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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 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 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.

Mini-IVF gives hope to older women who have trouble getting pregnant

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by Dr. Sherman Silber

St. Louis Post-Dispatch, June 30, 2010


It’s widely known that as women age, their chances of becoming pregnant decrease. Women older than 38, in particular, often have fewer and lower quality eggs and don’t respond as well as younger women to conventional efforts to produce eggs for in vitro fertilization — or IVF.

But plenty of women in this age group want to become pregnant. And they do have options.

Conventional IVF is one of these options, but it involves large doses of hormones and can cost $18,000 or more per cycle for older women, with poor results. Many IVF programs turn them down anyway. Some women choose to use donor eggs, but many want to become pregnant with their own eggs. The best solution for such patients is mini-IVF.

Mini-IVF aims to use smaller numbers of higher quality eggs. It requires fewer fertility drugs than conventional IVF, producing the best quality eggs possible and reducing the cost of drugs from an average of $5,000 to just $500. The procedure is minimally invasive, so women experience little to no pain afterward. And it doesn’t involve huge hormonal swings or ovarian hyperstimulation syndrome, a complication involving swelling of the ovaries that about one out of 10 conventional IVF patients experience because of certain fertility medications.

The success of mini-IVF is enhanced by a new method of embryo freezing called vitrification” [see technical video], or essentially “flash-freezing,” which avoids the damage caused by ice forming inside the cell during slow freezing. It is also enhanced by specialized air purification systems that give the eggs the best environment in which to develop.

Think of this simple parable: If you are sitting under an apple tree and wish to eat the most ripe and ready apples, you have a choice. You can chop down the tree and look at every apple on the fallen tree to see which ones were ready. Or you can simply try to shake the lower branches and eat the one or two that have fallen. That is the idea of mini-IVF. It may not work for everyone, but for many patients, especially older women, it will remove much of the aggravation and cost associated with conventional IVF.


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