Ovulation induction (OI) that is not part of an in vitro fertilization (IVF) cycle is the cause of 40-70 percent of high-order multiple pregnancies (HOMP), pregnancies with three or more conceptus, and 11-21 percent of twins, in countries where modern infertility treatment is practiced. Clomiphene Citrate (CC) increases follicular stimulation hormone (FSH) secretion from the pituitary by temporarily blocking the negative feedback of estrogen that is necessary to regulate production and secretion of FSH. Pulsatile gonadotropin-releasing hormone (GnRH) administered subcutaneously or intravenously results in pregnancy and multiple pregnancies similar to low-dose gonadotropins. A widely used technique for reducing HOMP during controlled ovarian hyperstimulation-intauterine insemination (COH-IUI) treatment is to withhold human chorionic gonadotropin (hCG) administration when excessive numbers of follicles or estradiol (E) concentrations are present. OI should not be attempted, and IVF should be used instead for women who cannot safely carry a twin pregnancy.