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 via 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.
Cover Story – West Newsmagazine, March 10, 2004
by Laura Saggar
“Getting pregnant and having a baby is a gift.”
Those are the words of Heidi Smith, a resident of Chesterfield who should know. Smith, 33, and her husband Randy, 40, spent several years trying to get that very gift.
Their daughter Caroline now is almost a year old and is as healthy as any other baby, if not healthier. But the Smiths did not get Caroline the conventional way. Instead, they sought help from modern medicine and conceived Caroline through in vitro fertilization (IVF).
The Smiths have been married for seven years. After one year of marriage, they began trying to get pregnant. Smith said that after six months of trying with no success, she knew something was not right, so she consulted her obstetrician/gynecologist.
“I was put on a drug called clomid,” Smith said. “It stimulates more eggs to be released.”
After three months on clomid, Smith said she began taking her temperature every day to keep track of her cycle and when it would be best to try to conceive. This went on for another year. But the Smiths still had no success.
“After one year of charting my temperature, I started reading books about infertility,” Heidi Smith said. “I also found out I had never been ovulating. I wasted so much time taking my temperature.”
Looking back, Smith said she would love for women to be able to talk openly about what they might be going through if they are having problems getting pregnant.
“Women who are thinking, ‘I can’t get pregnant,’ can be educated,” Smith said.
Smith said she knows the pain of so many women who think they can never get pregnant.
“I couldn’t go to baby showers for a few years,” Smith said. “I couldn’t talk to girlfriends who were pregnant. I couldn’t even say congratulations. I would just cry. I had one friend who had a baby and found out a few months later she was pregnant again and she was complaining so much and dreading it, but she didn’t know how lucky she was. The hardest part that still makes me cry today is when a parent of my students or people would say, ‘You’d be such a great mom. Why don’t you have kids?'”
It got to the point where Smith said she wrote a letter in their Christmas card one year telling all their friends and family they had been trying to get pregnant for years. She wrote, ‘Please don’t ask us, we’ll tell you.’
“Friends started calling,” Smith said. “A few were going through similar situations. It was better to talk about it, and it got easier the more I wrote about it in my journal.”
Still, Smith did not seek the help of Silber right away.
“When I read the book, I didn’t know Dr. Silber was in St. Louis,” Smith said. “But my husband and I asked ourselves, ‘Do we want to spend all this money?’ So we went to another doctor in the area and spent thousands.”
Smith said looking back, she now considers seeing this other specialist a waste of time and money.
“We spent around $5,000 with him,” Smith said. “He wasn’t very aggressive, and I still wasn’t pregnant.”
Smith said she contacted Silber but still waited an entire year before she went to see him.
She said she was not sure if she wanted to be on the fertility drugs required, and there also was the big expense.
“Nothing is covered by insurance,” Smith said. “Maybe some of the drugs, but not the process of getting pregnant. We spent $14,000 to 16,000 with Dr. Silber.”
Smith began her treatment with Silber in July 2002, nearly six years after she first began trying to get pregnant.
Before Smith began treatment, she was teaching elementary school. Smith and her husband decided she would quit her job once the treatment started so she could concentrate on getting pregnant.
Staying at home and not having her income was a slight adjustment to their budget, Smith said. But the Smiths said they have no regrets about their investment.
“Now I look at the life I have and it’s the best and most difficult job I’ve ever had,” Smith said. “We don’t go to Europe twice a year or out to dinner very much anymore. When you think about it, all it was is money. What we do with our money now means so much more.”
The Smiths are not alone in creating a baby through the IVF procedure.
Silber said that to date, more than 1 million IVF babies have been born, with 100,000 IVF babies born in the United States last year. Silber also said those numbers would be higher if insurance companies covered treatment for infertility.
Silber said he defines an infertile couple as one that fails to get pregnant after one year of trying. While 85 percent of those trying to get pregnant will within one year, 80 percent will get pregnant in the second year, Silber said.
“The population is changing,” Silber said. “Women are not interested in having a baby until later in their lives. They have their education, career and marriage. Everybody is so healthy, so why worry? I usually don’t see them until they’ve been trying for years.”
Silber recommends that any woman age 35 and older not wait to be seen by an infertility specialist if she is having trouble getting pregnant. Silber said when he first sees a patient, he takes a sperm count of the husband and sexual history of the couple.
While there are several causes of infertility and several options to get pregnant, Silber said in vitro fertilization not only is the most effective, but the most cost effective as well. Silber said $10,000 per IVF cycle is the average cost of treatment across the country. Silber also said IVF is the most common form of assisted reproductive technology available today.
“If the fallopian tubes are damaged or the sperm is poor, it is the only acceptable approach,” Silber said. “Thus, with such cases, the eggs must first be fertilized in our laboratory, and the resulting embryos then are placed into the uterus two days later. This procedure achieves remarkable pregnancies even in women with hopelessly damaged fallopian tubes. Our IVF pregnancy rate is about 50 percent per attempt, regardless of diagnosis.”
Silber said many couples have gone through other, more expensive conventional treatments that have not worked. Once a couple chooses to pursue IVF, they pick a target date for the IVF procedure with Silber and then count backward, usually six weeks. First, the woman is on hormones for two weeks to suppress the pituitary gland. The next two weeks, the woman is stimulated with hormones to get her ovaries to produce multiple eggs. Silber said 15 to 20 eggs is a good number with which to start.
For Smith, she said she was surprised the drugs did not adversely affect her. Her husband administered the shots, which she said probably was the most uncomfortable part of the process.
“St. Luke’s taught Randy how to give me the shots,” Smith said. “He still remembers exactly what drug I was taking and what time I had to take it. The only shots that hurt were the ones that went into my muscle, but other than that, it was OK.”
Next, Silber said the IVF process goes as follows:
“The eggs are retrieved by an ultrasound-guided needle aspiration under light sedation in the operating room. This involves no surgical incision and virtually no pain afterward. With IVF, you just leave the hospital directly from the operating room, with no pain, and come back three days later to have the embryo, or embryos, placed very simply into the uterus through the cervix with a tiny catheter. No incision and no anesthesia are needed. An hour later, you are able to go home.”
Silber said once the eggs are retrieved, they are cleaned off and then under a microscope, they pick up the sperm and literally inject it into the eggs. Then the eggs are cultured for three days, and two to three of the “best” embryos are transferred back to the uterus. When there is any problem regarding the sperm, Silber said they can fertilize the eggs with intra-cytoplasmic sperm injection (ICSI), which actually is injecting one sperm directly into an egg.
Silber and two other doctors developed this procedure in 1993. Silber said in his program, he routinely uses ICSI in all cases to guarantee against the risk of failed fertilization.
“If the embryo is genetically normal and it is transferred delicately back to the uterus, they will get pregnant,” Silber said. “It is very important not to irritate the uterus.”
Silber said 15 percent of all pregnancies end in miscarriage, and with IVF, the number is no different. The percentage goes up with the age of the woman. A woman 40 years old has a 35 percent chance to miscarry, Silber said.
Smith said she and her husband tried not to think that one round was the only round.
“I could not let myself think this is all or nothing,” Smith said. “I had to put that in my head. We might have to do this three times, but we knew three times was all we could afford.”
While Smith said she had no problems during the actual IVF procedure, five to six days later, she did begin having trouble breathing.
“I couldn’t catch my breath,” Smith said. “It turned out I had hyper-stimulation because of the fertility drugs I was on. My ovaries kept producing a fluid, and my lungs were filling up with the fluid.”
Smith was admitted to the hospital for three weeks while the fluid was drained from her lungs. But the surprise Smith got from the doctors the first day she was there is something she said she will never forget.
“They told me I was pregnant,” Smith said. “I didn’t even know they could tell so early. It was such a euphoria to think that I was pregnant. I didn’t care that I was in the hospital. I was pregnant.”
While it was Silber’s job to get Smith pregnant, once pregnant, IVF patients then see a regular obstetrician (OB) for the prenatal care and delivery.
Other than the hyper-stimulation, Smith said her pregnancy was pretty normal. At six weeks, she said she had her first ultrasound where two heartbeats were present, but then at eight weeks one had disappeared.
“It’s called a vanishing twin,” Smith said. “It’s supposedly common, but most women don’t have ultrasounds so early, so they don’t even know about the other heartbeat.”
While most women dread the weight gain a pregnancy creates, Smith said she was proud every time the scale went up, proving she had a healthy baby on board.
Like many women who have practically reached their due date, Smith could not wait to deliver the baby. Her due date was April 25, and it was quickly approaching.
“I thought, ‘I’ve got to walk this baby out,'” Smith said. “We went walking and I had spicy food. On April 14, I had dinner with my sister and came home and Randy was still out. She asked if she should stay with me because I was having contractions and was home alone. I didn’t think it was time because the contractions were still sporadic. Then I woke up around 2 or 3 in the morning and the contractions were strong. My water broke in the car on the way to the hospital.
“When we got tot the hospital, Randy dropped me off at the main doors and we found out they were locked. So here I am, in labor, walking around the hospital in the middle of the night down to the ER. But the whole time I was laughing and having a good time.”
Smith said the delivery of their daugher is the best thing that has ever happened to her. And Smith did not have any drugs during the delivery, not even an epidural.
“The happiness took all the pain away,” Smith said. “We never thought we would have a baby. She’s here because of Dr. Silber and she’s beautiful. We named her Caroline. When they (the delivery team) found out her name, the all started singing ‘Sweet Caroline.’ I’ll never forget it. I appreciate every pain.”
After all she went through to get pregnant the first time, Smith said she is ready to do it again.
“People who get pregnant and have babies so easily have no idea,” Smith said. “Before Caroline, we had gotten to the point where we thought there was no way we would ever have a baby.”
The Smiths said they could not be happier with Caroline or more grateful to Silber. She also said she still wants every couple who is trying to get pregnant to know they are not alone and options are available if they need help.