The use of assisted reproductive technology has contributed significantly to the increase in multifetal pregnancies. It is preferable to avoid the risk of higher-order multifetal pregnancy by limiting the number of embryos to be transferred or by cancelling a gonadotropin cycle when the ovarian response suggests a high risk of a multifetal pregnancy. When multifetal pregnancies do occur, incorporating an ethical framework will help obstetricians counsel and guide patients as they make decisions regarding continuing or reducing their multifetal pregnancies. Triplet and higher-order multiple pregnancies are well known to be associated with increased adverse outcomes including maternal medical complications, pregnancy loss, intrauterine growth restriction, and preterm delivery.