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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.

Multiple Sclerosis (MS) Patient

Dr. Jenny Remington-Hobbs is a 31 year old doctor from London, a neurologist, who had come down with multiple sclerosis (MS), one of the most common devastating neurological diseases, which at best has been treated palliatively with anti-inflammatory drugs, but never really cured. MS gradually incapacitates young adults and they wind up in a wheelchair and eventually die of complications of neuro-degeneration.

She came to the United States last year to try a remarkable new curative treatment involving a stem cell transplant similar to what young cancer patients have undergone for many years.

For cancer patients, the idea is to give lethally high doses of radiation and chemotherapy that would obviously kill the patient by destroying all of her bone marrow and blood cell producing stem cells. But the object is to kill all of her cancer cells too. Then to save her life from the otherwise lethal effect of the treatment, blood cell producing stem cells or bone marrow cells are then injected to restore what would otherwise be a total absence of blood cells. This saves her life from the lethal effects of the radiation and chemotherapy that has killed all of her cancer cells. This aggressive treatment, called BMT or bone marrow transplant, or stem cell transplant, has saved countless lives of young patients with otherwise non-curable cancers like Hodgkin’s disease and leukemia. This treatment also renders these cured cancer patients infertile or sterile. So we routinely freeze the ovary of such patients before their bone marrow transplant, and then after they are cured, we transplant that frozen ovary back to them so that they can then regain their otherwise lost fertility.

However such a stem cell transplant can now be use (in a milder fashion) to cure auto-immune disease, and the number one target right now for that treatment is multiple sclerosis (MS). So Dr. Remington-Hobbs had her own blood stem cells harvested and frozen, and underwent otherwise lethal myeloablative chemotherapy to destroy all of her white blood cells, immune cells that are attacking her nerves’ myelin sheaths and causing her multiple sclerosis because they mistakenly “think” her myelin sheath cells are foreign, and need to be rejected. After all of her immune white cells are destroyed by the chemotherapy, then her previously frozen bone marrow or blood stem cells are injected back to her as “naive” pluripotent blood stem cells. These cells then go through her thymus gland, just like happens when we are a fetus and our immune system is first recognizing “self” from “non-self” when we are still in our mother’s uterus. so her “naive” re-injected stem cells undergo a fresh “education”, and her immune system is completely rebooted, so that it no longer misreads her myelin sheaths as foreign, and so her immune system no longer attacks her nervous system as foreign, and she is cured of her MS.

But of course she is now sterile and indeed menopausal at age 32. However, we froze one of her ovaries last year one week before she had her stem cell transplant and chemotherapy. Now in October, one year later, and remarkably cured of her MS, Dr. Remington-Hobbs is flying back to St. Louis from London, to have her frozen ovary thawed and re-planted, so that she will then no longer be menopausal, and will have her fertility restored, so that she can now have children.

This is a remarkable first for millions of people suffering from a previously uncurable disease, MS, and she is now going through the final phase of this treatment, having her ovary transplanted back so that she can now be fertile again.

–Dr. Sherman Silber