<p>Enzootska leukoza goveda je maligna virusna neoplazma retikulohistiocitarnog sistema&nbsp;progresivnog karaktera, koja se karakteri&scaron;e intenzivnim razmnožavanjem limfocita. Ova&nbsp;bolest govedarstvu nanosi velike materijalne &scaron;tete dovodeći do visokog nivoa mortaliteta,&nbsp;pojave učestalijih oportunističkih infekcija, smanjenja produktivnosti i reprodukcije na&nbsp;leukoznim farmama. Imajući u vidu, da govedarstvo predstavlja strate&scaron;ku granu u stočarstvu&nbsp;Srbije i učestvuje u stvaranju znatnog dela nacionalnog dohotka od 1999. godine,&nbsp;preduzimana su sistematska dijagnostička ispitivanja ra&scaron;irenosti ELG na farmama goveda&nbsp;kako u intenzivnoj tako i od 2000. godine i u ekstenzivnoj proizvodnji goveda. Kori&scaron;ćene su&nbsp;savremene metode dijagnostike ELG najpre agargel-imunodifuzioni test (AGID), a potom i&nbsp;indirektna imunoenzimska metoda (ELISA) kao dijagnostički test izbora. Na osnovu&nbsp;dobijenih epizootiolo&scaron;kih podataka sprovo&ntilde;ene su mere za suzbijanje i iskorenjivanje EGL na<br />farmama goveda. U zavisnosti od tehnolo&scaron;kog procesa proizvodnje, kao i od ekonomskih&nbsp;mogućnosti farmi sprovo&ntilde;eni su različiti modeli kontrole i eradikacije.<br />ELG predstavlja veoma ozbiljan zdravstveni i ekonomski problem za govedarsku<br />proizvodnju posebno za zapate mlečnih goveda, a po&scaron;to se i pored sprovo&ntilde;enja mera za&nbsp;eradikaciju, leukoza jo&scaron; uvek zadržala u nekim na&scaron;im stadima i zapatima goveda smatrali smo&nbsp;da bi trebalo preispitati dosada&scaron;nju strategiju kontrole ELG.<br />Razmatrane su pote&scaron;koće u sprovo&ntilde;enju mera za suzbijanje i iskorenjivanje leukoze goveda&nbsp;kao i potreba za izučavanjem epizootiologije, odnosno kontrole kretanja leukoze u&nbsp;trakozvanim leukoznim zapatima koji predstavljaju potencijalne izvore &scaron;irenja leukoze.&nbsp;Imajući u vidu navedeno, cilj ovog ispitivanja je bio ustanoviti stepen ra&scaron;irenosti ELG i&nbsp;ispitaju do sada kori&scaron;ćeni programi kontrole i eradikacije oboljenja. Zadaci ovog istraživanja&nbsp;su bili da se ispitaju pogodnosti pojedinih dijagnostičkih metoda u cilju postavljanja rane&nbsp;dijagnoze oboljenja, istražiti incidenciju i prevalenciju bolesti, proceniti značaj pojedinih&nbsp;puteva preno&scaron;enja u okviru farmi i u regionu, izvr&scaron;iti analizu dosada&scaron;njih rezultata borbe i&nbsp;evaluaciju pojedinih modela, predložiti najpogodnije modele kontrole bolesti u cilju potpune&nbsp;eradikacije bolesti, a tako&ntilde;e razviti i adekvatan model nadzora bolesti kako bi se sprečila&nbsp;njena ponovna pojava i &scaron;irenje. Rezultati serolo&scaron;kih ispitivanja pokazuju da je otkriveno 10.181 pozitivnih životinja, odnosno 8,1% posto životinja u zapatima goveda na velikim farmama. Epizootiolo&scaron;ka situacija na farmama goveda individualnog sektora zahtevala je posebnu pažnju i tu je ispitano 281.369 uzoraka krvi goveda i otkriveno je 567 pozitivnih grla ili 0,4% posto na području 12 op&scaron;tina. Rezultati seroprevalencije predstavljali su ključnu informaciju od značaja za izbor modela kotrole ELG. Odnosno istraživanje efikasnosti pojedinih modela u postizanju rezultata i&nbsp;zadatih ciljeva. Značajnih za izradu komparativne analize kori&scaron;ćenih modela, njihove primene i evaluacije. Epizotiolo&scaron;ki modeli su analizirani, izvr&scaron;ena je njihova evaluacija i preporuka za primenu u epizootiolo&scaron;koj praksi.&nbsp;</p> / <p>Enzootic bovine leucosis is viral malignant neoplasm reticulohistiocytic system and has&nbsp;progressive character, which is characterized by intensive multiplication of lymphocytes.&nbsp;This disease is causing a great material damage to cattle farming, leading to high level of&nbsp;mortality, with the emergence of more frequent infections and a reduction in productivity&nbsp;and reproduction in farms in which the leukosis appeared. Having in mind that the cattle&nbsp;farming is a strategic branch of the Serbian livestock and participates in the creation of a&nbsp;significant part of the national income since 1999, systematic diagnostic tests of the&nbsp;prevalence of EBL were undertaken on cattle farms, both in the intensive cattle production&nbsp;and from 2000 extensive production. Modern diagnostics methods of EBL were used,&nbsp;firstly the agargel-immunodiffusion test (AGID), followed by an indirect enzyme&nbsp;immunoassay method (ELISA) as well as a diagnostic test of choice. Based on the&nbsp;obtained epizootic data, the measures for the control and eradication of EBL were carried&nbsp;out on cattle farms. Depending on the technological process of production, as well as the&nbsp;economic farm opportunities, different models of control and eradication were&nbsp;implemented.<br />EBL is a very serious health and economic problem for cattle farming, especially for<br />dairy cattle herds, and despite the implementation of the measures for the eradication of&nbsp;the disease, leucosis is still held in some of our flocks and herds of cattle. Because of that&nbsp;we thought that the current control strategy EBL should be examined.<br />The difficulties in implementing measures to suppress and eradicate bovine leukosis were&nbsp;discuses and the requirement to study the epizootiology , as well as to control the&nbsp;movement of leukosis in so-called leukostic herds, that represent potential source of&nbsp;spreading the leukosis.<br />Taking into account, the purpose of this study was to establish the degree of<br />prevalence of EBL to examine the programs that were used so far to control and eradicate&nbsp;the diseases. The task of this study was to examine the benefits of specific diagnostic methods in order to establish early diagnosis of the diseases, to see into the incidence and prevalence of the leukosis, to estimate the significance of some routes of transmission within the farm and in the region, and to carry out an analysis of recent results in fighting and evaluation of individual models, to suggest the most appropriate models of disease control in order to complete the eradication of leukosis, but also to develop an adequate model of disease control to prevent its re-emergence and spread. The results of serological tests indicate that 10.181 the positive animals were detected, or 8.1 % percent of the animals in cattle herds in large farms. Epizootiological situation in the cattle farms of individual sectors required special attention and 281.369 blood samples of cattle were examined and the 567 positive cases were discovered, or 0.4 % percent in&nbsp;12 communities. Results of seroprevalence were a key information for the choice of models to control ELG, or to investigate the efficiency of some models to achieve results and goals, and important for the production of comparative analysis of models that were used, their implementation and evaluation. Epizootic models were analyzed, their evaluation was made and recommendations for their implementation in the epizootic practice.&nbsp;</p>

<p>Uprkos rezultatima postignutih imunizacijom, veliki ka&scaron;alj je i danas vodeći uzrok smrti među zaraznim bolestima protiv kojih se sprovodi imunizacija. Postojanje različitih vrsta nadzora, prisutnih nedostataka laboratorijske dijagnostike oboljenja, slabosti u dostupnim definicijama slučaja velikog ka&scaron;lja i neprepoznavanje oboljenja, otežavaju realno sagledavanje opterećenja velikim ka&scaron;ljem i poređenje postignutih rezultata u različitim zemljama. Postojeće definicije slučaja velikog ka&scaron;lja nisu prihvatljive u svim uzrastima. Cilj istraživanja je bio da se na reprezentativnom uzorku Grada Novog Sada utvrdi: stopa incidencije velikog ka&scaron;lja tokom jedne godine savremenog nadzora; senzitivnost i specifičnost definicija slučaja velikog ka&scaron;lja, datih od strane Globalne pertusis inicijative za tri uzrasne grupe. U istraživanje je uključeno 213 ispitanika pacijenata iz sentinelnog nadzora nad velikim ka&scaron;ljem Doma zdravlja Novi Sad i 107 ispitanika pacijenata iz hospitalnog nadzora sa iste teritorije koji su ispunjavali predložene definicije slučaja za tri uzrasne grupe (0-3 meseca; 4 meseca-9 godina života; 10 godina i stariji). Podaci za istraživanje dobijeni su popunjavanjem anketnog upitnika. Laboratorijsko testiranje sumnji na veliki ka&scaron;alj sprovedeno je u Centru za mikrobiologiju Instituta za javno zdravlje Vojvodine. Kod pacijenata sa ka&scaron;ljem u trajanju do 21 dan testiranje je vr&scaron;eno upotrebom PCR metoda, a kod pacijenata sa ka&scaron;ljem u trajanju vi&scaron;e od 21 dan, dokazivanje oboljenja vr&scaron;eno je upotrebom ELISA IgA i IgG serolo&scaron;kih testova. Potvrđenim slučajem velikog ka&scaron;lja smatran je pacijent sa ispunjenom definicijom slučaja oboljenja i laboratorijskom potvrdom oboljenja, PCR ili ELISA testom. Procenjena stopa incidencije velikog ka&scaron;lja u Novom Sadu je 237,7/100.000, a stopa incidencije hospitalizovanih u Novom Sadu je 16,4/100.000. Najvi&scaron;e stope incidencije velikog ka&scaron;lja u sentinelnom nadzoru registruju se u uzrastu 10-14, a u hospitalnom u uzrastu od 7 do 9 godina. Senzitivnost, specifičnost i stepen verovatnoće pozitivnog rezultata testiranog simptoma/znaka iz predloženih definicija slučaja se razlikuju po uzrastima i po pojedinim simptomima/znacima. Predložene definicije slučaja u uzrastima od 4 meseca do 9 godina i u uzrastu od 10 godina i starijih imaju veću verovatnoću otkrivanja obolelih u hospitalnom u odnosu na sentinelni nadzor za pojedine simptome/znakove. Budući da je tokom istraživanja u sentinelnom nadzoru oboljenje potvrđeno kod svakog petog, a u hospitalnom kod svakog drugog testiranog pacijenta, predložene definicije slučaja se mogu koristiti u nadzoru nad velikim ka&scaron;ljem.</p> / <p>Despite all results achieved by immunization, pertussis is still the leading cause of death among vaccine preventable diseases. Different types of surveillance and laboratory confirmation of pertussis, weakness of existing case definitions for pertussis and broad spectrum clinical manifestation of disease, complicate overview of disease and result comparison of surveillance in different countries. The current pertussis case definition is not acceptable for all age groups of patients. The aim of this research was to determine: the pertussis incidence rate in population of Novi Sad during one year of modern surveillance; the sensitivity and specificity of clinical case definition for pertussis, given by the Global Pertussis Initiative for three age groups, with a representative sample of population in the City of Novi Sad. 213 patients from sentinel surveillance of pertussis Novi Sad Health Centre and 107 hospitalized patients from Novi Sad, who fulfilled criteria of case definition proposed for the three age groups (0-3 months, 4 months-9 years; 10 years of age and older), were included in the research. Research data obtained from a questionnaire. Laboratory testing of suspected cases were conducted at the Centre for Microbiology, Institute of Public Health of Vojvodina. For patients with coughing less than 21 days PCR method was used, and for patients with cough lasting more than 21 days, laboratory confirmation of disease was performed using ELISA IgA and IgG serological tests. Confirmed case of pertussis consider to be a patient with symptoms/signs according to proposed case definition and with laboratory confirmation of the pertussis, PCR or ELISA. Estimated incidence rate of pertussis for population in the city of Novi Sad was 237.7/100,000, and the pertussis incidence rate in hospitalized patient in Novi Sad was 16.4/100,000. The highest incidence rate of pertussis in the sentinel surveillance was registered in the age group 10-14 and in the hospital surveillance in the group 7 to 9 years of age. The values of sensitivity, specificity and positive likelihood ratio of symptoms/signs from the proposed case definition were calculated and they different by age and by certain symptoms/signs from proposed case definition. Certain symptoms/signs of the proposed case definition have a higher probability of detection among patients aged 4 months to nine, and at the age of ten year and older, in the hospital versus those in sentinel surveillance for pertussis. During research from the patients who were tested in sentinel surveillance every fifth was laboratory confirmed case and in the hospital surveillance every second patient was confirmed case, so the proposed case definitions can be used in the surveillance of pertussis.</p>

<p>Uvod: Vi&scaron;eplodne trudnoće se javljaju u 1,5% svih trudnoća nakon spontane koncepcije, dok nakon postupaka vantelesne oplodnje ovaj postotak u Evropi iznosi preko 20% uz velike varijacije među zemljama. U na&scaron;oj sredini, stopa vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje iznosi daleko iznad 30%. Pojava hipertenzivnog sindroma u trudnoći, gestacijskog dijabetesa, operativnog zavr&scaron;avanja trudnoće, prevremenog porođaja, male porođajne telesne mase, neurolo&scaron;kih sekvela kod rođene dece i gotovo svih drugih komplikacija po majku i plod, kao i celokupno opterećenje zdravstvenog sistema vi&scaron;estruko su veći kod vi&scaron;eplodnih u odnosu na jednoplodne trudnoće i udeo navednih komplikacija raste sa brojem plodova. Sa druge strane deca iz postupaka vantelesne oplodnje čine i do 4,5% sve živorođene dece u pojedinim zemljama, &scaron;to uz činjenicu da infertilitet pogađa 16-18% parova u na&scaron;oj sredini daje ovoj pojavi posebnu dimenziju i činije i dru&scaron;tvenim problemom. Perinatalni ishodi trudnoća iz postupaka vantelesne oplodnje su u velikoj meri kompromitovani visokom stopom multiplih trudnoća, koje se danas smatraju komplikacijom, a ne uspehom postupaka vantelesne oplodnje. Jednoplodne trudnoće iz postupaka vantelesne oplodnje u većim studijama pokazuju diskretno slabije perinatalne ishode u odnosu na one spontano začete, dok kod vi&scaron;eplodnih trudnoća ova korelacija nije jasno izražena i dokumentovana, uz prisutnu dilemu da li je vi&scaron;eplodnost sama po sebi ili način koncepcije glavni problem u zapaženoj pojavi. Cilj rada: Uporediti perinatalne ishode vi&scaron;eplodnih trudnoća nastalih postupcima vantelesne oplodnje i spontano začetih kao i perinatalne ishode jednoplodnih i vi&scaron;eplodnih trudnoća iz postupaka vantelesne oplodnje. Pored navdenog cilj rada je i ukazati sveobuhvatnost navedenog problema i na moguća re&scaron;enja za smanjenje njihove učestalosti. Materijal i metode: Kombinacijom retrospektivne opservacione studije i prospektivne longitudinalne kohortne studije u periodu analizom perinatalnih ishoda pacijentkinja porođenih na Klinici za ginekologiju i aku&scaron;erstvo Kliničkog centra Vojvodine u periodu od od 01.01.2008. do 31.12.2010. godine, studija je analizirala i poredila perinatalne ishode kod 174 spontano začete vi&scaron;eplodne trudnoće, 163 vi&scaron;eplodne trudnoće nastale postupkom vantelesne oplodnje, kao i 155 jednoplodnih trudnoća začete postupkom vantelesne oplodnje. Analizirani parametric bili su telesna masa novorođenčeta, dostignuta gestacijska starost, vrednosti Apgar skora, učestalost hipertenzivnog sindroma kod majke i brojni drugi parametri perinatalnog ishoda. Uzeti od strane obučenih kliničara i uno&scaron;eni u posebno dizajniranu bazu podataka, rezultati su statistički analizirani u program JMP ver 9.0 (SAS publisher) uz kori&scaron;ćenje ANOVA analize za testiranje statističke značajnosti između srednjih vrednosti kontinuiranih varijabli, dok je statistička značajnost razlike učestalosti kategorijskih varijabli je određivana Pearsonovim &chi;2 testom. Rezultati: Jednoplodne ART trudnoće uz prosečnu starost od 33,5 godine, prosečnu gestacijsku starost na porođaju od 38,26 gn, udeo prevremenih porođaja od 12,9%, prosečnu telesnu masu od 3258 g, AS u prvom minutu od 8,35 i u petom minutu od 9,2, stopu carskog reza od 65,81%, udeo GDM-a od 7,1%, anemije od 41,94% i preeklampsije od 4,52%, ima sve relevantne parametre perinatalnog ishoda statistički značajno (p&lt;0.0001) superiornije od kako ART tako i non ART blizanačkih trudnoća. ART blizanačke trudnoće pokazale su prosečnu starost majke od 32,9 godina, prosečnu gestacijsku starost na porođaju od 35,6 gn, udeo prevremenih porođaja od 58,27%, prosečnu telesnu masu od 2374 g, AS u prvom minutu od 7,45 i u petom minutu od 8,65, stopu carskog reza od 83,7%, udeo GDM-a od 15,11%, anemije od 78,42% i preeklampsije od 12,23%, dok su non ART blizanačke trudnoće pokazale prosečnu starost majke od 28,8 godina, prosečnu gestacijsku starost na porođaju od 36,08 gn, udeo prevremenih porođaja od 49,71%, prosečnu telesnu masu od 2433 g, AS u prvom minutu od 7,75 i u petom minutu od 8,75, stopu carskog reza od 58,33%, udeo GDM-a od 7,02%, anemije od 67,84% i preeklampsije od 11,11%. Pored godina majke i udela carskog reza koji su bili vi&scaron;i u ART blizanačkim trudnoćama (&lt;0.0001), kao i blago veće pojavi poremećaja količine plodove vode (p=0,033), gotovo svi ostali pokazatelji toka i ishoda trudnoće bili su komparabilni u navedenim grupama. Diskusija i zaključak: Studija je pokazala da su tok i ishod vi&scaron;eplodnih trudnoća nastalih spontano i postupcima vantelesne oplodnje ekvivalentni u gotovo svim pokazateljima uz sličnu prosečnu telesnu masu i gestacijsku starost novorođenčadi, kao i da su svi navedeni parametri ovih vi&scaron;eplodnih trudnoća bez obzira na način koncepcije upadljivo i podjednako lo&scaron;iji u poređenju sa jednoplodnim trudnoćama iz postupka vantelesne oplodnje. Izuzimajući vi&scaron;eplodnost kao factor rizika deca iz postupaka vantelesne oplodnje su generalno zdrava. Sama vi&scaron;eplodnost, a ne način koncepcije predstavljaju problem, koje se sa pravom smatra najvećom komplikacijom vantelesne oplodnje. Dodatna analiza iskustava drugih zdravstvenih sistema ukazuje da jedino &scaron;iroka i sveobuhvatna implementacija strategije vraćanja samo jednog embriona (Single embryo transfer &ndash; SET) može da dovede do smanjivanje stope multiplih trudnoća nakon postupaka vantelesne oplodnje, i sledstvenih komplikacija, a bez ugrožavanja samog uspeha vantelesne oplodnje. Iskustva drugih zdravstvenih sistema ukazuju da je uspe&scaron;na implementacija SET-a jedino moguća uz angažovanje celog dru&scaron;tva, zajedno sa brojnim legislativnim merama iz domena nadzora, kontrole i finansiranja postupaka vantelesne oplodnje. Obim i način finansiranja postupaka vantelesne oplodnje od strane države (uz vi&scaron;e besplatnih poku&scaron;aja za infertilne parove) uz obaveznu upotrebu SET-a, i sistema krioprezervacije na osnovu primera iz prakse predstavlja ključ u borbi za smanjenje problema vi&scaron;eplodnih trudnoća nakon postupaka vantelesne oplodnje.</p> / <p>Introduction: Multiple pregnancies occur in 1.5% of all pregnancies after spontaneous conception and in more than 20 % of all pregnancies concieved after assisted reproductive technologies in Europe, with large variations between countries. In our setting, the rate of multiple pregnancies after the ART is well above 30%. The occurrence of hypertensive syndrome in pregnancy, gestational diabetes, operative delivery, premature birth, low birth weight, neurological and developmental impairment in children, and almost all the other complications for the mother and fetus, as well as the entire burden of the health system are several times higher in multiple pregnancies compared with singleton pregnancies. Incidence of&nbsp; forementioned complications rises with number of fetuses. On the other hand, children from in vitro fertilization procedures make up 4.5% of all live births in some countries, which together with the fact that infertility affects aproximately 16-18% of couples in our country gives an extra dimension to this phenomenon and makes it not just medical but wider social problem. Perinatal outcomes of pregnancies after assisted reproductive technologies (ART) are greatly compromised by the high rate of multiple pregnancies, which are now considered to be a complication rather than success of ART procedures. ART Singleton pregnancies have, in larger studies, show discretely lower perinatal outcomes compared with those conceived spontaneously, while for the multiple pregnancies, this correlation is not clearly expressed and documented. There remains dilemma whether multiplicity itself or the way of conception (ART vs. non ART) constitutes a major problem in the observed differences regarding perinatal outcome of ART pregnancies. Objective: To compare the perinatal outcomes of multiple pregnancies conceived by In vitro fertilization (IVF) and spontaneously and perinatal outcomes of IVF conceived singleton and multiple pregnancies. Additional aim of this thesis is to point out the complexity of this problem and offer possible solutions. Materials and Methods: Design of a study was a combination of retrospective and prospective observational longitudinal cohort study. Analysis included pregnancies which had delivery at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in the period from 1.01.2008. to 31.12.2010. The study analyzed and compared the perinatal outcomes in 174 spontaneous conceived multiple pregnancies, 163 multiple pregnancies resulting from IVF procedures, and 155 singleton pregnancies conceived by IVF procedure. Analyzed parameters were newborns birth weight, gestational age at delivery, the value of the Apgar score, occurrence of hypertensive syndrome in pregnancy, gestational diabetes, as well as numerous parameters of perinatal outcome. Taken by trained clinicians and were entered into a specially designed database, the results were statistically analyzed in JMP ver 9.0 software (SAS publisher) using ANOVA analysis to test the statistical significance between the mean values of continuous variables, while the statistical significance of the difference in frequency of categorical variables was assessed by Pearsons &chi;2 test. Results: ART singleton pregnancies had an average mothers age of 33.5 years, the average gestational age at birth of 38.26 gestational weeks (gw), preterm delivery rate of 12.9%, average birth weight 3258 g, Apgar score (AS) in the first minute 8.35, and in the fifth minute 9.2, cesarean section rate 65.81%, Gestational diabetes (GDM) in 7.1% pregnancies, anemia occurred in 41.94% of pregnancies, while preeclampsia was observed in 4.52% of all pregnancies. All relevant parameters of perinatal outcome were significantly (p&lt;0.0001) superior to both ART and non-ART twin pregnancies. ART twin pregnancy showed the average mothers age of 32.9 years, the average gestational age at birth of 35.6 gw, the preterm delivery rate 58.27%, the average body weight newborns 2374 g, AS in the first minute of 7.45, and in the fifth minute of 8.65, the cesarean section rate of 83.7%, GDM in 15.11% of all pregnancies, anemia occurred in 78.42% and preeclampsia in 12.23% of pregnancies, while the non-ART twin pregnancy showed an average mothers age of 28.8 years, the average gestational age at birth of 36.08 gw, the preterm delivery rate of 49.71%, the average body weight of 2433 g, AS in the first minute of 7.75 in the fifth minute 8.75, the caesarian section rate of 58.33%, GDM-a occurred in 7.02%, anemia in 67.84% and preeclampsia in 11.11% of pregnancies. Except for maternal age and the caesarean section rate, which were significantly higher in ART twin pregnancies (p&lt;0.0001), as well as small increase in proportion of amniotic fluid volume disorders (p = 0.033), almost all other parameters of perinatal outcome of were comparable in these groups. Discussion and Conclusion: The study showed that the course and outcome of multiple pregnancies conceived spontaneous and after IVF procedures are equivalent in almost all parameters with similar average body weight and gestational age at birth, and that all these parameters of multiple pregnancies regardless of the conception mode are equally worse compared with singleton pregnancies from IVF procedures. With the exception of multiplicity as a risk factor children from in vitro fertilization procedures are generally healthy. Multiplicity itself and not the mode of conception presented a problem, which is rightly considered the major complication of IVF today. Additional analysis of the experiences of other health system indicates that only a broad and comprehensive implementation of strategy to return only one embryo (SET&ndash;single embryo transfer) can lead to a reduction of the rate of multiple pregnancies after IVF procedures, and the accompanying complications, without compromising IVF success. The experience of other health systems indicate that a successful implementation of SET is only possible with the involvement of the whole society, along with a number of legislative measures in the field of monitoring, control and reimbursement of assisted reproduction procedures. The scope and funding of an IVF procedures (with more free attempts for infertile couples, reimbursed by public health) with mandatory use of SET, and good cryopreservation programs are, based on examples in other countries who had successfully dealt with his problem, is the key in reducing the problem of multiple pregnancies after IVF procedures.</p>