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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
The Infertility Center of St. Louis
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Ovarian Tissue Transplant After Cancer: 20-Year-Old Eggs Restored

This case study follows a Hodgkin’s survivor whose ovarian tissue—harvested at age 20 before months of chemotherapy and an autologous bone-marrow transplant—was thawed and transplanted back 11 years later. After years of remission and multiple recurrences, she returned to use her “time-capsuled” fertility.

The lab work is exacting. Each cryopreserved cortical strip is thawed in ice-cold Leibovitz medium and meticulously thinned under the operating microscope to ~0.5–0.75 mm—about skin-graft thin—to minimize ischemia and speed revascularization. Rough, follicle-poor edges are trimmed away so only primordial-follicle-rich cortex remains. Because the tissue was slow-frozen years before vitrification became standard, multiple strips (10–15 per ovary) are first “quilted” together with fine 9-0 nylon into a single, translucent sheet that will seat flush on the recipient ovary.

Surgically, a mini-laparotomy with a Mobius retractor provides outpatient access. The scarred, “dead” cortex—destroyed by chemo/radiation—is completely excised from the medulla (and saved for histology), ensuring any ensuing pregnancy can be attributed to the graft. The quilted 20-year-old cortex is then sutured to the medulla with numerous interrupted edge and “stay” stitches to maintain uniform pressure and contact. Pinpoint micro-bipolar hemostasis prevents microhematomas; continuous pulsatile irrigation with heparinized saline reduces adhesion risk and preserves fimbrial pick-up.

Four essentials drive the program’s high success: super-thin grafts; immaculate hemostasis; constant heparinized irrigation; and tight approximation to avoid serum/blood pockets. Recovery is rapid—the patient ate breakfast, walked the hall, and went home the next morning. Functionally, she now carries a 20-year-old ovary on a 31-year-old body, with youthful oocytes and high pregnancy potential. Because several grafts remain in storage, future “refreshes” are possible when the current graft’s reserve wanes—turning a once “hopeless” oncology case into a realistic path to natural conception.

Her closing reaction says it all: with young ovarian tissue on board—and more in the freezer—“hallelujah.”