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Infertile patients cannot afford to wait for treatment while their eggs get older.

Dr. Sherman Silber, Infertility Center of St. Louis, is offering video consultations for patients who need to plan now for their treatment while stay-at-home orders are in place. He is talking to and evaluating patients in their home to comply with social distancing measures.

Dr. Silber is discovering that patients actually prefer this method of telemedicine consultation over the conventional office visit. Patients have conveyed that “it is so much more convenient and less stressful” to have a telemedicine personal consultation than to take a day off from work to travel to the doctor’s office and sit with other nervous patients in the waiting room.

The COVID-19 pandemic is thus changing much of the way we will do things in the future, and for the better. “Our patients are surprisingly much happier with this approach. Of course, at some point we need to perform hands on treatment. But with this new manner of seeing patients, we can come to the right diagnosis and treatment plan for most patients more efficiently, quickly, and painlessly, with no loss of personal one-on-one communication.” This is a very welcome new era of telemedicine that has been forced on us by the current difficult times.

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The Infertility Center of St. Louis
The Infertility Center of St. Louis
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IVF Success at 40: Mini-IVF Boosts Baby Rates at the Infertility Center of St. Louis

In this focused explainer, Dr. Sherman J. Silber demystifies how women about age 40 achieve markedly higher pregnancy rates at the Infertility Center of St. Louis than at most clinics. The secret, he says, is a refined “Mini-IVF” protocol that flips conventional wisdom: instead of flooding the ovaries with high-dose gonadotropins, his team uses a leaner combination of clomiphene, low-dose FSH, and an antagonist. The gentler stimulation often yields fewer oocytes per retrieval but of superior genetic and metabolic quality. Across one to three cycles, patients typically obtain three blastocysts—or six day-3 embryos—sufficient for multiple transfer attempts.

Silber cites internal data showing a 60% live-birth rate for 40-year-old patients—roughly three times the national average for this age bracket. Two additional practices boost those odds. First, every embryo is cryopreserved using vitrification; no “fresh” transfer occurs. This freeze-all approach permits chromosomal testing if desired and, more critically, allows the uterine lining to be primed in a later, medication-light cycle, synchronizing endometrial receptivity with the embryo’s developmental stage. Second, embryo transfer is delayed until the lab confirms an optimally prepared lining on ultrasound and serum progesterone testing, avoiding the hormonal chaos that can accompany stimulation.

Silber credits early collaboration with Japanese pioneers—where Mini-IVF originated—for perfecting dosage, timing, and luteal-phase support. Side-effect profiles improve as well: patients report less bloating, lower OHSS risk, and reduced out-of-pocket drug costs. The overarching message is empowering: women in their forties, often told their chances are slim, can attain success rates once thought exclusive to younger cohorts. Fewer drugs, higher-quality eggs, vitrification, and precise endometrial timing form an evidence-based pathway to parenthood that balances safety, affordability, and efficacy.