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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.
Savannah Guthrie: Born Today on Monday we watched miracles. Couples across the country welcoming new babies live, but for many other getting pregnant can be a financial, physical and emotional challenge. Today we are focusing on In Vitro Fertilization or IVF. NBC’s chief medical editor Dr. Nancy Snyderman is live from an operating room at St. Luke’s Hospital in St. Louis. Nancy, good morning to you!
Nancy Snyderman: Good morning, Savannah. I’m here with Dr. Sherman Silber sitting right here to the right of me and patient in front. What we’re looking at on the screen are ovaries with follicles with eggs in them. Remember they’re being harvested this morning.
You know 40 years ago there wasn’t much of an option for an infertile couple in order to go ahead and have a baby. But boy has technology changed. So this morning for the first time on live television, you’re not only going to see eggs being retrieved from the ovary, but we’re going to show you the fertilization process.
But first I’d like to introduce you to a couple who very graciously allowed us to be a part of their experience.
[music] Dr. Sherman Silber is a renowned fertility expert and a pioneer in something commonly known as IVF.
Sherman Silber: It’s short for In Vitro Fertilization, which simply means fertilization takes place in a laboratory dish.
Female nurse: The pregnancy will implant there.
Nancy Snyderman: Thirty-three-year-old Jessica Menkhausen and her fiancé Derek Manion are Silber’s patients, excited about the possibility of having a baby together.
Jessica Menkhausen: That’s where our baby is going to be.
Nancy Snyderman: Jessica had tried for nine years to have a baby and had almost given up on her dream of motherhood.
Jessica: It took years to get over it. I was really glad when we met Dr. Silber. He did give us so much hope.
Dr. Silber: Hi Jessica!
Nancy Snyderman: Jessica has been undergoing IVF pre-treatment for four weeks now, injecting hormones and getting regular blood work.
Jessica Menkhausen: Hopefully these children know one day when we show them this how much we wanted them.
Nancy Snyderman: And today, news that the medicine has worked. Jessica’s ovaries have produced a large number of follicles, which house the eggs that will be fertilized with Derek’s sperm.
Dr. Silber: If we count them, that count gives us an indication of how many eggs you’re going to have. And it’s just a huge count.
Nancy Snyderman: The couple have put off wedding plans until next year, citing the cost of IVF, which averages $12,000 to $17,000 per cycle. And it’s often not covered by insurance.
Jessica Menkhausen: We are borrowing to do this.
Nancy Snyderman: And they’re telling their personal story here, hoping to inspire others.
Jessica Menkhausen: It’s amazing to think what science can do now and how it can help us out in conceiving.
Nancy Snyderman: It’s an all or nothing gamble for Jessica and Derek who are spending their savings on what for them is a once in a lifetime chance at parenthood.
Jessica Menkhausen: We’re terrified of spending this amount of money and then it not working. If it doesn’t we’ll be sharing bad heartbreak together. But it will be heartbreaking.
Nancy Snyderman: They say they can’t afford to do it again but remain hopeful about the outcome.
Jessica Menkhausen: I want to be positive, and I think that we’re going to have twins. I think that they’re going to have red hair and blue eyes. [laughs] That’s what we have to keep thinking.
Nancy Snyderman: Right now Dr. Silber is inserting a micro-needle with a little suction into the ovary and each of these black sacks you see really houses an egg. Those are being sucked out and then will be examined behind us.
Can you feel that when you go in there and you’re looking at that egg, you know visually exactly where you are?
Dr. Silber: I know visually exactly where I am, and I also can feel it in answer to your questions. Like there is a follicle right there. We’re all right through.
Nancy Snyderman: That white line is the needle?
Dr. Silber: That white line is the needle. That opening, that little sack you see, has an egg in it. They’re really nice and big size, so we know we’re going to have good, mature eggs in there.
Nancy Snyderman: You’re already finding a lot of eggs. Is that because she’s been on stimulating hormones?
Dr. Silber: Well she’s been on stimulating hormones, but some women on stimulating hormones do not have that many eggs. It depends. She started out with a lot of eggs … let’s go for this one here.
Nancy Snyderman: So this bodes well for her to have such big follicles and have so many?
Dr. Silber: Yeah. We’re excited. She has very few small follicles, and those are the follicles that cause patients to get sick from IVF. The way we stimulated her, we have only big follicles. These big follicles are going to be mature. They’ll have …
Nancy Snyderman: And this is a safe procedure with these medications for Jessica, right?
Dr. Silber: It really is safe if done right. If not done right it could be dangerous. [laughs]
Nancy Snyderman: I have to underscore it. That’s exactly why you go to a center where IVF is not only established but doctors have been doing it for years and years and years. So that one, you harvest healthy eggs. Two, it results in healthy babies. And three, the health repercussions long term for mom, miniscule. [crosstalk]
That’s it. Savannah we’ll be back to you shortly. Hey Matt.
Matt Lauer: Can we just ask you real quickly, she is sedated but will there be discomfort from this procedure, you know, in the coming hours or days?
Nancy Snyderman: She is sedated and there will not be discomfort. There is a vaginal probe in her, which allows us to see the ovary, but it’s no more different than a pelvic procedure. So no, she’s going to have minimal discomfort, and they’ll watch for a little bleeding afterwards but they expect no complications. This has been going absolutely perfectly this morning.
Savannah Guthrie: We hope that continues. Dr. Nancy Snyderman, thank you so much. We know that in our next half hour she’s going to be there. We’ll watch the procedure live on television. This is the first time when Jessica’s eggs are fertilized. We hope … we are rooting for them.
Matt Lauer: Yeah, I was going to say after you hear their story how can you not root for them? [crosstalk all] It’s been successful in so many other couples around the country as well. [break]
Savannah Guthrie: But first in our series Born Today. In the last half hour, Dr. Sherman Silber conducted the first part of an IVF procedure retrieving Jessica’s eggs in the operating room. Now hold onto your French fries men. We’re going to turn to Dr. Nancy Snyderman. She’s actually moved into the lab where we’re hoping to capture a conception process live.
Jessica and Derek are in the recovery room. They’re ready to watch. Dr. Nancy good morning. Fill us in on what’s going on.
Nancy Snyderman: Hey you guys. Let me orient you because this is one of the coolest things you’re ever going to see. This is just a pipette that’s holding an egg in place. This is an egg that was taken from Jessica just a few moments ago.
This little thing on top is called a polar body. I’m only telling you that because the egg has to be oriented in space. What you’re going to see Kathy do right now with a needle on this side, which has a sperm in it, is puncture the outer layer of this egg.
You’re going to see how tough it is. That little sperm is right there – pop into it – the sperm will be released, and as soon as she knows the end of the needle is there, boom, there went the sperm. The sperm is right there. This is now a fertilized egg. Conception has taken place.
And this now will be put into a special medium for the next 48 hours as a fertilized egg and observed. You have now for the first time ever on television seen a sperm go into an egg, and that’s modern IVF. That is cool stuff.
Carson Daly: That’s amazing … [claps] [crosstalk]
Nancy Snyderman: We’re going to keep doing more. I know Matt you’re going to really love this part as Kathy goes ahead. These are sperm that are swimming around in this special solution. [crosstalk]
Matt Lauer: Not sure where you’re going with this Nancy.
Al Roker: Matt really loves to see that.
Nancy Snyderman: She whacks the tail off the sperm.
Matt Lauer: Yeah, no, it’s amazing. Now you have a fertilized egg. And then they will implant those fertilized eggs in Jessica. How long will we know, or will it take, to know if this is a viable pregnancy?
Nancy Snyderman: So, we got a lot of eggs out of her today. Again, there’s the sperm and the needle. Pop in, the sperm goes back up. Boom, it’s in. Another fertilized egg.
Forty-eight hours these will be watched. They’ll now start to grow under the microscope, and then Dr. Silber because he’s a very ethical doctor only implants two. You’ve heard of the controversies before where there are too many fertilized eggs put into women. The uterus is not a condominium. You put in two hoping for one or two healthy babies in pregnancies, right?
Dr. Silber: And we can freeze the extras safely.
Nancy Snyderman: She can hold onto them for a long, long, long time. And in some cases even be given to other women.
Dr. Silber: Absolutely. And they will never be hurt by our freezing process.
Nancy Snyderman: So this is safe for mom, cool for dad, great for science.
Savannah Guthrie: Well Nancy you really have a way with words. The uterus is not a condominium. I will remember that forever. [laughing]
Nancy Snyderman: This is pretty neat. So we’re just going to stand here and again watch this go on and on and on and keep fertilizing these. A lot of sperm. Very healthy. And with these eggs being able to be held here by suction, they have 26, 27, 28 eggs were harvested. And they’ll all be fertilized and then stored.
Then the best ones will be implanted in Jessica, and we will follow up with Derek and Jessica over the next couple days and months. I have no reason to not expect that this is going to result in a healthy pregnancy.
Dr. Silber: I’m sure this is going to work.
Nancy Snyderman: I have to tell you doctor talk earlier, we were also saying she has a really good-looking uterus. So I think this is going to be a go. [all laughing] [crosstalk] All is good at St. Luke’s in St. Louis.
Matt Lauer: [crosstalk] Well thanks for the folks out there for letting us do that.
Savannah Guthrie: Guys is that the first IVF procedure you’ve watched with French fries?
Carson Daly: Yes. [crosstalk]
Savannah Guthrie: Let’s just acknowledge the weirdness of that. [all laughing]
Al Roker: It’s called dinner and a show. [crosstalk]
Savannah Guthrie: Bizarre. We’ll keep track of Derek and Jessica to find out what happens