updated 2/6/2009 9:17:17 PM ET 2009-02-07T02:17:17

How did California octuplet mom Nadya Suleman wind up having eight babies? Here are some questions and answers about the births of the world's longest-living octuplets:

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Q: What do we know about the octuplet births?
A: Nadya Suleman gave birth to six boys and two girls on Jan. 26 in suburban Los Angeles. Doctors were expecting to deliver seven infants and were surprised to find eight. Suleman has six other children, two girls and four boys ages 2 through 7. The divorced single mother told NBC's "Today" show that all 14 of her children were conceived through in vitro fertilization using sperm donated by a friend. Her mother, Angela Suleman, has said her daughter just wanted to have one more girl.

Q: How does in vitro fertilization work?
A:
In vitro fertilization involves combining egg and sperm in a lab dish and transferring the embryo into the womb. Fertility drugs are used to stimulate the ovaries to develop multiple eggs that are surgically removed. It is not uncommon to have 15 to 20 embryos after IVF, but doctors normally implant one or two at a time to lower the chances of having multiples. The rest can be frozen for future use. The first so-called test-tube baby was born in 1978.

Q: Why did she use that method?
A: In the NBC interview, the 33-year-old Suleman said she struggled for about seven years before finally giving birth to her first child in 2001. She said she had unsuccessfully tried artificial insemination. The first IVF procedure worked, "And then I just kept going in," she said, according to excerpts provided by NBC. Fertility drugs coupled with artificial insemination is usually tried first before moving on to more complicated and expensive techniques like in vitro.

According to state documents related to a workers' compensation claim, Suleman told a doctor that she had three miscarriages. Another doctor disputed that, saying she had two ectopic pregnancies, a dangerous complication in which a fertilized egg implants somewhere other than in the uterus, usually the fallopian tubes or sometimes the cervix or abdomen. Suleman was injured during a 1999 riot at a state mental hospital where she worked.

Q: Is there a limit to how many embryos can be transferred?
A:
In the United States, there is no law dictating the number of embryos that can be placed in a mother's womb. However, there are national guidelines on how many embryos doctors should transfer, depending on a woman's age and other factors.

The recommendations: No more than one or two embryos implanted for a generally healthy woman under 35 "in the absence of extraordinary circumstances." For women over 40, no more than three to five, depending on the embryos' maturity.

Clinics that clearly violate guidelines can be kicked out of the Society for Assisted Reproductive Technology, which in turn affects whether insurance covers their services. But the guidelines, revised in 2006, do not have the force of law.

Some countries, including Britain, do restrict the number of embryos.

Q: What occurred in Suleman's case?
A:
Suleman said she had six embryos transferred for each pregnancy. Asked by NBC how many were implanted, she said: "The same as with the others, six." That would suggest that two of the embryos split, resulting in eight infants. She previously had twins.

Q: Can they reduce the number of embryos if there is a multiple pregnancy?
A:
Women found to be pregnant with several babies are given the option of aborting some of them to reduce the risks to the mother and the fetuses and increase the chances the others will survive. Suleman said in the NBC interview that she had been told about the risk of multiple births, and didn't want to reduce the number. "Oh no. Sometimes we have that dream and that passion and we take risks, and I did, and it turned out perfectly," Suleman said.

She said she used the same fertility specialist for all the births; the doctor has not been identified. The Medical Board of California is investigating whether there were any violations of medical standards by the fertility doctor.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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