Any woman who has gone through fertility treatments knows that one of the toughest challenges (besides desperately wanting a baby and knowing all too well that these costly treatments do not guarantee success) is dealing with the fertility drugs. I mean the side effects, the hassle of injecting yourself with the stuff, and the expense.

For years, I had read sporadic reports showing that lower doses of hormone drugs are not only safer but yield the same results. In other words, your chances of becoming pregnant are just as good with fewer drugs than with a lot of them.

So why aren't doctors changing their ways? Well a few are. But there are plenty of fertility specialists who seem to be stuck in their old habits of high-dose drugs. Or perhaps, they are afraid that if they cut back on the drugs, it will lower their pregnancy rate-despite evidence to the contrary. And that will hurt their overall success statistics. The fertility business is highly competitive. Clients, who are doling out thousands of dollars, are likely to compare success rates among centers. Or perhaps, women are afraid to cut back on the drugs for fear they won't make babies.
And so I was so relieved to hear Dr. Suheil Muasher, a professor of obstetrics and gynecology and director of the Muasher Center for Fertility and IVF-and a world renowned fertility expert-tell a group of experts who gathered for a conference at Johns Hopkins recently, why they should all be choosing the low-dose regime. The details of his talk were outlined in an article published this summer in Fertility and Sterility.

Hormone drugs make women spew lots of eggs in one cycle, instead of one egg per month without any drugs. Low-dose drugs yield about 10 eggs or fewer per cycle. High dose drugs trigger upwards of 20 eggs in one cycle.

No surprise that higher dose drugs increase the risk of hyper-stimulation of the ovaries, which at its worst prompts ovarian rupture and death. The risk of death is about 3 in every 100,000 cycles of IVF-which means, added Dr. Muasher, that in the US there are 4 patients who die every year due to ovarian hyper-stimulation but they are not reported in medical journals. Milder bouts of hyper-stimulation can cause bloating, nausea, weight gain, and abdominal and chest pains.

When doctors use the high-dose routine, they often start by giving women a drug that knocks out their normal sex hormones, so they can start from scratch. This process often causes menopausal symptoms, such as hot flashes, vaginal dryness, and headaches.

Dr. Muasher pointed to all of the studies showing that lower doses of the drugs were just as effective as using higher doses. One study, for instance, included 142 women divided into three groups. One group got standard high-dose therapy and the other two got varying low-dose regimes. The upshot? The pregnancy rates were about the same-all about 30 percent. At Muasher's Virginia clinic, he said that the pregnancy rates are slightly over 30 percent regardless of the amount of drugs used. (Some women still opt for the high-dose regime either because they want a lot of embryos to freeze or because they want a lot of embryos to do pre-implantation genetic diagnosis.) 

What's more, Dr. Muasher added, eggs and embryos from women who got high doses of medications are more likely to have chromosomal abnormalities compared with women taking lower doses of the drugs. No one knows why. "The issue is that the pregnancy rate is not only the
same with low dosage but there are adverse effects with high dosage," said Dr. Muasher.
Success aside, low-dose drugs saves thousands of dollars. One cycle of IVF drugs using high-dose drugs is about $8,000 for the drugs alone. Low-dose drugs, about $1,000.

During Muasher's talk, he showed a chart from Holly Finn's fertility memoir, The Baby Chase, that lists the shocking amount of drugs she was given each cycle. And, as of the book release, she was still not pregnant. As Dr. Muasher said, "this reminds me of the Food Network. Some of the chefs are trying to prepare a meal and they put in so many ingredients-a little ground pepper, parsley, and on and on, until the meal can't taste that good. Honestly. I prefer the French way. Very simple. Same with fertility. A few good ingredients. That's all you need. You don't need to add all of this mess."

You would think that women who have banded together for lesser surgery for breast cancer, and years before that, for a patients bill of rights, would start to join hands to convince fertility doctors that we do not need to be over-dosed to make a baby. We want healthy pregnancies and healthy births-and we'd like to do it with as few extra costs and side effects as possible. I hope that we don't need marches or races or protests or pink ribbons to convince the power-that-be to make the wisest choices. Or maybe it just takes every informed woman to start spreading the word to other women, and to start talking to her doctor asking the right questions. Here's a starter: Why do I need this particular dose of drugs? Is it just as effective to use less?

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