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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.

Women Could Delay The Menopause Indefinitely With Ovary Transplant: Doctors – The Telegraph


By Stephen Adams
The London Daily Telegraph Sunday Magazine, July 4, 2012

The controversial notion would allow career women peace of mind with a fertility insurance policy so they can find a partner, settle down and become financially secure before starting a family.
The controversial notion would allow career women peace of mind with a fertility insurance policy so they can find a partner, settle down and become financially secure before starting a family.

A technique to remove pieces of ovary, store it for decades and then replace it with delicate surgery could effectively put a woman’s menopause ‘on ice’, doctors said. The only thing preventing them from having babies into their old age would be their physical ability to carry a pregnancy, they said. The controversial notion would allow career women peace of mind with a fertility insurance policy so they can find a partner, settle down and become financially secure before starting a family. By delaying the menopause they could also avoid the increased risk of osteoporosis and heart disease that come with the end of their fertile life but may raise the risk of breast and womb cancer. A conference heard how 28 babies have been born worldwide to patients who either had their own ovarian tissue removed before treatment that would have left them infertile and replaced afterwards or twins where one donated tissue to the other.

Most of the children have been conceived naturally without the need for IVF for drugs.

Dr Sherman Silber, an American surgeon, has been involved in transplants for 11 women at St Luke’s Hospital in St Louis, Missouri, US, said: “A woman born today has a 50 per cent chance of living to 100. That means they are going to be spending half of their lives post-menopause.

“But you could have grafts removed as a young woman and then have the first replaced as you approach menopausal age. You could then put a slice back every decade.

“Some women might want to go through the menopause, but others might not.”

That would mean women would not have to “watch their body clocks”, he said, and would only be physically limited by their ability to carry a baby and give birth.

Transplants carried out eight years ago are still working showing the technique is ‘robust’ and it should no longer be considered experimental, he said.

One transplant from one 38-year-old to her identical twin [technical video], has lasted seven years so far without failing.

In that time the recipient has had two healthy baby boys and a baby girl, all without IVF, conceiving the last aged 45.

Originally it was thought the transplants would only last months, or a few years at most, giving the women just a brief chance of conceiving. But Dr Silber said early hopes had been surpassed.

In Belgium, a woman has given birth after her ovarian tissue was frozen [technical video] for decade, and in Italy a woman has just had a healthy baby girl after her tissue was frozen for seven years.

He said: “It’s really fantastic, we didn’t expect a little piece of ovarian tissue to last this long.”

He added that ovarian slices could now be frozen for decades, thawed out for replantation when needed, and be just as effective as ‘fresh’ grafts between twins.

In the meantime the tissue would not have aged – effectively putting the woman’s body clock on ice.

One of his patients has had a baby thanks to a slice frozen for 12 years.

He and European colleagues have presented their findings this week at the European Society for Human Reproduction and Embryology (ESHRE) in Istanbul.

They wrote: “All modern women are concerned about what is commonly referred to as their ‘biological clock’ as they worry about the chances of conceiving by the time they have established their career and/or their marriage and their financial stability.

“Most of our cured cancer patients, who have young ovarian tissue frozen, feel almost grateful they had cancer, because otherwise they would share this same fear all modern, liberated women have about their ‘biological clock’.’

The first operation, conducted on Oudara Touirat in Belgium in 2003, led to a pregnancy and successful birth a year later.

Strips of her ovarian tissue were removed before chemotherapy for Hodgkin’s lymphoma and were replaced after she was given the all clear.

In 2008, the Daily Telegraph revealed that Susanne Butscher, who received a whole ovary transplant in a world first from her twin sister, had given birth to a daughter, named Maja.

Mrs Butscher, then 39, had gone through the menopause early. Dr Silber carried out the operation in 2007 and 13 months later it was confirmed she had conceived naturally.

The majority of women who have undergone the procedure have had cancer but doctors said it is now time to extend it to others.

Dr Gianluca Gennarelli, a Turin-based gynaecologist involved in the Italian case, said in time it should be made available to women with other conditions – including those likely to suffer early menopause due to family history.

He said: “In the 21st century many women don’t want to have children until they are in their 30s, rather than at 18. But if your mother went through menopause before 40 that could be very difficult.”

Stuart Lavery, head of IVF at Hammersmith Hospital in London, said the findings showed ovarian transplants could last a lot longer than previously thought.

Previous studies had shown some only had “a very finite lifespan” of six to nine months, meaning women having to have repeat operations.

Tim Hillard, a gynaecologist and trustee of the British Menopause Society, said the technique was ‘exciting’.

He said: “This is an exciting developing as a fertility treatment, however we would need much more data before claims could be made about the menopause. You would have to balance it very carefully, the higher risks of breast and womb cancer that go with having oestrogen circulating for longer against the increased risk of heart disease, oesteoporosis and maybe dementia that go with the menopause.

“Theoretically it could be used as an alternative to hormone replacement therapy, particularly in women who go through the menopause prematurely, but that could be ten or 15 years away.’

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