The efficacy of assisted reproductive technology (ART) has progressed substantially in the last decades. The most important health risk of in vitro fertilization (IVF)-multiple pregnancies and births and the associated maternal and fetal morbidity-has been decreased by the implementation of an elective single embryo transfer (eSET) strategy in a large number of European countries. The German Embryo Protection Act (ESchG) regulates a range of practices related to reproductive medicine, such as the number of embryos to be created by ART per treatment cycle, and it also defines under what circumstances women may access IVF treatment. The aim of the act is to protect the human preimplantation embryo from misuse. The ESchG allows the creation of a maximum of three embryos with developmental potential and prohibits embryo selection, thus hindering the implementation of an eSET strategy. Over the course of time, the ESchG has caused an ever increasing medical, ethical, and legal dilemma for German patients and doctors alike.