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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.

After 25 Years of IVF, Couple Finally Conceives

ABC News Medical Unit

ABC News, January 19, 2010

After more than 20 years and nearly $200,000 worth of failed infertility treatments, Monique and Neil Ward of Stafford, England, have finally became the proud parents of twin boys, Britain’s Press Association reports.

The Wards’ case is certainly the extreme, but it can take many years of IVF for some couples to conceive, fertility experts say, especially if the couple is trying to conceive without the aid of donor eggs.

Dr. Sherman Silber, director of the Infertility Center of St. Louis at St. Luke’s Hospital, shared one example from a colleague in which an Israeli woman went through 31 cycles of IVF before finally becoming pregnant.

In the U.S., due to the high cost of IVF, women are often advised to consider using donor eggs after several failed rounds of IVF given that the odds of conceiving with donor eggs is so much higher.

“It would be extremely unusual for a donor egg not to work” within a few tries,” Silber said, “unless there is a uterine problem,” which usually would have been identified early on in infertility counseling.

“Most of the time the sperm is not a problem,” said Paulson. He said it is more common for the woman to have trouble producing viable embryos.

For the Wards, the quality of the sperm was also an issue because Mr. Ward had had a vasectomy earlier in life which had to be reversed.

Though the odds of conception increase greatly with the use of donor eggs, fertility specialists say women are often very reluctant to give up on the dream of having a child that shares their DNA.

“We deal with 40- and 42-year-old women all the time who absolutely don’t want donor eggs, but the chance is low but not always impossible at age 47 of a woman conceiving a child with her own egg,” said Silber.

25 Years Trying to Have a Baby

When a couple realizes that they will have to have another woman be the biological mother of their child, and pay thousands and thousands of dollars to do it, “the response might be, ‘Well, gee, shouldn’t they just have adopted?'” said Dr. Ellen Clayton, an ethicist and professor of genetics, health policy, pediatrics and law at Vanderbilt University.

“For many people [adoption] is a wonderful choice,” she said, but wanting to carry the child yourself is also “a choice that they ought to be able to make.”

“There is something really special about being pregnant,” she said, “something primal.”

“It’s very different from adopting,” Paulson agreed. “Everyone would rather have a baby from their own egg and their husband’s sperm, but if that’s not possible, the next best thing after that is that you get pregnant with donor egg.”

“With adoption you get to be a parent once the baby is born but with donor egg, you get to be a parent from the moment of conception,” he added.

The mother bonds with the child by carrying it for nine months, said Silber, “and whatever question marks she may have had by it not having her DNA are erased by this bonding process.”

For this reason, he said he has never seen a couple using donor eggs have problems feeling that the child “was not theirs” once it was born.

Quitting Time for IVF?

Pregnancy holds great emotional significance for many couples. But when fertility treatments fail time after time, is there ever a point when couples should be advised to stop trying?

It’s a tough and very personal question, fertility experts say.

“It all depends on the persistence and philosophy and desire of the couple,” said Silber.

“It is so hard to be absolutely definitive in telling someone to quit,” he said, but sometimes the emotional and financial stress of repeated failed attempts can take their toll on couples and dogged persistence is not always the best option.

Ultimately, age can become a factor as well, says Clayton.

One of the recurring ethical issues with IVF is whether it is fair to the children, she says, to have much older parents, considering that a 46-year-old new mother may not live to see her child graduate college or to see her grandkids.

But “a life with a 46-year-old mom that really wants you is better than not living at all or being an unwanted child,” she said. “We need to resist the temptation to demonize [older mothers using IVF] because of their age and their desire to have the sensation of gestation.”

And if they’re willing to “move with the technology” and use donor eggs if needed, Paulson says, it shouldn’t take a quarter of a century as it did for the Wards.

“I really feel that in today’s day and age, almost everyone can become pregnant.”

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