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.
A woman is born with approximately two million eggs in her ovaries. By her teenage years, this number is reduced to about 400,000. She will subsequently lose about one thousand eggs each month, until eventually no eggs remain. At that point, she begins menopause. The pace of this inexorable loss of eggs as a woman gets older is not affected by birth control pills, pregnancies, nutritional supplements, healthy living, or youthful appearance.
The ticking of her ovarian biological clock, and not knowing where she is on that biological clock, is one of the biggest dilemmas every woman faces [see Channel 11 St. Louis TV news video].
Most women (98%) are fertile through their early twenties. Yet by their mid thirties, the infertility rate increases to almost 30%. This phenomenon, referred to as the “biological clock”, is a direct result of the limited egg supply with which each woman is born.
Where are you on your biological clock? Many of the methods currently used to determine a woman’s fertility are incorrect, and can lead to useless (and costly) ‘treatments’. These ineffective fertility tests generally fail to address the major factor in the decline of a woman’s fertility: the aging of her ovaries.
Assessing where you are on your particular biological clock has always been like peering into a black box.
Some women remain fertile well into their forties, while others lose their fertility in their early twenties. Some of us have to face unexpected disease (like cancer, the treatment of which, though it can save your life, threatens to wreck your chances to have children). We all simply have to face age, as we are pressured to put off pregnancy by unexpected turns of career and marriage. You have your life and your career, which in the modern world may mean putting off childbearing, but nonetheless you do want eventually to have children.
Listen to Dr. Sherman Silber and Joan Hamburg discuss the remarkable infertility treatment meeting that recently took place in Hong Kong. WOR New York, February 28, 2013. (9:26 min)
Presently, there is a simple test to determine where you are on your biological clock: the Antral Follicle Count (AFC).(Ineffective old-fashioned tests are described here.)
Antral Follicle Count [see FOX St. Louis TV news video] is a precise technique of determining your ovarian reserve. Popularized in St. Louis by Dr. Silber, ultrasound is used to count the number of eggs left in your ovaries (more on Antral Follicle Count [see FOX New York TV news video]). We can thus calculate where you are on the biological clock (and even calculate the time remaining until menopause). This ultrasound test can be performed by any radiology center or gynecologist who is aware of what to look for (unfortunately, most still do not). Fortunately, the information needed to perform this test is not complicated, and can be easily described to your radiologist/ob-gyn by Dr. Silber’s book, How to Get Pregnant, in the chapter, “Beating Your Biological Clock”.
Antral Follicle Count is a singularly empowering tool in your decisions about career, marriage, birth control, and when you need to start being concerned. It solves one half of the riddle of preserving your fertility: knowing how long it will last.
There are now safe, successful techniques to preserve a woman’s fertility indefinitely.
Recent advances in cryopreservation make it possible to preserve female fertility for any length of time. [see video] It’s well known that for some years we have been able to preserve fertilized eggs, or embryos; we can freeze them indefinitely, then thaw the embryos at a later date, and achieve high pregnancy rates in IVF [See Sperm, Egg, Embryo, and Ovarian Tissue Freezing]. It’s essentially a time-delayed IVF procedure, with a waiting period as long as you like, from when we retrieve and fertilize the egg, until we do the embryo implantation.
But for unmarried women, the trouble had previously been that this freezing process (although safe for embryos) destroyedunfertilized eggs, because eggs are so much more sensitive to freezing damage than embryos. If she did not have a husband yet and didn’t want anonymous donor sperm, the standard egg freezing procedures could do nothing for preserving her fertility… until now!
Ovarian Tissue Freezing and reimplantation, which Dr. Silber helped to pioneer, and egg vitrification pioneered in Japan, changed all that. An ovary could be (1) removed from cancer patients before radiation and chemotherapy, (2) frozen for some time, and then (3) returned to her body successfully after the cancer had been cured. The key realization was that all of the eggs in each ovary live only in the outermost layer of tissue, just 1 mm thick. The ready diffusibility of cryoprotectant into this thin layer, and the primordial immaturity of this storehouse of undeveloped eggs, allows ovarian tissue (and the eggs within it) to be frozen successfully. With the right microsurgical techniques, just this outer layer can be removed, frozen, and successfully grafted back on to the ovary at a later date, somewhat like a skin graft.
“America is leaps and bounds ahead of the UK when it comes to fertility treatment, particularly in the field of Ovarian Tissue Freezing…” Fertility Roadmagazine, March/April 2011.Read More
This was a great success for female cancer patients [see technical video], and we realized that the same principles could be applied to preserve any woman’s fertility. She does not need to have found a partner yet, because the eggs can be preserved unfertilized. Furthermore, once the ovarian tissue layer is put back in her body, she can become pregnant by natural intercourse, without the need for additional IVF procedures.
A second option is to simply freeze her eggs with vitrification. Recently, the Infertility Center of St. Louis began partnering with the Kato Ladies Clinic in Tokyo, Japan, to bring these revolutionary egg vitrification [see video] techniques to the United States. With these procedures, even unfertilized eggs can be preserved indefinitely. We thus have two different approaches to beat the biological clock.
Some women may prefer egg freezing, because it does not involve a laparoscopy; only transvaginal ultrasound-guided needle aspiration. Still, it can require many aspirations plus preliminary medication to give them some assurance that they will have enough eggs frozen to insure them a high likelihood of future pregnancy. Other women will prefer ovarian biopsy because it involves no preliminary medication; only one brief outpatient procedure (and not multiple egg retrievals). Some women may prefer to do both just as an extra measure of assurance. Whichever strategy is chosen, a woman now has the option to breathe more easily, and not feel rushed into marriage or pregnancy before she is ready! Even those for whom egg donation is forbidden for religious reasons now have the option of ovarian tissue transplant [see technical video] or to read a detailed scientific paper on Ovarian Transplantation, Click Here [PDF File]. Also, you can watch News Coverage of an Ovarian Tissue Transplant [see video]
Research on the biological clock continues to go forward.
By studying and comparing the RNA expression of pairs of twins where the biological clock of one of the twins is shorter than that of the other, we hope that we will be able to determine the genomic regions where ovarian reserve, and hence the biological clock of women, is located. Since the biological clock is the main reason for the current worldwide infertility epidemic, this research may give us important genetic clues to the cause of this epidemic.
However, for right now, it is most important to realize, even as our scientific knowledge is still deepening, that clinically, we can already solve this problem for women, today. We simply need to preserve the fertility of young women by stopping their biological clock from ticking away, either by freezing their ovarian tissue or by freezing retrieved eggs.