Purpose: The aim of this study was to compare the perinatal and maternal outcome of our own cohort of twin pregnancies after IVF/ICSI and spontaneous conception to the respective available standards and findings in the current literature. Material and Methods: Perinatal and maternal data of 305 twin pregnancies conceived spontaneously and 74 pregnancies conceived by IVF/ICSI were compared. The following parameters were examined: maternal age, first parity, gestational age, Caesarean section rate, birth weight, sex constellation, umbilical arterial blood pH of the first and second child, maternal complications, fetal malformations, perinatal and neonatal mortality. These data were tested by retrospective statistical analysis (Fisher exact test, Wilcoxon Rank Sum Test). In addition, these parameters were also evaluated separately in dichorionic/diamniotic twins and monochorionic/diamniotic twins. Results: We found significant differences with higher maternal age, higher rate of first parity, an increased incidence of pre-eclampsia and a lower rate of SGA (VLBW) in the ART group and ART subgroup (di/di) compared to the SC group. Caesarean section rate, birth weight, arterial pH of the first and second twin, prematurity, rate of malformations, perinatal and neonate mortality, respectively, were not significantly different between the two groups. For prematurity < 37 weeks of gestation, a significantly higher frequency of the male/male sex constellation was observed. Conclusion: Actually, we are now able to more specifically counsel women conceiving by IVF/ICSI concerning maternal and perinatal outcome.