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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
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Dr. Silber Presents Research at Moroccan Fertility Society Symposium

Dr. Silber Travels to Morocco to Present Groundbreaking Research on Fertility Preservation

Sherman Silber, MD, director of the Infertility Center of St. Louis, recently traveled to Morocco to present his latest research to the Moroccan Fertility Society at the 8th International Symposium of the Marrakech Fertility Institute. Dr. Silber was greeted with a standing ovation and gave two very-well received presentations at this world-renowned conference: “Successful Fertility Preservation in Cancer Patients Who Never Had Fertility Preservation” and “In Vitro Oogenesis and IVM From Ovarian Tissue.” Both studies were created in collaboration with Dr. Katsuhiko Hayashi.

Can a woman have a baby after cancer treatment? This research says “yes”

Cancer treatments, including chemotherapy and bone marrow transplants, can lead to early diagnoses of diminished ovarian reserve, premature ovarian failure and early menopause. Dr. Silber’s study focused on fertility preservation for women, including cancer patients, with undetectable levels of anti-Mullerian hormone (AMH).

Working with the hypothesis that compression by granulosa cells induces ovaries’ dormant state, Dr. Silber noted that there are usually a few eggs trapped in the ovary cortex of menopausal women with premature ovarian failure. Because normal eggs can still be found in these women, Dr. Silber attempted multiple cycles of IVF to retrieve oocytes for freezing or fertilization.

At the Morocco symposium, Dr. Silber presented the results of six case studies, in which women facing menopause due to cancer treatment, Turner syndrome, diminished ovarian reserve, and age-related fertility decline were all able to freeze oocytes, despite their undetectable AMH levels.

One young patient, who underwent chemotherapy and a bone marrow transplant at age five and was diagnosed with menopause at 21, was able to freeze 8 oocytes total with 10 cycles of “mini IVF.” Another patient with Turner syndrome was able to freeze five oocytes across four IVF cycles. All of the other case study patients, ages 41 to 47, were able to freeze one oocyte or embryo.

This study proves that ovarian longevity is controlled by tissue pressure gradient. When it appears that there are no oocytes remaining in a depleted ovary, there may be a few that are “trapped” because as the ovarian reserve goes down, the rate of primordial resting follicle recruitment also goes down. This indicates that the ovary can function longer, despite low ovarian reserve.

In vitro oogenesis and IVM from ovarian tissue

Dr. Silber also presented research into the process of converting skin cells into fertile oocytes in humans. This process is called in vitro gametogenesis and replicates the early embryonic formation of oocytes.

Induced pluripotent stem cells (IPS cells) can be made readily by incubating somatic cells (like the skin) with just four known genes: KLF4, SOX2, OCT4 and C-MYC. Created IPS cells can be maintained in just three genes: LIF, FGF-i and GSK2B-I (no feeder layer of fibroblasts). The cells are then incubated in three different genes (activin A, b FGFi, and KSR) to make epiblast-like cells. Then, the epi-L (epiblast) cells are incubated with five genes, creating in vitro PGCs (primordial germ cells). The five commercially available genes needed to do this are BMP4, SCF, LIF, EGF and BMP8a.

The resulting oocytes are very “young,” comparable to a younger woman’s eggs. In the future, Dr. Silber predicts, this approach will enable women approaching menopause to create usable oocytes through a skin biopsy, rather than undergoing an egg retrieval for IVF.

Contact us for expert fertility care

Dr. Silber is world-renowned as a groundbreaking leader in IVF techniques and research, which is why patients come from all over the world seeking out his expertise. Contact us to schedule a consultation with Dr. Silber.