SHANTI AND PATIENT: At UAMS.
Three out of four women patients of the in vitro fertilization program of the University of Arkansas for Medical Sciences in the last year have produced what’s called a “take home baby” — a healthy baby.
The percentage is a huge jump from the 39 percent pregnancy rate the clinic reported in 2001, the last year data is available from the Centers for Disease Control in Atlanta, which monitors artificial reproduction techniques.
The reason for the success is, medical director Dr. Aida Shanti believes, is the individualized treatment she designs for each of her patients.
An IVF specialist for eight years, Shanti said, “I think it’s a very intellectual specialty, to be honest with you. You use your brain a lot. … You can’t look at a book” and find a protocol that fits all women, no matter what age or reproductive concerns.
Shanti, 43, came to UAMS last July from Atlanta, where she directed the in vitro fertilization (IVF) program of the Emory Center of Reproductive Medicine and Fertility. The Jordanian native — she’s lived in the United States for more than 20 years — brought with her firm ideas on what the UAMS IVF program should look like and where it should head. She’s working to create a state-of-the-art laboratory that offers genetic testing and to expand the clinic’s patient load.
Shanti also wants publicity — she thinks the public needs to know that the ob/gyn staff at UAMS includes some of the best maternal-fetal physicians to be found anywhere.
“I like a challenge,” Shanti said, and a challenge is what she got when she arrived at UAMS, which had lost its two well-known infertility specialists to private practice.
The last cycle of IVF patients seen by Shanti (they’re treated in groups as a cost saver), in which 18 embryos were transferred, produced a “take home baby” rate of 86 percent.
Healthy women 32 and under have a 25 percent chance of getting pregnant every month. Out of 100 couples trying to conceive, 80 percent should be successful within a year, and 90 percent within two.
Shanti and her staff at UAMS evaluate couples who’ve been unable to get pregnant after a year of trying (or six months for women 36 and older), looking for such conditions as endometriosis, tubal blockages or other problems in the woman and sperm production in the man. Treatment starts with the simplest answers — such as stimulating egg production with medicine. IVF is usually a last-resort technique unless a woman is suffering from a blockage in the fallopian tubes that shuttle eggs from ovary to uterus.
When IVF is required, eggs are retrieved from the ovary via the vagina in a simple 10- to 15-minute procedure in the operating room, Shanti said. An egg and 10,000 sperm are placed in a petri dish stew of proteins, antibiotics and other nutrients. Should the combination fail to produce an embryo, Shanti can isolate a sperm and inject it directly into an egg. IVF knowledge is now wide enough that Shanti transfers no more than two embryos into women 32 and under, and no more than three into older women. More embryos were transferred in the past to increase the chance of success — but the chance of multiple, riskier pregnancies also increased.
Different stages of development call for different media in the petri dish, and it is better knowledge of what the medium should be composed of that accounts for much of the progress in IVF, Shanti said.
Even when the outcome is good, going the IVF route to become pregnant can be traumatic to patients. “Every experience is so emotional,” Shanti said, that they remember every detail of the process. Knowing this, Shanti said teamwork is crucial, and the staff “has to be — how do I say? Fuzzy, warm and fuzzy.” Even the waiting room must be welcoming.
An Atlanta focus group Shanti observed from behind a glass wall included eight women who’d become pregnant via IVF and “were totally miserable” for various reasons, including the fact that no one in the office congratulated them on their successful pregnancies.
But along with warm and fuzzy comes honest and direct. “I don’t coat things with sugar. … In the long run, it is better to put everything on the table.” A patient may be upset, cry — but they will remember that “you were honest with them and never betrayed them,” she said.
Shanti has also brought to Little Rock an open mind. In Atlanta, she designed a double-blind clinical trial to test the effect of acupuncture on fertility after she read about similar work in the Netherlands. She initiated the study after learning from a colleague of a woman who’d sought treatment for a sore shoulder in Atlanta’s “Chinatown” and had been warned by her acupuncturist that he could help her shoulder, but that if he did, she might get pregnant. Two months after her shoulder therapy, she became pregnant with twins.
Shanti struck a deal with the Chinatown acupuncturist for a small study with her medical group and others in Atlanta. The result: Patients who’d been treated with acupuncture had a 10 to 15 percent higher pregnancy rate than those in the control group.
(There is research that indicates acupuncture relaxes blood vessels, and improves blood supply to the ovaries.)
As yet, Shanti has not found an acupuncturist in Little Rock to work with. However, she does recommend therapies that may sound unusual, though they’ve been tested — like raw honey for women with endometriosis, a condition that renders 30 to 40 percent of its sufferers infertile.