of the increase rate of CS in LBW, considering the changes in pattern of health insurance; and second, we will investigate the impact of multiple births in infant mortality. Methods: This is an observational study of all live births registered between 1996 and 2011, in Porto Alegre (RS). Birth weight, type of delivery, type of pregnancy (single or multiple), prenatal coverage, maternal characteristics and health care insurance according to type of hospital (private, mixed, public) were obtained from the Information System on Live Births (SINASC). Information on mortality was obtained from Information System on Mortality (SIM), only in the period of 1996 to 2010. In the study of LBW, multiple births were excluded. Trends in LBW, CS and covariates were assessed using joinpoint regression models, general and according to the type of hospital. Poisson regression was used to calculate the relative risk for LBW over the period, adjusted for covariates. Generalized Estimated Equations model was used to evaluate the relative risk for infant mortality among multiple births and sigletons, adjusted for covariates. Populational Attributable Risk was calculated to evaluate the impact of multiple births on infant mortality. Results: In the study of low birth weight, there was a total of 319,597 live births included in the analysis during the period. An intense change in the pattern of health insurance was observed with an increase of 43% in private sector coverage from 14.9% (1996) to 21.3% (2011). CS rates increased 52%, reaching 86.9%, 51.0% and 37.5% in 2011, respectively, in private, mixed and public hospitals. LBW rates increased significantly in private and mixed hospitals independently of the type of delivery. In opposition, LBW rates decreased in public hospitals for babies born by CS and remained stable for those born by vaginal delivery. Increases in CS and in prenatal coverage were associated with rising of LBW rates during the period. Reduction in the number of adolescent mothers and improvements in maternal education were the main protector factors for LBW during the period. There was a significant increase in multiple births rate from 1.97% (1996) to 2.45% (2010), p<0.001, among which 65% were dizygotic in 2010. There was a reduction in IMR and its components, in singletons: IMR fell from 15.4‰ to 8.3‰, TMN, from 8.3‰ to 5.04‰ and PNMR from 7.0‰ to 2.9‰. Between twins these rates remained constant at around 44‰, 33‰ and 11‰, respectively. In 1996, 1.7% of the infant mortality rate, 2.0% of the neonatal mortality rate 1.4% and the rate of post-neonatal mortality could be attributed to DZ twins. In 2010, the contribution of DZ twins rose to 8.4% in infant mortality, neonatal mortality 9.8% and 5.7% in the post-neonatal mortality. Conclusion: Increase in LBW was related with an intense change in patterns of health insurance associated with overuse of medical technologies. In counterpart, social improvements and increase in access to prenatal care reduced this impact in public and mixed hospitals.

Introdução: O Brasil está passando por uma transição demográfica e epidemiológica, com melhorias na área da saúde. Apesar desse cenário, as taxas de baixo peso ao nascer (BPN) e a mortalidade infantil permanecem altas. O objetivo deste estudo é avaliar o impacto do uso extensivo de tecnologias, como o parto cesáreo e a concepção assistida, sobre resultados perinatais, durante os últimos 16 anos. Esse objetivo foi dividido em duas partes: (1) avaliação do impacto do aumento da taxa de parto cesáreo no BPN, de acordo com tipo de hospital (privado, público ou misto) e (2) avaliação do impacto das taxas de nascimentos múltiplos nas taxas de mortalidade infantil. Métodos: Estudo observacional de todos os nascidos vivos registrados entre 1996 e 2011, em Porto Alegre (RS). Características maternas, do parto, de assistência e do recém-nascido foram obtidas através do Sistema de Informações sobre Nascidos Vivos (SINASC). Informações sobre a mortalidade foram obtidas a partir do Sistema de Informações sobre Mortalidade (SIM), apenas no período de 1996-2010. No estudo do BPN, os nascimentos múltiplos foram excluídos. A análise de tendência foi realizada através de modelos de regressão joinpoint. A Regressão de Poisson foi utilizada para calcular o risco relativo para BPN ao longo do período, ajustado pelas covariáveis. O modelo de Equações de Estimação Generalizadas foi utilizado para avaliar o risco relativo para mortalidade infantil entre gemelares e nascimentos únicos ao longo do período, ajustado pelas covariáveis. Foi calculado o risco atribuível populacional, para avaliar o impacto dos gêmeos dizigóticos sobre taxas de mortalidade infantil (TMI) e seus componentes, taxa de mortalidade neonatal (TMN) e taxa de mortalidade pósneonatal (TMPN). Resultados: No estudo sobre baixo peso ao nascer, foram incluídos 319.597 nascidos vivos durante o período. Foi observado um aumento de 43% na cobertura do setor privado, de 14,9% em 1996 para 21,3% em 2011. As taxas de cesarianas aumentaram 52%, chegando a 86,9%, 51,0% e 37,5% em 2011, nos hospitais privados, mistos e públicos, respectivamente. As taxas de baixo peso ao nascer aumentaram significativamente nos hospitais privados e mistos, independentemente do tipo de parto. Nos hospitais públicos, diminuíram no grupo de recém-nascidos por parto cesáreo e se mantiveram estáveis para os nascidos por parto normal. Houve associação entre o aumento das taxas de cesarianas com o aumento nas taxas de baixo peso ao nascer, durante o período. Em relação aos gêmeos e à mortalidade infantil, foi observado um aumento significativo na taxa de nascimentos múltiplos, de 1,97% em 1996 para 2,45% em 2010, p<0,001, entre os quais 65% eram dizigóticos (DZ) em 2010. Houve uma redução na mortalidade infantil e seus componentes para o grupo de nascimentos únicos: a TMI caiu de 15,4‰ para 8,3‰; a TMN, de 8,3‰ para 5,04‰; e a TMPN, de 7,0‰ para 2,9‰. Entre gêmeos, essas taxas permaneceram constantes, em torno de 44‰, 33‰ e 11‰ respectivamente. Em 1996, 1,7% da TMI, 2,0% da TMN e 1,4% da TMPN podem ser atribuídos aos gêmeos DZ. Em 2010, a contribuição de gêmeos DZ subiu para 8,4% (TMI), 9,8% (TMN) e 5,7% (TMPN). Conclusão: A assistência à saúde intensa e não regulamentada fornecida pelo setor privado e as melhorias na saúde, no setor público, apresentam cenários contraditórios, sugerindo abordagens diferenciadas para esses grupos, a fim de diminuir a diferença entre as taxas de baixo peso ao nascer e a mortalidade infantil no Brasil. / Introduction: Brazil is undergoing demographic and epidemiological transitions with improvements of health care standards. Despite this scenario, low birth weight (LBW) and infant mortality (IM) rates remains elevate, mainly in more developed areas of the country. The aim of this study is to evaluate the impact of extensive use of technologies, such as cesarean section (CS) and artificial insemination rates on neonatal outcomes, during the last 16 years. At first, we will investigate the impact of the increase rate of CS in LBW, considering the changes in pattern of health insurance; and second, we will investigate the impact of multiple births in infant mortality. Methods: This is an observational study of all live births registered between 1996 and 2011, in Porto Alegre (RS). Birth weight, type of delivery, type of pregnancy (single or multiple), prenatal coverage, maternal characteristics and health care insurance according to type of hospital (private, mixed, public) were obtained from the Information System on Live Births (SINASC). Information on mortality was obtained from Information System on Mortality (SIM), only in the period of 1996 to 2010. In the study of LBW, multiple births were excluded. Trends in LBW, CS and covariates were assessed using joinpoint regression models, general and according to the type of hospital. Poisson regression was used to calculate the relative risk for LBW over the period, adjusted for covariates. Generalized Estimated Equations model was used to evaluate the relative risk for infant mortality among multiple births and sigletons, adjusted for covariates. Populational Attributable Risk was calculated to evaluate the impact of multiple births on infant mortality. Results: In the study of low birth weight, there was a total of 319,597 live births included in the analysis during the period. An intense change in the pattern of health insurance was observed with an increase of 43% in private sector coverage from 14.9% (1996) to 21.3% (2011). CS rates increased 52%, reaching 86.9%, 51.0% and 37.5% in 2011, respectively, in private, mixed and public hospitals. LBW rates increased significantly in private and mixed hospitals independently of the type of delivery. In opposition, LBW rates decreased in public hospitals for babies born by CS and remained stable for those born by vaginal delivery. Increases in CS and in prenatal coverage were associated with rising of LBW rates during the period. Reduction in the number of adolescent mothers and improvements in maternal education were the main protector factors for LBW during the period. There was a significant increase in multiple births rate from 1.97% (1996) to 2.45% (2010), p<0.001, among which 65% were dizygotic in 2010. There was a reduction in IMR and its components, in singletons: IMR fell from 15.4‰ to 8.3‰, TMN, from 8.3‰ to 5.04‰ and PNMR from 7.0‰ to 2.9‰. Between twins these rates remained constant at around 44‰, 33‰ and 11‰, respectively. In 1996, 1.7% of the infant mortality rate, 2.0% of the neonatal mortality rate 1.4% and the rate of post-neonatal mortality could be attributed to DZ twins. In 2010, the contribution of DZ twins rose to 8.4% in infant mortality, neonatal mortality 9.8% and 5.7% in the post-neonatal mortality. Conclusion: Increase in LBW was related with an intense change in patterns of health insurance associated with overuse of medical technologies. In counterpart, social improvements and increase in access to prenatal care reduced this impact in public and mixed hospitals.

Background: In Sweden, annually, approximately 1,5% out of 115 000 newborns are twins. Itis widely documented that multiple gestation pregnancy contributes to an increased risk of maternal morbidity. Nevertheless, the direct impact of multiple gestation on some maternal complications remains debated. The expected difference in maternal characteristics between populations may also contribute to divergent conclusions. Objective: The aim of this study is to assess the risk of maternal complications and the occurrence of different mode of delivery during pregnancy and childbirth in nulliparous women with multiple gestation. Study design: A population-based cohort study based on data from the Swedish Medical Birth Register between 1999 and 2017.Results: In total 13 014 nulliparous women with multiple gestation and 850 021 nulliparous women with single gestation were included in the study. Women with multiple gestation were slightly older and more often gave birth prematurely than single gestation counterparts. Pregnancy through IVF were almost five times as common in the multiple gestation group. These women suffered a four times increased risk of both preeclampsia and severe forms of preeclampsia. Multiple gestation in nulliparous women was, in this cohort, associated with nearly six times elevated risk of developing ICP, relative to single gestation counterparts. Intrapartal bleeding and post-partum hemorrhage were also more common in women with multiple gestation. The majority of the nulliparous women with multiple gestation had a caesarean section, elective or acute, while nulliparous women with single gestation more often delivered vaginally. An increased risk for placenta previa and GDM, as a consequence of multiple gestation, could, however, not be observed in this study. Conclusion: Multiple gestation is associated with increased risk of several obstetric complications. It is important that healthcare professionals become fully aware of these risks in the encounter with the woman in order to be able convey appropriate information and take appropriate preventive measures. Continued work to reduce multiple gestation caused by IVF is also recommended. / Bakgrund: I Sverige föds ca 115 000 barn årligen och av dessa är knappt 1,5% tvillingar. Flerbördsgraviditet innebär ökad risk för maternell morbiditet, men forskningen går isär gällande flerbörds inverkan på somliga komplikationer. Dessutom kan variationer i maternella karakteristika skilja sig åt mellan populationer. Syfte: Syftet med denna uppsats är att studera risken för maternella komplikationer samt förekomst av olika förlossningssätt under graviditet och förlossning vid flerbörd hos förstföderskor. Metod: En populationsbaserad kohortstudie utifrån data från Medicinska födelseregistret mellan åren 1999–2017.Resultat: Totalt ingick 13 014 förstföderskor gravida med flerbörd i studien och 850 021enkelbörd. Flerbördsgruppen var något äldre än de i enkelbördsgruppen och de födde oftare prematurt. Graviditet genom IVF var nästan fem gånger så vanligt i flerbördsgruppen. Preeklampsi och svår preeklampsi var fyra gånger så stor i flerbördsgruppen och risken för ICP var nästan sex gånger så stor. Även intrapartal blödning och PPH var betydligt vanligare hos kvinnorna i flerbördsgruppen. Majoriteten av personerna i flerbördsgruppen förlöstes medkejsarsnitt, planerat eller akut, medan förstföderskorna i enkelbördsgruppen i större utsträckning födde vaginalt. Ökad risk för placenta praevia och GDM kunde ej observeras. Slutsats: Att vänta flerbörd är förenat med en ökad risk för flera obstetriska komplikationer. Denna risk är viktigt att vårdpersonal är medvetna om i mötet med kvinnan för att kunna informera, förebygga och behandla. Även ett fortsatt arbete att minska flerbörd som uppkommit genom IVF rekommenderas.

This study examines the production and the introduction of a fertility treatment which gained great attention both in Sweden and internationally during the 1960s. In the procedure, hormones were extracted from human pituitary glands which had been collected from autopsies. After this, the hormones were purified and injected into the female patients as a treatment for certain kinds of sterility. Carl Gemzell, professor of obstetrics and gynecology at Uppsala University, was a key figure in the development of the treatment. He was described by the media as a medical pioneer and later became one of Sweden’s most famous doctors and scientists. The fertility treatment also gained a lot of attention in the media as ”the miracle drug that made barren women pregnant”, especially since it often resulted in multiple pregnancies. In the 1960s, pregnancies with quadruplets, quintuplets, sextuplets and even septuplets became world sensations. By using the sociology of expectations as theoretical approach, which focuses on the performativity of expectations and visions in science production, this study aims to investigate how expectations of an effective fertility method were articulated in both the scientific sphere and in the media. This of course also relates to how the risks of the multiple pregnancies were dealt with. The analysis is divided into three chapters, where the first chapter examines the politics of science in Sweden during the post-war period and how Gemzell’s work in Uppsala generated expectations of a scientific milieu on the front line of fertility research. The next chapter is focused on the media’s interest in Gemzell and how he became a celebrity. A central argument for the study is that his public status helped to create scientific credibility for the treatment, especially among the public. The final chapter focuses on the media reporting about the multiple pregnancies. They were often treated as sensations, which was somewhat paradoxical as they were hazardous and frequently resulted in the death of the premature children.