Multifetal pregnancy reduction: evolution of the ethical arguments.

Multifetal pregnancy reduction (MFPR) was developed over 20 years ago to rescue higher-order multifetal pregnancies and has become a major component of improving the outcomes in infertility therapies. By definition, MFPR will always be controversial, but opinions do not follow the traditional "pro-life/pro-choice" dichotomy that has sabotaged the more generalized abortion debate. If one defines SUCCESS as a healthy mother and healthy offspring, clearly, with multiples, fewer are always safer. The ethical issues surrounding MFPR are for most people not a clear black-or-white but varying shades of gray. The ethical principle of proportionality takes precedence (i.e., trying to obtain the most good for the least harm while looking for areas of moral compromise to achieve the best outcomes).