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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.

Cold Comfort: Young Women with Cancer Can Freeze an Ovary to Keep Kids in the Picture


by Katie Moisse

Scientific American
February 2010

More recently, a relatively new procedure can preserve fertility by removing and freezing the “biological clock” itself: The ovary.

Before starting cancer treatment, one walnut-size ovary is removed in a 30-minute, minimally invasive laparoscopic procedure. The tissue is then cut into pieces the size of rice grains and flash frozen in liquid nitrogen at temperatures nearing –200 degrees Celsius by a process called vitrification video

After the treatment regime is completed, should the survivor choose to become pregnant, the tissue is thawed and re-implanted video onto the surface of the remaining ovary or the ligament next to the fallopian tube. Four months later—the time it takes for thawed primordial follicles (the functional units of the ovary) to mature and start ovulating—the survivor can conceive without hormones and in vitro fertilization, making the procedure a “natural” and effective way to preserve fertility in young women and girls with cancer, says Sherman Silber, director of Saint Luke’s Hospital’s Infertility Center of Saint Louis.

“Five to 10 years down the line these women are going to want to have babies, even though when they’re 19 they’re only thinking about their cancer,” Silber says. Whereas childbearing might not be on the minds of these girls and young women, eager to start their therapy, this quick procedure can keep kids in the picture without interfering with the fight to survive. “We just take out the ovarian tissue and two days later they can start their treatment,” Silber says.

Although the procedure is still relatively new, Silber insists that it is no longer experimental. Nine babies have been born to women who had prematurely stopped menstruating (not all cancer survivors) and later received frozen ovarian tissue implants in his clinic.

But Silber thinks all young patients beginning certain cancer treatment regimes should freeze ovarian tissue regardless of the model. “These young women do lose their fertility. They do become menopausal,” Silber says. “Maybe they do hit menstruation, but they do go into menopause early. Up to 90 percent of young women with cancer will lose their fertility from the treatment that cures them.”

The procedure costs roughly $4,000, according to Silber, an expense that he says should be (and usually is) covered by health insurance providers. “Insurance is paying $200,000 for cancer treatment; $4,000 isn’t too much to preserve fertility,” he says.

In the early days of the procedure (about five years ago) the frozen ovarian tissue was re-implanted under the skin of the forearm (for ease of egg retrieval) where it became revascularized and, under stimulation, resumed its natural role producing eggs, despite the very unnatural environment. The eggs would then be collected from the arm and fertilized in vitro. But Silber says that re-implanting the tissue

at the ovary site where it belongs using microsurgical techniques allows the woman to conceive naturally.

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