Lower Cost, Better Results, World Renowned Doctor. Free Consultation.

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.

Menu
Phone +1 (314) 576-1400
Contact Us
The Infertility Center of St. Louis
The Infertility Center of St. Louis
About Dr. Silber
Patient Comments
X

Mini IVF Explained: Science-Based Protocol, Faster Timeline & Higher Egg Quality

In this Facebook Live Q&A, Dr. Sherman J. Silber of the Infertility Center of St. Louis explains why his “mini-IVF” is less about low drug amounts and more about a tightly defined, evidence-based stimulation protocol refined since 2003. He contrasts science-driven care with formulaic, private-equity clinic models, then walks through the four pillars of his approach:

  1. Synchronize first. ~18+ days of birth-control pills shut down poor-quality follicles and align stimulation with the precise window when follicles become FSH-sensitive.
  2. Low-dose FSH. Typically 150 IU daily (younger/high reserve) or every other day (≥40), because higher doses can degrade egg quality.
  3. Physiologic LH via clomiphene. 50 mg/day of clomiphene raises the patient’s own LH (no long-acting LH exists), improving oocyte competence better than menotropins or micro-dose hCG alone.
  4. Prevent premature ovulation without suppressing quality. Continue clomiphene (± a “pinch” of antagonist only if needed) rather than full-dose antagonist that can deprive eggs of necessary gonadotropin exposure.

Timing from pill start to egg retrieval is ~1 month. Monitoring is usually 2–3 visits (day 5, day 7–8, and possibly day 9–10). Retrievals are followed by freeze-all and transfer later, leveraging vitrification methods learned directly from Dr. Masashige Kuwayama; embryos are transferred when the uterine lining is optimal and clomiphene effects have resolved. He notes mini-IVF virtually eliminates OHSS (use of Lupron trigger when indicated) and improves baby-per-egg efficiency, especially for older patients. He discourages IUI (“no better than timed intercourse” and often mistimed) and explains handling of blocked tubes: create embryos now, then surgically address hydrosalpinx before transfer.

On PGT: PGTM (single-gene disease) and PGT-SR (translocations) are highly accurate; PGTA (aneuploidy screening) has limits due to mosaicism—use selectively (very accurate for sex selection). Twins aren’t guaranteed by transferring two embryos; decisions are individualized to minimize risks (e.g., avoid twins in uterine anomalies). BMI rarely blocks stimulation; very high BMI may delay anesthesia but embryos can be created now and transferred after weight loss.