Infertile patients cannot afford to wait for treatment while their eggs get older.
Dr. Sherman Silber, Infertility Center of St. Louis, is offering free 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 free 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.
“What would you guys say to someone who’s unsure they’ve been trying and are just not sure where to turn in terms of fertility care?”
[Transcript from Video]
I actually have a friend we have friends that have been going through you know and I don’t know all the science of everything but I think that they’ve done things that kind of beat around the IVF and they’re just really nervous about doing it because of all the things you have to do leading up to it.
But I would say I was my experience of it was that I was nervous and scared but your desire to start a family just overruns that you just kind of keep your eye on the prize and I’ve been lucky to have somebody so like good at helping me through everything. He was taking me to my appointments when he could and things like that but honestly like I don’t even remember all those bad things that might be in a journal if I ever want to open it up one day. It’s just kind of something that you do and and I got good results from it and I really wish that… you know it breaks my heart because I know that their pain is real and I think that they’re scared of going through you know maybe like all the injections that you have to have and things but it really was not that bad as it sounds
…and that’s coming from someone that’s very afraid of needles.
yeah. I mean you’re not one of the biggest needle people but you know…
I’m not like “anybody got a needle?”
…but her being able to do it on her own when she traveled or if I had to go out of town I mean she was able to do her own injections and yeah just takes you know… I think I think too, like when people think IVF the the thing that comes to mind too is financial reasons like I mean you know depending on the process you have to go through it there’s there are costs incurred to it. So I think if you just look past that and look towards the goal, I mean we… don’t you know have like this huge paying jobs but it was it was doable it was we were able to plan and work accordingly to the goal and I mean even if it meant to you know have to borrow or do whatever it was so much worth it because in the end goal like you you’re never going to have that what-if moment like what if I would have had kids or what if you know we can look past that and I hope you know people on the future can look past that to it like we have that what if we can move forward and say we know we have these two beautiful babies and we’re we’re happy we do everything the needles and injections the money everything nothing added up to seeing these girls wake up every morning and having them in our lives.
See, I think too many patients are pushed through a lot of preliminary stuff because IVF sounds like it’s such a major ordeal but you can wind up spending a lot more money any more aggravation on some of these ridiculous preliminary treatments that supposedly would be easier than IVF but they’re not they really add up to a lot of money a lot of heartache and it may sound overly aggressive but it isn’t it’s the simplest easy a usually most cost-effective thing is to go to IVF sooner.
if you want results in my opinion you just go for you know it rather than spending years trying this and trying that and it’s like no let’s say you do all these other silly things from age 35 to age 38 and then finally age 38 you decide what or the doctor says well maybe we ought to try IVF. well you’re eggs are 3 years older now and they’re in a worst category so delay will lower your success rate. That’s where I kind of felt like I was that I was like this you’re years yeah.
What do you think some of those IVF treatments are what would you categorize…
oh well one of the well first place women will go through laparoscopy routinely which i think is a waste of time with three-dimensional ultrasound you to find out everything you need to find out about them structurally even if they have dilated tubes or Hydrosalpinx. so it’s just I think a complete waste of time to go through that but that’ll be first and that surgery and that pays money to the doctor and the insurance actually even pays for it so I mean it’s kind of stupid but insurance will pay for that you know if they don’t pay for IVF yeah and that they can put the man on Clomid for years almost to try to get his sperm count up and it fluctuates around like sperm counts always do and so you actually are fooled into thinking it’s helping except next month it’s even worse and so you get frustrated and maybe the dose is increased and all that is just fodder all really. then there’s IUI now this I’m going to get into it controversially because this is maybe the most common infertility treatment there is Intrauterine Insemination you wash the sperm and you put it in the wife’s uterus and that’s often done 3 to 12 times before anybody resorts to IVF and usually with simulation with hormones and drugs and the prints are it is so low IUI – I call it adivistic – it’s an ancient primitive treatment and yet it’s what almost all infertility patients wind up being put through before they go to IVF and it’s negative because your eggs are getting older you’re spending money you’re getting frustrated you’re emotions are being really toyed with and here’s why it’s popular back in 84 nobody could do IVF except the Jones Clinic in Norfolk but we wanted to everybody wanted to so fertility doctors that have these big meetings every year were concerned because it was doing microsurgery which I was a fan of and it still am actually and hormonal treat… all kinds of other fertility treatments that weren’t very effective because they really couldn’t do IVF and furthermore IVF wasn’t as successful even in England then and so it was introduced that you could just wash the sperm put it in the uterus and anybody could do the sperm washing with an ordinary urinalysis centrifuge it required no laboratory expertise and supposedly that would replace IVF and you didn’t have to really do IVF. and of course it was and there were publications written that were absolutely apocryphal that talked about high pregnancy rates with IUI and a pregnancy rates are terrible with IUI and and it winds up costing a lot of money after 12 cycles that’s what our friends have told us that they’ve tried over and over and so far and I’m just I just get so frustrated because I know that my friends really want this and there’ll be good parents but you know I just.. they just haven’t had any luck with it. it’s a terrible waste of time and wasting time isn’t just frustrating from that point of view its frustrating because the eggs are getting older while you’re doing a very relatively ineffective treatment and I remember the air of this because I’m a little guy and I remember in 84 everybody was so excited but I remember Al Abidjan has passed away a long time ago presented this at a meeting all you needed we didn’t have catheters for IUI or for IVF then so all you need is an infant feeding tube because their infant feeding tubes that the pediatric hospital had. so you just have your secretary wash the sperm and then you put it in a small volume an infant feeding tube and you put it in the uterus and I know from our experience going way back to the 70s that it’s no better than intercourse. Intercourse is better and in fact if you’re going to do an intercourse and try to put off IVF the worst thing you can do is try to time it and look at clearblue easy and see when you ovulate it’s much better to have intercourse two or three or four times a week so there’s always sperm there because after you ovulate the egg is only good for eight hours and the sperm is good for two or three days so if you’re having intercourse three times a way I don’t you can have it seven times a week ten times a week there’s a lot of jokes about that but don’t worry about depleting it there is if there’s sperm in your tract whatever you ovulate that’s the ideal situation yeah and IUI actually thwarts that because you’re bypassing cervical mucus by putting in the uterus so IUI is actually worse than worse than intercourse.