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Infertility is a disease that affects up to 15.5% of reproductive-aged couples. Until the birth of the first neonate born from in vitro fertilization (IVF) in 1978, many infertile couples did not have an opportunity to conceive a biological child. Over the past 40 years, access to and effectiveness of IVF have increased; currently 1.7% of births in the United States result from IVF. As with any medical intervention, potential risk exists. In the case of IVF, both maternal risks (ovarian stimulation, oocyte retrieval, and subsequent pregnancy) and fetal risks that vary based on maternal age and fetal number must be considered. Importantly, risk quantification varies by comparison group, which is typically either spontaneous conception in a fertile couple or assisted non-IVF conception in an infertile couple. It must also be considered compared with the alternative of not undergoing IVF, which may mean not having a biological child. Although increased compared with spontaneous conception, absolute maternal–fetal-assisted reproductive technology risks are low and can be minimized by optimizing ovarian stimulation and transferring a single embryo. In this article, we aim to summarize maternal and fetal risk associated with use of assisted reproductive technology. The review focuses on ovarian stimulation and procedural risks as well as adverse perinatal outcomes among resultant singleton and twin pregnancies in young women and women of advanced maternal age.