The available data on selective MFPR demonstrates that selective MFPR has the potential to improve perinatal outcome significantly for patients carrying higher-order multiple gestations. Patients undergoing selective MFPR deliver at later gestational ages than if they had not reduced, and neonates subsequently have higher birthweights. For the very-high-order multiple gestations, selective MFPR allows patients to carry a pregnancy that would almost certainly be lost completely without reduction.Furthermore, studies revealed no serious maternal complications in the reduced group, yet life threatening complications occurred in the group continuing with high-order multiple gestations.Multifetal reduction is far from an ideal solution to the problems associated with multifetal pregnancies. It would be much better to avoid the problem by effectively monitoring patients receiving ovulatory stimulants and minizing the number of embryos transferred in invitro fertilization / embryo transfer programs.It is understood however, that even in the most skilled hands, multifetal pregnancies can’t be entirely eliminated with existing modalities. Nevertheless, it should be possible to substantially reduce the number of triplets and to virtually eliminate those with four or more fetues with appropriate monitoring. When however, three or more fetuses have been conceived, the experience to date suggests that selective MFPR is a relatively safe and effective option to consider for patients whose only choices in the past were either to accept the risk of extreme prematurity or terminate their entire pregnancy.