ABSTRACT: From 1980 to 1985 not only were more infants delivered at higher-order multiple births, but more survived. The rise in multiple gestation has been attributed in part to the drugs and procedures used in the management of infertility and assisted conception, especially multiple embryo transfer after in vitro fertilization and multiple egg transfer in the gamete intrafallopian transfer procedure. Very often, survival of small infants from higher-order multiple gestations taxes the resources of the medical and social services. If they survive the perinatal period, the feeding, nurturing, and physical care of triplets, quadruplets, quintuplets, or sextuplets places extraordinary demands on their caretakers. The problems and risks extend far beyond individual clinical cases to the wider social ramifications of the birth and care of these children.