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Simultaneous videoconferencing among three or more remote points is possible by means of a Multipoint Control Unit (MCU). This is a bridge that interconnects calls from several sources (in a similar way to the audio conference call). All parties call the MCU unit, or the MCU unit can also call the parties which are going to participate, in sequence. There are MCU bridges for IP and ISDN-based videoconferencing. There are MCUs which are pure software, and others which are a combination of hardware and software. An MCU is characterised according to the number of simultaneous calls it can handle, its ability to conduct transposing of data rates and protocols, and features such as Continuous Presence, in which multiple parties can be seen onscreen at once.

MCUs can be stand-alone hardware devices, or they can be embedded into dedicated VTC units.

Some systems are capable of multipoint conferencing with no MCU, stand-alone, embedded or otherwise. These use a standards-based H.323 technique known as "decentralized multipoint", where each station in a multipoint call exchanges video and audio directly with the other stations with no central "manager" or other bottleneck. The advantages of this technique are that the video and audio will generally be of higher quality because they don't have to be relayed through a central point. Also, users can make ad-hoc multipoint calls without any concern for the availability or control of an MCU. This added convenience and quality comes at the expense of some increased network bandwidth, because every station must transmit to every other station directly.