Fetal Reduction has been employed over the past two decades as a mechanism to reduce the morbidity and mortality of multiple pregnancies. Utilization of the procedure has increased dramatically as IVF has become commonplace but the average starting number has decreased with the transfer of fewer embryos. Success rates from fetal reduction have improved as a function of increasing experience, better ultrasound, and lower starting numbers. Genetic diagnosis prior to reduction can improve the overall outcomes. Reduction of triplets or more clearly improves outcomes, and reduction of twins to a singleton is now a reasonable consideration.