A fetal reduction is recommended in two circumstances. When serious fetal anomalies are detected early in a multiple pregnancy, then a reduction might be considered. Although more controversial, fetal reductions might also be considered when a pregnancy involves higher order multiples (known as selective reduction). Several individual factors lead to the recommendation for a reduction based on number of fetuses.

Does the mother have medical issues that might adversely affect a successful outcome for a higher order multiple gestation? Is the mother at high-risk for preterm delivery based on uterine factors? Perhaps the most controversial reason involves a reduction done to decrease the number of fetuses the patient is carrying during a triplet, quadruplet, quintuplet or other higher-order multiple pregnancy to achieve a "better outcome".

While some physicians recommend reductions for any pregnancy greater than twins, others never recommend reduction. The decision to reduce based on fetal anomalies detected early in pregnancy or on the number of fetuses the pregnancy involves needs to be based on several factors specific to each patient. Individualized counseling is most important when the issue of reduction is considered.