Monitoring national and regional trends in utilization as well as safety and effectiveness of assisted reproductive technologies (ART) constitutes an important tool to examine how treatments are performed and their outcome under different social and cultural situations; and also, how they evolve in time. An example of this is the world trend in reducing the number of embryos transferred so that there is a balance between effectiveness with the highest possible delivery rate and safety with the birth of singletons. Although every country is moving in this direction, implementation of lower number of embryos transferred is very much influenced by availability and the ease of access to treatment; therefore, there are great differences in different regions of the world. The Nordic countries, Australia and Japan are world leaders in transferring single embryos to avoid multiple births. Different countries have various ways of registering their health data. Furthermore, there are many countries in the world where health interventions, such as ART procedures, are not registered nationally; instead, regional registries collect outcome data directly from the institutions providing services. It is therefore a major challenge to collect data and integrate it in a way that is comprehensive for all stakeholders. The vast majority of information presented in this article derives from data collected longitudinally by the International Committee Monitoring ART (ICMART) from procedures performed up to 2012. We will examine how utilization affects access to treatment. World trends and variations in effectiveness and safety as well as the influence of new technology such as gamete and embryo freezing and preimplantation genetic testing (PGT) will be presented.