RMA third-year fellow Dr. Shelby Neal is going home.
After three years at RMA’s Basking Ridge office as a Reproductive Endocrinology and Infertility (REI) fellow, during which time she handled all aspects of patient care, learned the processes of the andrology and embryology laboratories and conducted impactful infertility research, Dr. Neal is heading back to North Carolina.
At the beginning of August, she will begin work as an Assistant Professor in the REI division at Wake Forest University, an academic medical center in Winston-Salem, NC. In addition to teaching OB/GYN residents and medical students about infertility, Dr. Neal will be seeing patients at the Center for Fertility, Endocrine and Menopause, the clinic associated with Wake Forest University.
“It’s bittersweet,” Dr. Neal said about the move. “I am sad to be leaving RMA, where I have had such an enriching fellowship, but I am happy to be going back to North Carolina, where I have a lot of history and have a unique opportunity to teach and provide care to hopeful parents.”
“It’s an exciting time!”
North Carolina isn’t technically home for Dr. Neal. Born in Baltimore and raised in Maryland until she was 18, Dr. Neal landed in North Carolina for her undergraduate education when she decided to follow in her engineer father’s footsteps and study biomedical engineering at Duke University in Durham.
After she graduated, however, the opportunities on the job market didn’t appeal to her, and she began to reconsider her career path to something that was all three technical, scientific and people-centric.
“I’ve always been really interested in the human body and how it works, and since my favorite parts of my undergraduate degree were my lab experiences, I decided to apply to medical school.”
By that point, Dr. Neal’s family had relocated from Maryland to North Carolina, so continuing her education there made sense. North Carolina became her new home base.
She attended medical school at the University of North Carolina, and while she initially thought she’d go into surgery, she fell in love with OB/GYN during her third year rotation in that department.
“I love this patient population,” she said. “There is something very special about working with women.”
She was matched with an OB/GYN residency program at the Medical University of South Carolina in Charleston, where her husband was pursuing a residency in orthopedics, and dove into the program. She decided about halfway through she had found her calling in REI and wanted to spend her career helping couples conceive.
“Fertility has a huge spectrum of emotions, and to be there for people during this time, that’s what really drew me to this field.”
In 2014, at the end of her third year of residency, Dr. Neal was urged by her friend, RMA’s first fellow Dr. Eric Forman, to think about RMA. Dr. Neal took him up on the offer, and spoke to RMA founding partner Dr. Richard Scott about a two-month research rotation at RMA. He agreed, and Dr. Neal got her first taste of RMA that summer.
“I was in awe of this place,” she said. “Here, it was like everything was going on all at once – doctors were taking care of patients, they had this amazing embryology lab where everything was being done on the cutting edge, and there were so many research projects.”
Dr. Neal’s research during that rotation focused on whether the number of cells removed in an embryo biopsy for Comprehensive Chromosome Screening (now known at RMA as NexCCS) had an effect on In Vitro Fertilization (IVF) outcomes. Dr. Neal wanted to know if the size of an embryo biopsy impacts pregnancy rates following embryo transfer, and her research showed that it does.
“We ended up finding that very large biopsies actually do result in lower implantation rates,” she said. “We concluded that laboratories should exercise quality controls to ensure appropriate size biopsies are being taken.”
After Dr. Neal graduated from residency in 2015, she spent a year working at the Medical University of South Carolina, where she delivered about 300 babies, and had a child of her own, too (she is now a mother of three).
The next step was clear: go back to RMA for her REI fellowship.
“I learned that RMA was not typical of other fellowships,” she said. “The patient volume, mentorship and research opportunities here are unparalleled.”
“There really wasn’t anywhere else that had everything RMA had.”
So in July 2016, Dr. Neal began her fellowship at RMA, touching off three years of invaluable experience in patient care and research.
One of her research projects was the 3D ultrasound study, which involved taking a 3D image of a woman’s uterus the day before her embryo transfer to see if the images could predict IVF outcomes. If they could, perhaps 3D ultrasound imaging could become routine in fertility care, Dr. Neal said.
“We were looking at pregnancy outcomes to see if anything was different in the uterus of patients who got pregnant versus those who did not,” she said. “We wanted to see if there was something predictive we could learn from 3D ultrasound.”
Turns out there were at least two things, which Dr. Neal outlined in papers currently under review for publication. First, the shape of the uterus is important to pregnancy outcomes. Women with a T-shaped uterus, the research found, had a higher risk of adverse outcomes such as miscarriage and ectopic pregnancy than those with a uterus having a normal shape.
Second, the presence of adenomyosis, a condition marked by the growth of endometrial tissue into the walls of the uterus that can cause pelvic pain, irregular bleeding and infertility, is not associated with adverse outcomes following Frozen Embryo Transfer (FET). Dr. Neal presented the initial findings from this study last fall and won an American Society for Reproductive Medicine (ASRM) award.
Dr. Neal worked on another vital study that showed that for women with more than one embryo, embryo genetic testing (NexCCS) saves money, reduces time to live birth and reduces the risk of failed transfers and miscarriage.
When compared to patients who pursued IVF without the testing, patients who used the testing saved between $931 and $2,411, reduced their time in treatment by up to four months, and experienced fewer failed transfers and miscarriages.
Another project she began into the reproductive microbiome is ongoing, and she hands it off to the remaining fellows. That project seeks to better understand the microorganisms that live inside the male and female reproductive tracts in an effort to increase fertility and IVF success.
It’s been an eventful road for Dr. Neal, and one she wouldn’t give up for the world.
“I couldn’t imagine spending the last three years anywhere else,” she said. “I’m so grateful.”
And ironically enough, a little piece of RMA will still be with Dr. Neal in her new home at the Center for Fertility, Endocrine and Menopause: Dr. Scott actually helped design the building where she’ll be treating patients.
“It’s fitting, because my time here will never leave me,” she said. “It sticks.”