Access to assisted reproduction techniques (ARTs) is highly variable worldwide. The aim of this paper is to analyse the association between systems for ART coverage, patterns of clinical practice, and outcomes for these procedures. We performed a retrospective analysis of ART activity records in the USA and Europe, and concluded that the availability of ART services, and the activity in this respect, is higher in public than in private coverage systems. Effectiveness decreases with greater coverage, but this occurs in parallel with lower numbers of embryos transferred and with multiple birth rates. Healthcare policy on assisted reproduction should take into account the necessary balance between the effectiveness of the treatment provided and its associated risks, the latter mainly concerning multiple pregnancies.