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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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PCOS Explained & Mini-IVF Solution: Dr. Silber at the Infertility Center of St. Louis

In this concise educational video, Dr. Sherman J. Silber reframes polycystic ovary syndrome (PCOS) from “egg shortage” to “egg overload.” Women with PCOS, he explains, are born with an unusually large primordial-follicle pool. That abundance sends a negative feedback signal to the pituitary gland, blunting secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Without a decisive FSH surge, no single follicle rises to dominance; the ovary stalls in a state of arrested development, leading to irregular cycles, delayed or absent ovulation, acne, hirsutism and, most frustratingly, infertility—despite a plentiful egg supply.

Traditional high-dose IVF regimens attempt to bulldoze through this blockade with massive gonadotropin injections, often triggering ovarian hyper-stimulation syndrome (OHSS), excessive estrogen levels and a cache of poor-quality oocytes. Silber’s answer is Mini-IVF, a low-dose protocol refined at the Infertility Center of St. Louis in collaboration with Japanese colleagues. It combines clomiphene citrate and minimal FSH to nudge rather than flood the ovary, coaxing a manageable cohort of high-quality eggs to maturation. The approach leverages PCOS’s “too many eggs” biology—turning surplus into strength.

Silber outlines a typical cycle: oral clomiphene from day 3–7, sub-cutaneous FSH micro-doses on alternate days, antagonist added only if premature LH rise threatens. Ultrasound and estradiol levels guide fine-tuning; retrieval occurs when 2–6 follicles reach 18 mm. Because exposure is gentle, patients experience less bloating, lower OHSS risk and reduced drug costs. Retrieved oocytes are fertilized via intracytoplasmic sperm injection (ICSI) if needed, and embryos are vitrified for later transfer in a hormonally calm cycle—maximizing implantation rates.

Silber’s data show Mini-IVF yields comparable pregnancy and live-birth outcomes to conventional IVF in PCOS patients, with far fewer side-effects. By transforming a hormonal roadblock into a fertility advantage, Mini-IVF offers an effective, patient-friendly route to pregnancy for women grappling with PCOS.