The article discusses the features of genetic counseling (GC) in the detection of hereditary and congenital pathology in one of the fetuses in case of multiple pregnancies. The GC algorithm with the main indications for counseling, the goals and objectives of the GC are defined, as well as the factors influencing the decision made by the family regarding the tactics of pregnancy management is presented. The gestational age at the time of the primary GC and the timing of the invasive prenatal diagnosis (IPD) have an impact on the family’s decision. The average time of primary GC was 11 weeks of gestation in the 1st trimester, and 16 weeks in the 2nd trimester. Such early GC timing allowed families to gain information, make sense of it, analyzed all medical and psychological aspects of invasive methods and perform invasive procedures at 12 weeks and 17 weeks, respectively. The article also presents clinical observations of multiple pregnancies resulting from in vitro fertilization (IVF) when one of the couples carries a chromosomal translocation, as well as the observation of monozygous (MH) twins discordant for autosomal-dominant Van der Woude syndrome.