When a woman in Southern California gave birth to octuplets, it sparked immediate attention.

To help you understand fertility treatment and multiple births, we talked to Dr. Richard Paulson, director of the fertility program at the University of Southern California (USC), and Dr. Karine Chung, founder and director of USC’s fertility preservation program.

Q: How do multiple births, specifically octuplets, occur? 

Dr. Paulson: Multiple gestation is a serious complication of fertility therapy. We’re not as good as nature is, to make sure only one egg is produced. Even though that is always our goal, sometimes we overshoot it and get multiple eggs, which can then lead to multiple births.

Dr. Chung: The purpose of fertility treatments is to help patients conceive one baby at a time. Fertility treatments stimulate a woman’s ovaries to produce eggs. Increasing the number of eggs increases the chances of conception. Higher-order multiples result from super-ovulation with intrauterine insemination (inserting sperm into the uterus), or combining that with intercourse. We try to optimize the dosing of the medications, but there’s no way to control it 100 percent. That’s the type that results in multiples—most frequently twins and triplets, and occasionally quadruplets. Octuplets…10 years ago it happened in Houston. With the current guidelines, there’s about a 20 to 30 percent chance of twins and about a 5 percent chance of triplets.

Q: How does in vitro fertilization (IVF) work?

Dr. Chung: With in vitro fertilization, the same medications are used to stimulate women’s ovaries but instead of intrauterine insemination, we extract the eggs and fertilize them in the lab, then decide how many embryos to put back into the uterus. Typically in a woman at [Nadia's] age [33], it’s two embryos. With three embryos, serious counseling needs to take place first. Triplets is a bad outcome—selective reduction [terminating one fetus or more] needs to be considered. Some people aren’t aware that triplets aren’t a good outcome. My job is to tell them it’s not a good outcome; it’s not healthy for the mom or the baby.