Sarah Goldman and her husband wanted to start a family, but because of his spinal cord injury, they knew they wouldn't be able to conceive traditionally. The Greenville, North Carolina, family looked at fertility clinics close to home, but after asking around they chose the Duke Fertility Center and fertility specialist Tom Price, MD.
“Even though it’s a two-hour drive, we thought it was definitely worth it,” Goldman says. “We’d heard such great things about Duke, and Dr. Price was a wonderful doctor. The whole team was great. The in vitro fertilization [IVF] coordinator explained everything very thoroughly, and everyone was so friendly.”
It’s that high-quality care and teamwork that attracted Suheil Muasher, MD, a reproductive endocrinologist and leading infertility specialist from Johns Hopkins, to join the Duke team. A contributor to more than 180 research studies and chapters in medical textbooks, Dr. Muasher is a popular speaker internationally.
In fact, Dr. Muasher is considered an authority in hormonal regulation in IVF cycles and brings to the Duke Fertility Center a new option for women and infertile couples. Dr. Muasher suggests couples talk to their physicians and consider that a less-aggressive, nontraditional option--called mild/minimal-stimulation in vitro fertilization--might be right for them.
Traditionally, IVF is started by giving a woman hormones to produce multiple eggs. In a woman’s regular cycle, these hormones—such as follicle-stimulating hormone and luteinizing hormone—usually stimulate the release of one egg at a time. With IVF, the high-dose stimulation can help women produce about 20 to 30 eggs. The eggs are then fertilized in the lab and transferred to the uterus. Usually, several embryos are transferred. Ideally, an embryo implants in the uterine wall, and the woman goes on to carry and deliver the baby. The large number of eggs initially produced with this process can increase the odds of successful fertilization and pregnancy.
But there can be challenges with aggressive traditional methods, Dr. Muasher says. “Sometimes you end up with too many fertilized eggs and can have a high-risk pregnancy with multiple embryos,” he adds. Another risk is ovarian hyper- stimulation syndrome, Dr. Muasher says. That can lead to extreme bloating, abdominal pain, shortness of breath, and vomiting.
Dr. Muasher suggests women explore all options available to them and consider mild/minimal-stimulation IVF. Using this method, women receive oral fertility medications and low- dose injectable hormones. Instead of producing upward of 20 eggs, mild/minimal-stimulation IVF will result in fewer eggs—about three to 10. “There’s less physical stress on the patient, and the incidence of complications is reduced to almost zero,” Dr. Muasher says.
But aren’t more eggs better? Not necessarily, Dr. Muasher says. There is some recent evidence that suggests that when you use a lot of medication and an aggressive traditional approach to IVF, you may be getting a lot of eggs, but with mild/minimal stimulation, you’ll still benefit from the quality of those fewer eggs. “If you get a large number of eggs but a large percentage is abnormal, you really have not achieved anything,” Dr. Muasher says.
Whichever process you choose, Dr. Muasher says, the fertility center is ultimately the most important decision. “In vitro fertilization is a team process,” he says. “The physicians and genetic counselors see the patient, but the eggs and sperm are managed in the lab, which needs good quality control.”
Several years ago, the Duke Fertility Center became home to one of the few certified ultrapure labs in the nation. The air purification system blocks toxic airborne invaders from harming the fragile sperm, eggs, and embryos inside. Immediately after the completion of the lab, the center saw a 30 percent increase in IVF success rates.
The introduction of mild/minimal-stimulation IVF is a good example of how Duke Fertility Center is dedicated to leading the way in medical advancements. That dedication has paid off for couples seeking to have babies—the Duke Fertility Center has an impressive implantation rate that is well above the national average.
In July, Goldman and her husband found out she was pregnant. “We’re so excited,” Goldman says, “and definitely grateful to Duke for getting us to this point.”
Patients’ names in this story have been changed to protect their privacy.