A 29-year-old woman was given isotretinoin for severe, recalcitrant acne. During the first 3 months of treatment, she was taking an oral contraceptive agent that she had started at the same time as the isotretinoin. After deciding she wanted to become pregnant, the patient stopped taking the contraceptive agent but continued to take iso tretinoin for another 2 months.When the patient became pregnant, she sought advice from the Motherisk program regarding the fetal risks of exposure to iso tretinoin. With counselling, it became apparent that the patient had not understood the connection between isotretinoin and birth defects, and hence the need for continued effective contraception while taking the drug. After repeated counselling, the patient decided to terminate her pregnancy.