Recent rapid advances have occurred in ovarian stimulation regimens and laboratory procedures but unresolved issues remain in assisted reproduction treatment, particularly in centres with relatively poor resources. One is the success rate, which is not optimal; another is the unprecedented rise in incidence of multiple pregnancies over the past two decades, with IVF responsible for approximately 50% of all multiple births worldwide. The main reason for this is the increased number of embryos transferred, in order to obtain high IVF success in terms of pregnancy rate, yet the patient may be exposed to an increased health risk. Another issue concerns multifetal pregnancy reduction, the procedure specially developed to cope with problems unique to multiple gestations: the most important aspect arising is the conditions under which a clinician has a licence to kill. Other major issues that decrease the success of treatment are poor ovarian response, which poses medical and physiological difficulties in its management, and advanced maternal age. Finally, professional challenges to ensure transparency regarding potential outcomes and risks must be met. After careful consideration of the ethical issues, it is recommended that written informed consent about all treatment steps should be given before commencing treatment.