Infertile patients cannot afford to wait for treatment while their eggs get older.
Dr. Sherman Silber, Infertility Center of St. Louis, is offering free 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 via 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 free 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.
“Infertile couples from all over the world come to St. Louis, Missouri, to chase their dream, because Dr. Sherman Silber and his team are simply the best there is.” –Discovery Health Channel Documentary
FIGURE 3: The decreasing follicle pool and age-related decline in female fertility.
While I have written that it is easier to get pregnant when you’re younger than when you’re older, we have developed a wonderful new method for getting pregnant with your own eggs even at an older age. I have urged women in their thirties not to delay high-tech treatment until it is too late. I’m going to turn around completely now and point out that if you have completely run out of eggs it is really still not too late to have a baby. All that is needed is an egg donor, and you can still carry your baby in your late forties or fifties, or even sixties.
I recently saw a woman in her forties who first got pregnant seventeen years ago, and because she was not married had an abortion. She went on the birth control pill for ten years and finally fell in love and had a happy, stable marriage. She had been trying unsuccessfully to get pregnant in that marriage for six years. She had irregular, occasional periods and was clearly about to go into menopause. We tried our best IVF & Mini IVF protocols but she just was completely out of eggs. When I delicately suggested the idea of giving up on her eggs and using a donor, she surprised me with her complete absence of anguish. She jumped up with excitement and told me immediately that she had two or three very good friends in mind who were in their early thirties who she felt would be happy to donate. Sometimes one can find close friends or younger sisters who are more than happy to donate an egg. However, in the vast majority of cases, we have to find and match egg donors for such patients. This is not difficult for us to do and the wait is never more than 3 months. We are very good at this.
NATURE VS NURTURE
Naturally, if you receive a donor egg, the genes of the baby will be a combination of your husband’s genes and those of the woman who donates the egg, even though you will carry the baby for nine months and deliver it. What are the psychological consequences of your carrying a baby that is genetically not your own? In fact, how will the baby develop regarding personality., intelligence, character, emotional competence? This has been asked since 1983, when the first case was reported in Australia. I can say unequivocally that carrying that baby for nine months results in a solid, loving bond between the mother and the child, regardless of the genetic origin of the donated egg. Donor eggs never have led to any problems, in our experience. The fact that the child has been carried for nine months in the uterus results in solid bonding between mother and baby, regardless of the genetic origin of the egg, and this results in a child that is just like your own.
Most of the development of personality, character, intelligence, emotional security, and even athleticism begin with the parent in the first three years of life. The DNA is just the house the person lives in. But the person which that baby becomes develops in the earliest months and years of life. He or she is learning those first several years and their brain is developing faster than any other times in their lives. Their BLANK personality develops independently of their DNA. The wives naturally understand this and no donor eggs are no problem after they think about it and the men have no issue because it is their sperm anyway. Of course, everyone wants their child to have their DNA, not a stranger. That is why we have become so good at helping older women and women with very few eggs get pregnant with their own eggs. But in some cases, the woman is simply out of eggs completely. When that is the case, donor eggs are a very good (though at first strange seeming) option.
IT IS THE AGE OF THE DONOR AND NOT THE AGE OF THE RECIPIENT THAT MATTERS
Much older women (late forties and fifties) have no difficulty getting pregnant (greater than a 50 percent pregnancy rate per cycle) so long as the donor eggs come from young women. The age of the uterus is not what is significant in the high pregnancy rate of these patients, but rather the fact that: 1) the eggs came from healthy younger women, and 2) the recipient’s only infertility problem was that she had run out of fertile eggs. With these two operative factors, pregnancy rate usingIVF and donor eggs in menopausal women is over 50 percent per transfer, and when frozen extra embryos are BLANK with BLANK over 95%, no different than what one would expect in younger women. The main determinant of pregnancy rate is the age of the woman from whom the eggs originate.
Women as old as sixty-three years of age have gotten pregnant quite easily with egg donation and have delivered healthy, happy babies. The oldest mother on record was reported by Dr. Richard Paulson in April of 1997. Dr. Paulson normally will not perform egg donation for women over fifty-five years of age, but this healthy-looking sixty-three-year-old woman successfully lied in order to get into the program. Although she was only two years away from being eligible for Medicare, she had no trouble conceiving and carrying the pregnancy normally because the eggs came, of course, from a younger woman.
Many of these older women getting pregnant with egg donation have multiple and often large fibroids in the uterus. These fibroids completely distort the uterine shape, and in prior decades they were thought to be a cause of infertility. On the basis of the ease with which these women become pregnant with donor eggs and deliver healthy babies, it is now apparent that the vast majority of uterine fibroids, no matter how large, have no effect on a woman’s fertility, and should not be overzealously operated upon. In fact, the only fibroids that should be removed for fertility are those that are indenting the cavity of the uterus. But removing fibroids is an easy operation and certainly can be removed before the embryos are transferred, again it is the age of the egg that matters.
Many women in their late 30’s and early 40’s who have run out of fertile eggs initially resist adamantly the suggestion of using donor eggs. They may insist on going through one unsuccessful IVF cycle after another, unwilling to even consider donor eggs. Eventually, years later, most of these women request donor eggs. Many of these women become like personal “friends” of the clinic because we come to know them so well. Despite years of negative feelings about the idea, all of them are overjoyed when they finally have a baby via donor eggs. We have no unhappy experiences with this.
FIND THE DONOR
It is not difficult with nationwide screening to quickly find the right donor for you, that you will be happy with. It is usually better for this to be anonymous. The egg donor should not know who the recipient is and vice versa. This is your baby and the egg donor is making nothing more than a donation. The donor feels better that way and the recipient also does. This privacy is guaranteed by our laws and also guarantees that the “intended” mother is the mother no matter where the egg came from.
In 1980, I received a very sad letter from a 25-year-old woman in the Bronx, New York, saying that when she had surgery for uterine fibroids, the doctor had to perform a hysterectomy, and she lost her uterus. Now she desperately wanted to have children. Unfortunately, at that time, I had to write to tell her there was no hope. I had predicted in my original book in 1979 that with the “new” in-vitro fertilization technology on the horizon, perhaps at some time in the future a woman without a uterus could have someone else carry her genetic child for her. But by the time this futuristic medical prediction became a reality, this lady had already run out of eggs and was in menopause. (Of course today we can solve that problem, too, as you have seen in the first part of this section). It is a readily available, beautiful solution in the U.S.
HISTORY OF GESTATIONAL SURROGACY
In 1985, Dr. Wolf Utian and Dr. Leon Sheehan from Cleveland reported the first successful case whereby a woman with no uterus whatsoever was able to have her own genetic child. The story of that first case, reported in the New England Journal of Medicine, was absolutely spellbinding: A thirty-seven-year-old woman became pregnant, but the uterus spontaneously ruptured at twenty-eight weeks of gestation, necessitating a cesarean section and a hysterectomy. The baby girl subsequently died and the woman was left childless and without a uterus. The couple, however, remained strongly committed to having their own genetic child and the wife asked that an embryo of hers be transferred to the uterus of a friend who was interested and willing to carry the child as a surrogate. The friend was a healthy, married young mother of two. The reproductive cycles of the two women were synchronized (this will be explained later). The patient’s eggs were incubated with sperm from the husband, and three days later an eight-cell embryo was transferred to the uterus of the surrogate. The surrogate became pregnant and nine months later delivered the healthy genetic baby of her ecstatic friend.
At the American Fertility Society meeting in 1986, a lady introduced herself to me and thanked me for the prediction that I made in my original book about gestational surrogacy. She told me it had prompted her to go to the in-vitro fertilization program in her community where she told them what she would like. Performing this kind of procedure is so simple that it turned out not to be a problem, and indeed, when I saw her at that meeting, her best friend was already pregnant with her genetic baby and ready to deliver and give it to her.
WHAT IS THE LEGAL PROTECTION
Laws now in the United States are very clear and strict that the intended parent is the parent. If it is her genetic baby, then she has every right to it. The egg must come from a source other than the surrogate, therefore a surrogate for another couple must not be the egg source also. That is, to be a surrogate, a woman must not be the genetic mother. Similarly, if there is an egg donor, the egg donor must not also be the surrogate. The common laws are very consistent with what makes biological and psychological good sense and completely protects the intended parent and the surrogate.
In the 1908s, one of our earliest surrogate cases was 27-year-old woman who had lost her uterus from a hysterectomy necessitated by severe bleeding occurring in her previous pregnancy. The only way the doctors could save this young woman’s life from this obstetric disaster was to remove her uterus. Yet she had normal ovaries and her husband had good sperm. What was the solution? As it turned out, her 48-year-old mother was quite willing to serve as a surrogate uterus to carry her daughter’s baby. Their menstrual cycles were synchronized with birth control pills so that day one of the mother occurred simultaneously with day one of the daughter. The daughter was stimulated in the usual fashion for in vitro fertilization, her eggs were fertilized with her husband’s sperm, and her embryos were transferred into her mother’s uterus. Astoundingly, the 48-year-old mother became pregnant with her daughter’s twins. Nine months later, she gave birth to two healthy grandchildren whom she then immediately turned over to her daughter and son-in-law.
HOW IS IT DONE?
Although the gestational surrogacy procedure is medically simple (now that you have read the rest of this section, and understand howIVF technology works), I will outline the methods we use for synchronizing the cycles of the donor and recipient. This work had been going on for decades in cows before we applied it to humans. Embryos from highly prized cattle would be placed into the uterus of very low milk-producing cows, who would then give birth to prize heifers. Since embryos could be obtained every month, a prize cow could deliver twelve heifers a year via the uterus of surrogate cows rather than just one prize heifer a year. This vastly improved the efficiency of milk production in the world. Every time you go to the grocery store and notice how relatively inexpensive nature’s most perfect food (milk) is, realize that it is partly because of these reproductive advances.
In humans, the synchronization is a little more difficult than in cows. Both women are placed on birth control pills. These pills, started at the beginning of the follicular cycle, put the women “on hold” and can be discontinued at the same time for both of them. The key factor in synchronizing the cycles of donor and recipient is that the recipient must start on progesterone injections one day after HCG is given to the donor. The purpose of synchronizing the donor and recipient is that the endometrial lining of the recipient must be at the stage of development in the monthly cycle where it is receptive to implantation of the embryo at its stage of development.
You will see our protocol for synchronization, whether it involves a surrogate uterus or an egg donor, two clinically opposite situations. For both situations, this synchronization schedule works quite reliably. Both the donor and recipient are put on birth control pills to synchronize their cycles. The recipient also goes on Lupron so as to completely suppress her pituitary. On the first day the donor receives gonadotropin, the recipient starts on Estrace (an oral, absorbable form of natural estrogen). The recipient’s Estrace dose is 6 mg per day. Often an estrogen patch is also used to guarantee that an adequate uterine lining forms. The length of the artificial follicular phase during which the recipient is on Estrace and the patch is not important; the only significant factor is when she goes on progesterone. Whenever the donor receives HCG, which is often (but not always) on the tenth to twelfth day after gonadotropin has begun, the recipient starts on progesterone one day later.
This always allows the synchronization to time out perfectly for embryo replacement into the recipient. Keep clearly in mind that the donor-recipient synchronization is exactly the same whether this is the case of a gestational surrogate recipient, or in reverse, of a donor giving eggs to a patient with a uterus who has no viable eggs of her own.
Please recognize that legally you are completely protected, whether using donor eggs or gestational surrogates. The reason is that the basic rule is that the intended parent is the parent. So, therefore, whether you are using a donor egg from someone else, or you are putting your eggs into someone else’s uterus, the intended parent is always the legal parent.
IN THE WORDS OF THE PATIENTS:
We take great pride in our staff, medical expertise, continual exploration to find new solutions to infertility, and mission to help those who often feel that there is no hope in having a child. Often, the most valuable information we can share is the words of our patients. Here are just a very few of the countless reviews our clinic has received:
“I owe Dr. Silber my whole world! His expertise and skill played a major part in my son Liam’s existence. As a single woman of 33 who initially visited Dr. Silber to just evaluate my fertility and who soon realized I had to act quickly to take advantage of the few remaining eggs I had left, I experienced nothing but support and encouragement from Dr. Silber and his office staff. The curse of infertility is a painful, difficult and heartbreaking situation to deal with and one that is unfortunately far too common. When time and money are of the essence and one’s impatience must be dealt with, it is comforting to know that you can trust and rely on your doctor’s years of experience and know-how to see you through. Through three mini IVF cycles, two successful retrievals, one miscarriage and one wondrous birth I can attest that miracles do happen! Miracles that get a little assistance from an amazing and genius doctor in St. Louis!”
“Thanks to Dr. DeRosa and Dr. Silber I now have a beautiful, healthy baby girl. At the age of 40, I got married for the first time and was ready to start a family. After six months of trying to conceive with no luck, I had a meeting with Dr. DeRosa who did an ultrasound to check my ovarian reserve. He found that my reserve was very, very low. Dr. DeRosa suggested that I meet with Dr. Silber to discuss IVF options.
At the age of 41, I started the mini IVF procedure. In a year’s time, we did three mini-IVF cycles and ended up with two good embryos. I had the two embryos implanted and one developed into a full-term pregnancy. Our baby girl is so beautiful and healthy – I couldn’t have asked for more! And we could not have done it without Dr. Silber and Dr. DeRosa’s help!”
“After being diagnosed with cancer and going through chemo my wife and I could not get pregnant despite our best efforts. Dr. Silber and his team are passionate about the care they give and walked us through the process every step of the way. Our nurse coordinator Mindy responded to each and every question that we had (which was a lot) thoroughly and immediately. We never once felt like we were navigating the many steps of IVF alone, which allowed us to relax during a stressful time. We were blessed with a beautiful baby girl after one round and cannot thank everyone enough!”
“Im looking foward to doing mini ivf with Dr.Silber in a couple month’s, i pray we are able to bring healthy baby into this world. So far i have nothing bad to say about him or his team!! Ill update my status after the procedure is complete!”
“Dr. Silber and his office are AMAZING! They are the best in the field and everyone is so nice and easy to work with. I knew we were at the right place during our consultation and meeting with Dr. SIlber. We were able to get pregnant with our twins on our first round!! We will be forever grateful to Dr. Silber and his team for helping us grow our family.”
“Thank you to Dr. Silber and his team for making our dream come true. The experience with the office staff was great. Stacy our coordinator was extremely helpful and patient. Dr. Silber is straight forward, he is an expert in his field. Thankfully, we were able to do one round of invitro with two embryos and we now have one beautiful baby boy. If you need invitro services/support, Infertility Center of St. Louis is definitely the place to go.”
“I would like to thank Dr. Silber, his staff, and St Luke’s Hospital for our opportunity on our daughter. I have children of my own but my husband did not. I had my tubes tied and untied twice. But with maternal age and maybe a little on the hubby, we was unsuccessful in getting/staying pregnant. With two miscarriages and myself getting older it was time to look for help. Dr. Silber was confident in what he was doing or he would make it right (as much as he could). It took us two tries before we got our big fat positive and our baby girl is perfect!! Again Thank You and I recommend him to everyone!!”
“Just wanted to thank Dr. Silber, Dr. DeRosa and staff for our new baby boy born 1 week ago. We are grateful that mini IVF worked for us!! It was a stressful process but in the end it’s all worth it!!! We have been blessed.”
“Thanks to Dr. Silber & his staff we have 2 beautiful babies girls!!! Had a great experience with IVF – everything was extremely organized & everyone was very kind. We have complete confidence and faith in Dr. Silber, he is the BEST!”
“Dr. Silber and his staff are phenomenal! I had the utmost confidence in Dr. Silber’s abilities and was positive that he would help in making my dreams of having a family turn into a reality. Not only did I have success once, but twice! I would not have wanted to go through this experience at any other center. Everything worked seamlessly.”
“We are extremely grateful for Dr. Silber and his team for providing us with the opportunity to have children. It’s easy to see that Dr. Silber is passionate about infertility and giving people a chance to have children who might not be able to otherwise. While we were in St. Louis, we received the utmost care and were treated as though we were their top priority. Their kindness and care comes second to none. We were very comfortable throughout the process because we always knew what was next. We were always told in great detail of what was happening now and what will happen next. It was very reassuring to know what laid ahead of us and to know that there was always someone there to guide us and answer any questions we had. We will be forever thankful for Dr. Silber and everything he and the wonderful folks at St. Luke’s have done for us. We will continue to share our story with others and hope that we inspire those who struggle with fertility to visit Dr. Silber.”
“We got what we came for. A healthy baby girl! Thank you, Dr. Silber and DeRosa. Great staff!”
“I married my high school sweetheart after dating for 11yrs. We were married at least 5yrs. We tried having a baby on our own for several yrs. I had tried herbs to help me it helped but had a miscarriage within 2-3 weeks of being pregnant. We then decided to try IVF here locally (Louisville, KY). We went thru 2 frozen egg transfers both eventually failed within a month. We then decided to take a break and tried again on our own. The next following January 2016 we found Dr. SILBER’ S CLINIC. We read and watched his video’s and had a great feeling about this place. We immediately called and setup a consult with Dr. SILBER for January. He read thru our history and immediately stated he believed it’s a chromosome inversion in one of us, but wanted us both to get blood tests to be sure and which one of us it could be. He made us feel like we still had hope of having a successful pregnancy. Found out I (Jessica) had a chromosome inversion. The chromosome inversion is what was causing my miscarriages. Stated my inversion only gave about 15-20% of my eggs to be healthy. Dr. SILBER stated all we would need to do is have ALL my eggs that they retrieved to be tested. This way they know which eggs are healthy to be successful candidates for egg transfer. That March we had our egg retrieval and 5 out 7 eggs were healthy to candidates for frozen egg transfer. That May 2016 we had our egg transfer. JANUARY 2017 our dream came true!! We had a extremely strong, active and healthy son. Dr. SILBER and his whole team made us feel like family. Each staff/ team member was very organized, extremely nice, very educated and easy to get a hold of for anything thru this entire process. We are planning on going back in near future to give Oliver a brother or sister. Reccommend Dr. SILBER and his team to everyone!”
“I began working with Dr. Silber to ensure a future family beginning with my cancer diagnosis in 2006…11 years ago. HE IS A PIONEER! He, his associates, and staff are, in a very large part, responsible for our little family. It is not uncommon to sit in a waiting room at St. Lukes Hospital in St. Louis along with other Silber patients from all over the country and world who have come to finally try Dr. Silber when other agencies have failed them tens of thousands of dollars later. These firsthand testimonies are perhaps Dr. Silber’s strongest accolades. He will take the time to answer your questions and explore possibilities with you. If you are struggling with infertility, I strongly recommend you reach out and schedule an appointment with him. You will be impressed with his extensive knowledge, experience, and network. He maintains nothing but the most professional, courteous, and compassionate staff.”
“My husband and I got married later in life. I was 33 and Patrick was 37 at the time. We both knew that time was starting to go against us when it came to starting a family. After about five months of marriage, we began trying to conceive. A few months in with no success, I was at my normal well woman check-up and made a comment that my ovulation tests were never positive. This raised concern and my doctor started me on Clomid. (Yes, the dreaded Clomid that made me a crazy person haha!) One month, two months, now five months on this medicine and still no success. Plus, now we had the added stress of this becoming more like a job than fun and my husband having to live with a crazy woman. We were then referred to Dr. Pineda for more extensive help. After a lot of tests and visits, Dr. Pineda informed us that my case was more severe and I would need IVF to conceive. We were referred to Dr. Silber. Luckily he had a cancellation and we were in his office within the week! Upon our first meeting, Patrick and I knew we were in the right place. Dr. Silber took time with us one on one to answer questions and explain processes. He was also the first doctor to diagnose me with PCOS which helped explain a lot of unanswered questions and concerns. Patrick and I set up our IVF egg retrieval and transfer dates. We worked with Mindy extensively on administering drugs, ultrasound and bloodwork appointments, payment methods, and making sure we understood what was going on. She was always attentive and available and we never felt like a bother. Our egg retrieval went well. However, we still felt we had some questions and needed some clarification on things. Patrick called the office and Mindy got us in to meet with Dr. Silber one on one immediately. Having him take the time to explain things to us was wonderful. He has a very caring demeanor that made us both comfortable. After weeks of shots, medicines, ultrasounds, and bloodwork, we completed our first transfer of two embryos. We were so excited and ready to share our news that we were finally going to be parents. Unfortunately, on my birthday we got the call from Mindy with the heartbreaking news that this didn’t work for us. She was extremely compassionate and kind but the news sent me into a dark place. I began to slide into a depression. Our world was turned upside down. Our savings was dwindling, Patrick had a wife who never smiled and couldn’t think of anything except for the fact she couldn’t be a mother, and our relationship was being pulled apart at the seams. Again, Dr. Silber found time to meet with us one on one. He talked us through options moving forward and ways to cope with the difficult situation we found ourselves in. That meeting meant the world to me. It gave me the strength to say I believe in this doctor and I want to try again. Mindy got us on the schedule for the soonest possible time we could transfer. After more shots, and medicines, and stress we completed another transfer of two embryos. It was the longest two weeks ever waiting for those results. I remember shaking when I saw Mindy calling and not sure if I would be able to handle more bad news. Fortunately for me, her news was great! We were finally going to get the greatest gift ever- we were going to be parents! Patrick and I just welcomed our little baby girl, Harper Grace Durham, to the world on October 22, 2017. We couldn’t be happier!! All of the struggles and heartache seem to have just disappeared. Without Dr. Silber and his staff, we would not be where we are today. We are forever grateful for their compassion, attention, and medical expertise throughout this entire long and fatiguing process. Thank you Dr. Silber and staff for making our dreams come true!!!”
“Dr. Silber is one of the very few IVF experts in the US who really knows reproductive endocrinology well. He’s the pioneer of fertility preservation and still leads the trends in this area. He and his team are totally dedicated to providing holistic care to the patients, and they are always updating their treatments by the best up-to-date evidence. They are very sensitive to the feeling of the patients and their family, and they are constantly supportive while patients are enduring the stress from infertility and even cancer treatments. They are the best!”