Counseling for treatment of infertility should include a discussion of the risks of multifetal pregnancy, multifetal pregnancy reduction should be discussed with patients before the initiations of any treatment that could increase the risk of multifetal pregnancy. In almost all cases, it is preferable to terminate an ovulation induction cycle or limit the number of embryos to be transferred to prevent a situation in which fetal reduction will have to be considered. The best interest of the patient and the future child or children should be at the center of the risk-benefit equation. Although no physicians need to perform fetal reductions if they believe that such procedures are morally unacceptable, all obstetricians and gynecologist should be aware of the medical and ethical issues in these complex situations and be prepared to respond in a professional, ethical manner.