Patients Comments - 27

DR. SILBER IS AWESOME!!!!!!!

Dr. Silber and his staff are absolutely wonderful. They give patients 110%. They gave us hope were there was none for such a long time and without the work that he does we would not have our precious miracle. God Bless Dr. Silber and everyone in his office for the work they do!
Michael & Gigi Earl
Salem, OH

Patients Comments - 26

Dr. Silber,

Thank you so much for giving me a second chance by performing a very successful tubal reversal. You performed my reversal in March of '09 and by July I was pregnant. She is our little miracle.
Thank you!
Nick and Marge Jennings
St. Louis, MO

Celine Dion Gives Birth to Twin Boys after IVF

Great Celebrity Celine Dion gave birth to two healthy twin boys after numerous attempts to conceive through IVF.  It’s wonderful to hear success stories such as those publicized by celebrities, even emotional for those that are loyal fans and followers. In reality, many women are affected by this inability to conceive naturally and cannot afford an expensive reproductive assisted procedure such as IVF. The average cost of IVF treatment in countries such as the US or UK can be as high as $11,000, leaving many couples to seek IVF treatment abroad. Those considering Asia should look into Thailand as a possible destination for its affordable rate and top notch doctors.

What is Implantation Bleeding?

Implantation bleeding normally occurs a week to a few days before your period would normally start. Spotting that occurs around a week after ovulation is likely implantation bleeding; whereas, spotting that occurs very close to the time that your period would normally start may not be. A normal menstrual cycle generally starts off light and then gets heavier. Spotting can sometimes be the sign of an early period. If this is the case, the spotting will pick up to heavier bleeding. If you have spotting right around the time your period would normally start, it can be more confusing. You will need to take the wait and see approach or take a pregnancy test to determine pregnancy.

Quick facts on infertility according to the National Women’s Health Resource Center (NWHRC):

    * Approximately 6.1 million couples in the United States, or 10 percent of all couples of childbearing age, have difficulty conceiving.
    * When no fertility problems are present, the average couple between ages 29 and 33 has about a 20 to 25 percent chance of becoming pregnant during any given menstrual cycle.
    * About one-third of infertility cases can be attributed to males, another third to females and the remaining third to both members of a couple. About 10 to 20 percent of infertility cases go unexplained, although these couples often later succeed in becoming pregnant.
    * Ovulation abnormalities and sperm deficiencies are the most common causes of infertility. Together, they are responsible for two-thirds of infertility problems.
    * About 15 percent of female infertility cases are the result of fallopian tube disease while irregular ovulation accounts for about 25 percent.
    * About 60 to 70 percent of women who have a laparoscopy as part of their infertility assessment are found to have endometriosis, a painful condition in which endometrial cells — usually only found lining the uterus — grow in other locations.
    * A 29-year-old woman has a 20 percent per month chance of getting pregnant — compared to 7 percent for a woman at age 39.
    * In 85 to 90 percent of all cases, infertility is treated with either medication or surgery. Just 5 to 10 percent of infertility treatments involve in vitro fertilization or other kinds of assisted reproductive technologies, in which a laboratory is used to try to help a couple become pregnant.
    * There are about 600 reproductive endocrinologists (fertility specialists) in the United States, compared to 28,000 ob/gyns (obstetricians-gynecologists).

Patients Comments - 26

Dear Dr. Silber,

We wanted to send you a picture of the baby that you helped us conceive. I had the vasectomy reversal procedure done on September 25, 2008. Evan Michael was born on May 3, 2010. He is a very happy and healthy boy. Thanks you for all that you have done to assist us in making our dreams come true. We couldn't be happier.

With much thanks,
Mark & Alyssa
Chatham, IL

Patients Comments - 25

Dr. Silber,

On October 6th, Sophia Grace Manganelli was born. She weighed 8lbs. 11oz. and was 20 1/2 in. and is perfectly healthy. This would not have been possible without the great fortune we had in finding you. We just wanted to thank you for helping us bring Sophia into our lives. Thank you again to you and your staff.

Sincerely,
Chuck & Tori Manganelli
St. Peter's, MO

The History of IVF -The Milestones

2009

Simon Fishel and his group from CARE Fertility, Nottingham, reported about a Live birth after polar body array comparative genomic hybridization. (Fishel S, Gordon A, Lynch C, Dowell K, Ndukwe G, Kelada E, Thornton S, Jenner L, Cater E, Brown A, Garcia-Bernardo J. Live birth after polar body array comparative genomic hybridization prediction of embryo ploidy-the future of IVF? Fertil Steril.

Prof. Laufer at the Hadassah Medical Center in Jerusalem reported on a viable pregnancy achieved in a woman who carries the defective BRCA2 genes after In-Vitro Fertilized Embryos were tested and implanted. (Sagi M, Weinberg N, Eilat A, Aizenman E, Werner M, Girsh E, Siminovsky Y, Abeliovich D, Peretz T, Simon A, Laufer N. Preimplantation genetic diagnosis for BRCA1/2--a novel clinical experience. Prenat Diagn.

The History of IVF -The Milestones

2008

The first report of DNA fingerprinting to identify the blastocyst of origin for live-births and that gene expression profiles of biopsied trophectoderm can discriminate between viable and non-viable blastocysts. (Gayle M. Jones, David S. Cram, Bi Song, Georgia Kokkali, Kostas Pantos, and Alan O. Trounson. Novel strategy with potential to identify developmentally competent IVF blastocysts. Hum. Reprod. 2008; 23: 1748-1759).

Cryopreserved oocytes in cancer patients: first ever birth of healthy twins after oocyte cryopreservation and bilateral ovariectomy. (Porcu E, Venturoli S, Damiano G, Ciotti PM, Notarangelo L, Paradisi R, Moscarini M, Ambrosini G. Healthy twins delivered after oocyte cryopreservation and bilateral ovariectomy for ovarian cancer.  Reprod Biomed Online.

Patients Comments - 24

Dr. Silber and Staff,

We are excited to send you the announcement of our daughter, Thea Rose. She was born October 20, 2009 and perfect in every way.

Our vasectomy reversal was done October 7, 2008. This was our second reversal attempt. It proved to be a difficult surgery requiring double VE connection. We found out we were pregnant only three months after the surgery. We were thrilled and a bit shocked to find out we were pregnant so soon after surgery.

Thank you so much for helping us complete our family. It would never have been possible without your talent and skill. We are grateful to you for making our dream a reality.

Our deepest gratitude,
Jim and Ami Lis
Lockport, NY

Patients Comments - 23

Our Story

We struggled with infertility for eight years, with countless tests, procedures, and doctors. At a time when we'd just about given up, Dr. Silber and the Infertility Center of St. Louis gave us more than hope — they gave us a family. We knew we were working with the right team from the beginning. Dr. Silber and his staff are fully committed to achieving the best possible outcome for every patient, and that is evident in even the little things. Dr. Silber and Dr. DeRosa worked so well together during procedures and consultations, and made us feel both comfortable and confident… no small feat after our previous disappointments.

Augusten (AJ) was born October 9th, 2008, to two very thankful parents. Eighteen quick months later, we look back at our journey and know that every hurdle was worthwhile. AJ is a gift, a miracle of modern science, and a joy every single day! He wouldn't be here without Dr. Silber's expertise, and we can never fully articulate how much we appreciate his work for families dealing with infertility. We will be forever grateful for the dedication, innovation, and integrity of Dr. Silber, Dr. DeRosa, and the staff at the Infertility Center of St. Louis.

Scott and Elizabeth
St. Louis, MO

The History of IVF -The Milestones

2007

Report from McGill Reproductive Center, Canada and Maria Infertility Hospital Seoul, Korea on deliveries after transfer of human blastocysts derived from oocytes matured by In Vitro Maturation (IVM) (Son WY, Lee SY, Yoon SH, Lim JH. Pregnancies and deliveries after transfer of human blastocysts derived from in vitro matured oocytes in in vitro maturation cycles. Fertil Steril.

Introducing the concept of Mild Treatment Strategy for IVF (Heijnen EM, Eijkemans MJ, De Klerk C, Polinder S, Beckers NG, Klinkert ER, Broekmans FJ, Passchier J, Te Velde ER, Macklon NS, Fauser BC. A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial. Lancet. 2007;369(9563):743-9) .

A novel multi-gradient freezing technique for the cryopreswervation of the whole ovary. Thawing the ovary resulted in normal ovarian architecture and no damage to the vascular wall or intima. (Arav and Pasquale 2007 Yale Practice 12:2)

First IVM egg donation pregnancy in North America achieved by McGill Repro­ductive Centre (Holzer H, Scharf E, Chian RC, Demirtas E, Buckett W, Tan SL. In vitro maturation of oocytes collected from unstimulated ovaries for oocyte donation. Fertil Steril.

The History of IVF -The Milestones

2006

First successful pregnancy after preimplantation genetic diagnosis for aneuploidy screening in embryos generated from natural-cycle IVF combined with IVM, achieved at the McGill Reproductive Centre. (Ao A, Jin S, Rao D, Son WY, Chian RC, Tan SL. First successful pregnancy outcome after preimplantation genetic diagnosis for aneuploidy screening in embryos generated from natural-cycle in vitro fertilization combined with an in vitro maturation procedure. Fertil Steril.

Cryopreservation of intact human ovary with its vascular pedicle. (Mohamed A. Bedaiwy, Mahmoud R. Hussein, Charles Biscotti, and Tommaso Falcone. Cryopreservation of intact human ovary with its vascular pedicle.  Hum. Reprod.

The History of IVF -The Milestones

2005

Pregnancies and live births after trophectoderm biopsy and preimplantation genetic testing of human blastocysts. (McArthur SJ, Leigh D, Marshall JT, de Boer KA, Jansen RP. Pregnancies and live births after trophectoderm biopsy and preimplantation genetic testing of human blastocysts. Fertil Steril.

First birth in Israel from thawed ovarian cortex retransplants, (Meirow D, Levron J, Eldar-Geva T, Hardan I, Fridman E, Zalel Y, Schiff E, Dor J. Pregnancy after transplantation of cryopreserved ovarian tissue in a patient with ovarian failure after chemotherapy. N Engl J Med. 2005;353(3):318-21).

The first live-birth after trophectoderm biopsy and preimplantation genetic testing of human blastocysts for beta-Thalassaemia (Kokkali G, Vrettou C, Traeger-Synodinos J, Jones GM, Cram DS, Stavrou D, Trounson AO, Kanavakis E, Pantos K. Birth of a healthy infant following trophectoderm biopsy from blastocysts for PGD of beta-thalassaemia major. Hum Reprod.

Patients comments - 22

Here's our personal story…

Jason and I started trying to have a baby just few months after we were married in 2004. As the months went by and we weren't having any luck, I got sick. I developed a tumor on my left ovary and had to have surgery. Due to the nature of my tumor, surgeons removed my left ovary and my left fallopian tube. During the surgery, it was discovered that I had tumors growing on my right ovary. Luckily, the doctors only had to remove half of this ovary.

Once I healed, Jason and I started looking into our options for conceiving a child. I had only one half of one ovary. Jason had given a sperm sample to make sure everything was working on his end. Turns out, it wasn't. We saw countless urology specialists and it looked like there weren't any options for us that didn't involve getting extra help. After getting Dr. Silber's name from my gynecologist, we made the appointment to meet with him. He listened to our situation and recommended that we think about IVF. We took home the packet of information, read through it all, and watched the DVD to help us better understand the process. Since this was a huge financial endeavor, we weighed our options to go through with IVF or try adopting. We knew that we had to give it a try if it was possible to have our own child. I had few eggs and my husband had few sperm.

We began the process with a sense of excitement and the worry that it might not work. As part of Dr. Silber's requirements, Jason had to have a blood test for Dr. Silber to learn more about his make up. We were dealt another blow when we learned that Jason was a carrier for a genetic defect that could end my pregnancy if I did get pregnant. At this point, we didn't know what to do.

We decided to keep going. Dr. Silber recommended that we could have a special test done on the embryos to determine which ones would have the genetic defect.

On the day we were scheduled to have our transfer, we got all of the results from the genetic testing. Four of my eggs were no good. Seven of the embryos carried the genetic defect. That only left us with four embryos. Not as many as we had hoped, but it was something.

Dr. Silber came in and showed us the pictures of our four embryos. He even told us the gender of each one, three boys and one girl. We were still waiting on the results of one of the embryos, so Dr. Silber thought it would be best to put in two of the three boy ones.

Jason and I were so excited! We thought for sure that this was going to work. Later, we went back for my blood test to find out the good news. Jason and I were driving in the car, so we pulled off and listened to our results on speaker phone. "I'm so sorry. You're not pregnant." We were shocked. I immediately burst into tears.

We decided to try one more time over the summer. We only had one embryo left. So came the time for the blood test. This time we prepared ourselves for what was to be. I had my blood drawn and we went straight home. It was harder this time to keep busy. I made Jason call to find out our results this time. He had a huge smile on his face. He kept saying, "It worked? Are you sure?"

I couldn't stop smiling. I was so convinced I wasn't pregnant and to find out I really was realize my prayers had been answered.

Our son, Lachlan, was born March 13, 2008. We just celebrated his 2nd birthday. Every day Jason and I look at him and are so grateful that he is here with us. He is truly a miracle. We owe thanks to God, Dr. Silber, and his staff for all that has been given us.

Lachlan is especially a miracle to us because I had to undergo a hysterectomy in June of 2009. He is our joy and our blessing.

Jason, Beth, and Lachlan K.
Ballwin, Missouri

Patients comments - 21

Our Story

Infertility used to be a word that was very unfamiliar to me. However, after months of trying to conceive with no success, I was told that my husband and I were considered “infertile.” Little did I know we were about to embark on the longest and most emotional roller coaster of our lives. That is the best way I know how to describe the years of infertility treatment we went through.

Each and every day brought a new high hoping your prayers are finally going to be answered or a devastating low when your dreams are crushed. There were so many days I wanted to give up. I cried all the time, but I had to believe that one day it would all be worth it.

After years of medications, doctors appointments, shots, procedures, and surgeries, my wish finally came true I was pregnant thanks to the help of Dr. Silber. Then after a very complicated pregnancy full of more shots, medications, doctors visits, and hospitalizations our son was born. I couldn’t believe he was finally here.

Our son is a miracle who would not be here without the help of Dr. Silber and the work that he does. At the time, I resented having to go through everything I did, but I realize now that it made me a better person and better parent. Each and every day is a gift and I do no take anything for granted.

Cathie and Roger
Imperial, MO

The History of IVF -The Milestones

2004

Successful pregnancy and delivery following combined treatment of In Vitro Maturation (IVM) and Testicular Sperm Extraction (TESE). (Fuchinoue K, Nakajo Y, Yagi A, Takeda M, Kyono K. Successful pregnancy and delivery following combined treatment of in vitro maturation (IVM) and testicular sperm extraction (TESE): a case report. J Assist Reprod Genet.

Jaques Donnez reporting on the first Live birth after orthotopic transplantation of cryopreserved ovarian tissue (Donnez J, Dolmans MM, Demylle D, Jadoul P, Pirard C, Squifflet J, Martinez-Madrid B, van Langendonckt A. vebirth after orthotopic transplantation of cryopreserved ovarian tissue. Lancet.

Gardner and colleagues performed the world’s first prospective single blastocyst trial, which showed the feasibility of SBT and in keeping high pregnancy rates (Gardner DK, Surrey E, Minjarez D, Leitz A, Stevens J, Schoolcraft WB. Single blastocyst transfer: a prospective randomized trial. Fertil Steril.

The first preimplantation HLA matching for stem-cell transplantation to an affected sibling (Verlinsky Y, Rechitsky S, Sharapova T, Morris R, Taranissi M, Kuliev A. Preimplantation HLA testing. JAMA.

First report of fertility preservation for cancer patients using IVM and oocyte vitrifica­tion (Rao GD, Chian RC, Son WS, Gilbert L, Tan SL. Fertility preservation in women undergoing cancer treatment.

First report on oocyte cryopreservation to save fertility in cancer patients.
Porcu E, Fabbri R, Damiano G, Fratto R, Giunchi S, Venturoli S. Oocyte cryopreservation in oncological patients.  Eur J Obstet Gynecol Reprod Biol. 

The first reported live born following preimplantation genetic diagnosis for Retinoblastoma (Xu K, Rosenwaks Z, Beaverson K, Cholst I, Veeck L, Abramson DH. Preimplantation genetic diagnosis for retinoblastoma: the first reported liveborn.

First report on a natural cycle in IVF combined with IVM as a potential approach to infertility treatment (Chian RC, Buckett WM, Abdul Jalil AK, Son WY, Sylvestre C, Rao D, Tan SL. Natural-cycle in vitro fertilization combined with in vitro maturation of immature oocytes is a potential approach in infertility treatment. Fertil Steril.

The History of IVF -The Milestones

2003

Live births after vitrification of oocytes in a stimulated in vitro fertilization–embryo transfer program (Yoon TK, Kim TJ, Park SE, Hong SW, Ko JJ, Chung HM, Cha KY. Live births after vitrification of oocytes in a stimulated in vitro fertilization-embryo transfer program. Fertil Steril. 2003;79(6):1323-6) .

First live birth after ovarian stimulation using a chimeric long-acting human recombinant follicle-stimulating hormone (FSH) agonist (recFSH-CTP) for in vitro fertilization (Beckers NG, Macklon NS, Devroey P, Platteau P, Boerrigter PJ, Fauser BC. First live birth after ovarian stimulation using a chimeric long-acting human recombinant follicle-stimulating hormone (FSH) agonist (recFSH-CTP) for in vitro fertilization. Fertil Steril.

Implantation of the human embryo is the limiting factor in the success of IVF. Dr. Barash and Prof. Dekel showed an Increasing implantation rate following endometrial injury, performed by Pipelle curettage as a simple outpatient procedure. (Barash A, Dekel N, Fieldust S, Segal I, Schechtman E, Granot I. Local injury to the endometrium doubles the incidence of successful pregnancies in patients undergoing in vitro fertilization. Fertil Steril.

Normal birth after microsurgical enucleation of tripronuclear human zygotes (Kattera S, Chen C. Normal birth after microsurgical enucleation of tripronuclear human zygotes: Case report.

The History of IVF -The Milestones

2002

First live birth following blastocyst biopsy and PGD analysis. (De Boer K, McArthur S, Murray C and Jansen R. First live birth following blastocyst biopsy and PGD analysis. Reprod Biomed Online 2002;4,35).

First clinical application of comparative genomic hybridization and polar body testing for preimplantation genetic diagnosis of aneuploidy. (Wells D, Escudero T, Levy B, Hirschhorn K, Delhanty JD, Munné S. First clinical application of comparative genomic hybridization and polar body testing for preimplantation genetic diagnosis of aneuploidy. Fertil Sterile.

Patient Comments - 20

HIGHLY RECOMMEND!

In our 20s and early 30s, the last thought on our minds was infertility. Most doctors just told us to keep trying and be patient. After 2 years and a recommendation from family friends, we went to see Dr. Silber and his team. We could hardly believe that such a world renowned infertility doctor was right in our area! After sitting down with Dr. Silber, we finally felt like we had some answers. Although IVF was not our dream, he gave us hope. His team was so patient in explaining each aspect of the process.

In May of 2009 we gave birth to our first child, a son. He is more than we could have ever imagined. Our little family of 3 couldn’t be happier. We cannot say thank you enough to Dr. Silber, Dr. DeRosa, and all of the staff. When we are ready for a bigger family, we will definitely be back to see you!

If you have to go through IVF, Dr. Silber is the doctor that you want to go to. He is world renowned. People come from all over to seek out his expertise. I can't thank him enough for all that he has done for my family.

Michael, Sarah, & Tyler Brokering
Granite City, Illinois

Patient Comments - 19

Our Personal Story

Our family cannot say enough wonderful things about Dr. Silber and his entire team. We had struggled with infertility for several years before we saw Dr. Silber on the Discovery Channel television show "Baby Lab". We made the trip to St. Louis from Kansas to meet with Dr. Silber and discuss our options. We left our meeting feeling encouraged and hopeful. We quickly scheduled our IVF procedure. We couldn't wait to see if this would be the end of our journey with infertility.

We will never forget the JOY of that first positive pregnancy test! It seemed as if our family was now going to be complete and we couldn't imagine being any happier. Little did we know that three months into our pregnancy we would receive a phone call from an adoption agency asking if we would like to adopt a baby girl. After the shock subsided, we happily said "YES"! I was six months pregnant when our daughter Elizabeth Joy was born. Four months later, I delivered a healthy and beautiful baby girl we named Annie Joy.

We are blessed beyond measure to have TWO beautiful daughters. Thank you to Dr. Silber and his team for helping make our dreams come true!

Martin, Allison, Elizabeth, and Annie White
Wichita, Kansas

The History of IVF -The Milestones

2001

Birth of an infant from cryopreserved embryos (zygotes) produced by IVM oocytes derived from an unstimulated patient with PCOS (Chian RC, Gülekli B, Buckett WM, Tan SL. Pregnancy and delivery after cryopreservation of zygotes produced by in-vitro matured oocytes retrieved from a woman with polycystic ovarian syndrome. Hum Reprod. 2001;16(8):1700-2).

Ongoing twin pregnancy after ICSI of PESA-retrieved spermatozoa into in-vitro matured oocytes reported by the McGill group. (Ahmad Kamal Abdul-Jalil, Tim J. Child, Simon Phillips, Nicola Dean, Serge Carrier, and Seang Lin Tan. Ongoing twin pregnancy after ICSI of PESA-retrieved spermatozoa into in-vitro matured oocytes: Case report, Hum. Reprod. 2001 16: 1424-1426).

Live birth after sperm retrieval from a moribund man (Belker AM, Swanson ML, Cook CL, Carrillo AJ, Yoffe SC. Live birth after sperm retrieval from a moribund man. Fertil Steril. 2001;76(4):841-3).

The History of IVF -The Milestones

2000

Oktay and Karlikaya were the first to report on ovarian tissue transplants after frozen storage. (Oktay K, Karlikaya G. Ovarian function after transplantation of frozen, banked autologous ovarian tissue. N Engl J Med. 2000 Jun 22;342(25):1919).


The development of a completely chemically defined protein-free embryo culture medium and the births of the first batch of babies generated from the fertilization of eggs collected and inseminated in the said protein-free medium using spermatozoa also prepared in the same protein-free medium in both conventional IVF and ICSI. (Ali, Shahata MAM., Al-Natsha SD. Formulation of a protein-free medium for human assisted reproduction. Hum. Reprod. 2000 15: 145-156).

Cryopreserved oocytes and frozen sperm: first ever birth. (Porcu E, Fabbri R, Damiano G, Giunchi S, Fratto R, Ciotti PM, Venturoli S, Flamigni C. Clinical experience and applications of oocyte cryopreservation. Mol Cell Endocrinol. 2000:27;169(1-2):33-7).

The History of IVF -The Milestones

1999

First unaffected pregnancy using preimplantation genetic diagnosis for sickle cell anemia. (Xu K, Shi ZM, Veeck LL, Hughes MR, Rosenwaks Z. First unaffected pregnancy using preimplantation genetic diagnosis for sickle cell anemia. JAMA. 1999, 12;281(18):1701-6).

Birth following vitrification of human oocyte (Lilia Kuleshova, Luca Gianaroli, Cristina Magli, Anna Ferraretti, and Alan Trounson. Birth following vitrification of a small number of human oocytes: Case Report. Hum. Reprod. 1999 14: 3077-3079).

Chian et al. demonstrated that hCG priming prior to immature oocyte retrieval in women with PCO increases the maturation rate and produces high pregnancy rates of 40% per IVM started cycle (Chian, R.C., Gülekli, B., Buckett, W.M. and Tan, S.L. Priming with human chorionic gonadotrophin before retrieval of immature oocytes in women with infertility due to the polycystic ovary syndrome. N. Eng. J. Med., 1999;341, 1624–1626).

World’s first IVF/ICSI pregnancy and live-birth after successful air transport of oocytes reported by the McGill Reproductive Centre, enabling the creation of an air-transport IVF program in large countries with scattered populations or in areas remote from infertility centers (Buckett WM, Fisch P, Dean NL, Biljan MM, Tan SL. In vitro fertilization and intracytoplasmic sperm injection pregnancies after successful transport of oocytes by airplane. Fertil Steril. 1999;71(4):753-5).


Cryopreserved oocytes and testicular sperm: first ever birth. (Porcu E, Fabbri R, Petracchi S, Ciotti PM, Flamigni C. Ongoing pregnancy after intracytoplasmic injection of testicular spermatozoa into cryopreserved human oocytes. Am J Obstet Gynecol. 1999;180:1044-5).

Cryopreserved oocytes and epididimal sperm: first ever birth. (Porcu E, Fabbri R, Ciotti PM, Petracchi S, Seracchioli R, Flamigni C. Ongoing pregnancy after intracytoplasmic sperm injection of epididymal spermatozoa into cryopreserved human oocytes. J Assist Reprod Genet. 1999;16(5):283-5).

Patient Comments - 18

Our Story

My name is Denise and my husband's name is Scot. Four years ago, we met in Rio de Janeiro, where I am from originally. Since my husband has cystic fibrosis, we knew it would be difficult for us to have any children naturally, if we were to get married. Despite this, we were married three and a half years ago. When it came the time to make a decision about having a baby, we struggled with the choice of trying IVF or adoption. Initially, our decision was the adoption route, but at the last minute, I had a change of heart. I told my husband I really thought we should try IVF or else we would never know if we would have been able to have a child of our own. At the time, I was 37 years old, adding to our difficulties. Once we committed to trying IVF, we met with Dr. Silber and his staff to begin the process. We endured the whole process of the medication regime, injection schedules, and the anxiety that accompanies it all.

When our retrieval date arrived, not only were we very nervous, but we ran into more problems. Dr. Silber discovered my husband had a congenital defect, making the sperm retrieval difficult. After some searching, he was able to retrieve two sperm from my husband. From me, they were able to retrieve only two eggs. After fertilization, we learned that we only had one viable embryo to implant. Despite our low odds, I never gave up hope.

My mom in Brazil would keep telling me that everything was going well and she knew for certain that I would get pregnant. I truly believed in what she told me. I can not describe the feeling of joy I had when I was told by Dena that I was pregnant. Even now, writing our story brings many, many tears to my eyes. It is a blessing to be able to look at our beautiful, healthy daughter Giovanna everyday and I encourage anyone to try because it is the most wonderful feeling one can have. We are so grateful to Dr. Silber and his staff for helping us start our family.

Denise, Scot and Giovanna Colgrove
Fenton, Missouri

Patient Comments - 17

Dear Dr. Silber,
My husband and I were married in 2000. In 2003, we decided we would like to try having children, however, Mark had undergone a vasectomy about 17 years prior. After researching reversal options on the internet, I happened upon Dr. Silber's office and was very impressed by his success rate, even with "old" vasectomies. In February 2004, Mark underwent a reversal... and endured a couple of weeks of teasing while he walked slightly bowlegged! Six months later we became pregnant! Our daughter was born healthy and happy, and has since been joined by a lively younger sister. We HIGHLY recommend Dr. Silber for his excellent work, professionalism and kindness. It was worth the travel and every penny.

With happy regards from Wisconsin,
Mark and Nancy Tritt
Amery, WI

The History of IVF -The Milestones

1998

First establish pregnancy using recombinant FSH and GnRH antagonist (Itskovitz-Eldor J, Kol S, Mannaerts B, Coelingh Bennink H. First established pregnancy after controlled ovarian hyperstimulation with recombinant follicle stimulating hormone and the gonadotrophin-releasing hormone antagonist ganirelix (Org 37462). Hum Reprod. 1998;13:294-5).

Gardner introduced sequential media and blastocyst transfer which is now greatly assists in the move to single embryo transfer (Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens J, Hesla J. A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod 1998;13:3434-40).

Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter's syndrome (Palermo GD, Schlegel PN, Sills ES, Veeck LL, Zaninovic N, Menendez S, Rosenwaks Z. Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter's syndrome. N Engl J Med. 1998, 26;338(9):588-90).

The first pregnancies following embryo culture in sequential media and transfer at the blastocyst stage of development (Jones GM, Trounson AO, Gardner DK, Kausche A, Lolatgis N, Wood C. Evolution of a culture protocol for successful blastocyst development and pregnancy. Hum Reprod. 1998 ;13:169-77).

First ovum pick-up under 3-D ultrasound vision (Feichtinger W. Follicle aspiration with interactive three-dimensional digital imaging (Voluson): a step toward real-time puncturing under three-dimensional ultrasound control. Fertil Steril. 1998;70(2):374-7).

In 1998 first reports on births from frozen GV eggs, and donor eggs: - Tucker et al. Birth after cryopreservation of immature oocytes with subsequent in vitro maturation. (Tucker MJ, Wright G, Morton PC, Massey JB. Birth after cryopreservation of immature oocytes with subsequent in vitro maturation. Fertil Steril. 1998;70(3):578-9); Tucker et al. Clinical application of human egg cryopreservation. (Tucker MJ, Morton PC, Wright G, Sweitzer CL, Massey JB. Clinical application of human egg cryopreservation. Hum Reprod. 1998;13(11):3156-9).

The History of IVF -The Milestones

1997

First report on cytoplasmic transfer (Cohen J, Scott R, Schimmel T, Levron J, Willadsen S. Birth of infant after transfer of anucleate donor oocyte cytoplasm into recipient eggs. Lancet, 1997, 19;350(9072):186-7)

Sun, Jurisicova and Casper described the use of TUNEL for detection of DNA fragmentation in sperm and correlation with IVF outcome. They showed almost uniform presence of DNA fragmentation in round spermatids as the explanation for failure to achieve pregnancy with these immature gametes. (Sun JG, Jurisicova A, Caspe RF. Detection of deoxyribonucleic acid fragmentation in human sperm: correlation with fertilization in vitro. Biol Reprod. 1997 Mar;56(3):602-7).

First births of babies from frozen oocytes following use of ICSI: - Porcu et al, Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes. (Porcu E, Fabbri R, Seracchioli R, Ciotti PM, Magrini O, Flamigni C. Birth of a healthy female after intracytoplasmic sperm injection of cryopreserved human oocytes. Fertil Steril. 1997;68(4):724-6).

First report on cytoplasmic transfer (Cohen J, Scott R, Schimmel T, Levron J, Willadsen S. Birth of infant after transfer of anucleate donor oocyte cytoplasm into recipient eggs. Lancet, 1997;19;350:186-7).

Falloposcopic GIFT: Births after transcervical gamete intrafallopian transfer with a falloposcopic delivery system. (Porcu E, Dal Prato L, Seracchioli R, Petracchi S, Fabbri R, Flamigni C. Births after transcervical gamete intrafallopian transfer with a falloposcopic delivery system. Fertil Steril. 1997 Jun;67(6):1175-7).

Pregnancy after treatment with three recombinant gonadotropins (Agrawal R, West C, Conway GS, Page ML, Jacobs HS. Pregnancy after treatment with three recombinant gonadotropins. Lancet. 1997;4;349:29-30).

The History of IVF -The Milestones

1996
The Valencia group reported on the first pregnancy employing cryopreserved testicular sperm following IVF-ICSI. . (Gil-Salom M, Romero J, Minguez Y, Rubio C, De los Santos MJ, Remohí J, Pellicer A. Pregnancies after intracytoplasmic sperm injection with cryopreserved testicular spermatozoa. Hum Reprod. 1996;11(6):1309-13).

Discovery that some men with severe oligoasthenospermia have deletions in the Y-chromosome (Reijo R, Alagappan RK, Patrizio P, Page DC. Severe oligozoospermia resulting from deletions of azoospermia factor gene on Y chromosome. Lancet, 1996, 11;347(9011):1290-3).

Jurisicova from the Casper group was the first to recognize that preimplantation of human embryo fragmentation involved programmed cell death. (Jurisicova A, Varmuza S, Casper RF. Programmed cell death and human embryo fragmentation. Mol Hum Reprod. 1996;2(2):93-8).

Casper and his colleagues were the first to demonstrate and introduce the use of the hypo-osmotic swelling test for selection of immotile sperm for ICSI. (Casper et al. 1996 Fertil Steril 65:972)

Patient Comments - 16

My husband and I had three children and then decided to get a vasectomy. A few years later we were led by the Lord to leave our fertility in His hands. We decided to go to the best, Dr. Silber. We wanted expert care for my husband. After surgery Dr. Silber talked with me and even shared pictures. It was amazing. My husband opted out of seeing the pictures! Anyway, we conceived 6 mos after the surgery with our first reversal miracle and had a boy in April of 2007, one year and two months after the surgery. We conceived again 9 mos later and had another boy in Sept. 2008. We conceived again two years later and are due Sept. of 2010. I am 40 and my husband is 44 and we had these babies 7 years after the original vasectomy.

Dr. Silber's office staff is amazing too and I always felt I could call with questions and they celebrated with me every time I called to announce another pregnancy. I wouldn't hesitate to recommend this to anyone considering it. It was through the Lord and Dr. Silber's hands that we have three new lives into this world that wouldn't have been here without a reversal. Our lives are blessed.

William and Wendy K.
St. Louis, MO

Patient Comments - 15

We were first introduced to Dr. Silber by a friend of Ashley's who was an employee of Dr. Silber’s. From the very first appointment with Dr. Silber, we were very impressed with him and his staff. We were treated as a high priority with care and respect. Through a second round of IVF we conceived a beautiful little blessing known as Georgia Lou Powell. Without the Lord, Dr. Silber, and his amazing staff we would not have our beautiful baby girl.

Jarrod, Ashley, and Georgia Powell
Moscow Mills, MO

The History of IVF -The Milestones

1995

Pregnancies after Testicular Sperm Extraction (TESE) and ICSI in non-obstructive azoospermia. (Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, Van Steirteghem A, Silber S. Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod. 1995;10(6):1457-60).

Birth after blastocyst development from IVM oocyte plus ICSI plus Assisted Hatching (Barnes FL, Crombie A, Gardner DK, Kausche A, Lacham-Kaplan O, Suikkari AM, Tiglias J, Wood C, Trounson AO. Blastocyst development and birth after in-vitro maturation of human primary oocytes, intracytoplasmic sperm injection and assisted hatching. Hum Reprod. 1995;10(12):3243-7).

The first report of aneuploidy testing (Munné S, Sultan KM, Weier HU, Grifo JA, Cohen J, Rosenwaks Z. Assessment of numeric abnormalities of X, Y, 18, and 16 chromosomes in preimplantation human embryos before transfer. Am J Obstet Gynecol. 1995;172(4 Pt 1):1191-9; discussion 1199-201 ).

Zenzes from the group of Casper in Toronto demonstrated adverse effects of cigarette smoking on nuclear spindle. (Zenzes MT, Wang P, Casper RF. Cigarette smoking may affect meiotic maturation of human oocytes. Hum Reprod. 1995;10(12):3213-17).

The first report in which spermatids were used to achieve pregnancy. (Fishel S, Green S, Bishop M, Thornton S, Hunter A, Fleming S, al-Hassan S. Pregnancy after intracytoplasmic injection of spermatid. Lancet. 1995, 24;345(8965):1641-2).

Dmitri Dozortsev and coworkers have discovered that oocyte activation during ICSI is triggered by a water-soluble, heat-sensitive, non species specific cytosolic sperm factor. (Dozortsev D, Rybouchkin A, De Sutter P, Qian C, Dhont M. Human oocyte activation following intracytoplasmic injection: the role of the sperm cell. Hum Reprod. 1995;10(2):403-7).

The larget study done in the filed of IVF comparing urinary FSH with Rec-FSH (Out, H.J., Mannaerts, B.M., Driessen, S.G. and Coelingh Bennink, H.J. A prospective, randomized, assessor blind, multicenter study comparing recombinant and urinary follicle-stimulating hormone in in vitro fertilization. Hum. Reprod., 1995: 10, 2534 –2540).

The History of IVF -The Milestones

1994

The first live birth as a result of IVM following transvaginal ultrasound–guided oocyte collection. (Trounson A, Wood C, Kausche A. In vitro maturation and the fertilization and developmental competence of oocytes recovered from untreated polycystic ovarian patients. Fertil Steril 1994;62(2):353-62).

Development of the first highly purified FSH preparation for use in IVF (Howles CM, Loumaye E, Giroud D, Luyet G. Multiple follicular development and ovarian steroidogenesis following subcutaneous administration of a highly purified urinary FSH preparation in pituitary desensitized women undergoing IVF: a multicentre European phase III study. Hum Reprod. 1994;9(3):424-30). First pregnancy after use of r-hLH (Hull M, Corrigan E, Piazzi A, Loumaye E. Recombinant human luteinising hormone: an effective new gonadotropin preparation. Lancet 1994;30;344(8918):334-5).

The History of IVF -The Milestones

1993

The second term pregnancy after ICSI reported by a group in Sweden (Hamberger et al, 1993, In Gordts S (ed) Proceedings of European Symposium on Micromanipulation. Drukkerij Nauwelaerts, Leuven, Belgium, pp 85).

Confirmation that men with congenital absence of the vas defference, have cystic fibrosis mutations which can be transmitted to the offspring (Patrizio P, Asch RH, Handelin B, Silber SJ. Aetiology of congenital absence of vas deferens: genetic study of three generations. Hum Reprod. 1993;8(2):215-20).

First report on the use of TESE (testicular sperm extraction) and ICSI (Silber SJ, Nagy ZP, Liu J, Godoy H, Devroey P, Van Steirteghem AC. Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration. Hum Reprod. 1994;9(9):1705-9).

First Preganancy and birth following treatment with Rec-FSH (Devroey P, Mannaerts B, Smith J, Coelingh Bennink H, Van Steirteghem A. First established pregnancy and birth after ovarian stimulation with recombinant human follicle stimulating hormone (Org 32489). Hum Reprod.1993 Jun;8(6):863-5).

Pateints comments - 14

Dr. Silber,
I just wanted to drop you a note thanking you for your part in the birth of our son – Hugh Benjamin Jay. He was born November 3rd and weighed 6 lbs. 13 oz. May God Bless you for all that you do. We are eternally grateful.

Love,
Ben & Chanda Ruff
Bay City, MI

Pateints comments - 13

Dear Dr. Silber, Dr. DeRosa and staff,
We are writing to inform you of the birth of our fraternal twin sons, Abram David and Colton Willard. They are two beautiful, healthy, happy boys. They were born on August 8 at 37 weeks and 2 days via vaginal delivery without any complications and came home with us on the 10th. They are doing wonderful and are growing and changing every day. They already have their own individual personalities. Abram is laid back, happy and smiling all the time and Colton is a character who likes to cuddle and be held all the time. We feel so blessed to be writing this letter and we know it would not be possible without you. Everyone was such a pleasure to work with, especially Dena, our IVF consultant who we received the good news from! We cannot thank you all enough… you have helped make our dream come true of having a family and we will never forget you.

God Bless,
David & Emily Seaton
Collinsville, IL

The History of IVF -The Milestones

1992

Successful in-vitro fertilisation and embryo transfer after treatment with recombinant human FSH. Presented simultaneously by two groups: (Germond M, Dessole S, Senn A, Loumaye E, Howles C, Beltrami V. Successful in-vitro fertilisation and embryo transfer after treatment with recombinant human FSH. Lancet, 1992 9;339:1170) (Devroey P, van Steirteghem A, Mannaerts B, Bennink HC. Successful in-vitro fertilisation and embryo transfer after treatment with recombinant human FSH. Lancet. 1992;9;339:1170).

Assisted zona hatching was introduced in IVF programs to breach the zona pellucida and promote the natural process of hatching. (Cohen J, Alikani M, Trowbridge J, Rosenwaks Z. Implantation enhancement by selective assisted hatching using zona drilling of human embryos with poor prognosis. Hum. Reprod. 1992 7: 685-691).

Discovery that men with congenital absence of the vas deferens have a mild form of cystic fibrosis: Two papers:

(Anguiano et al. 1992, JAMA 267(13)1794)(Patrizio and Asch 1992, Annals Acad Med Singapore 21:533)

Report of the first pregnancy after intracytoplasmic sperm injection (ICSI) by the group in Brussels (Palermo G, Joris H, Devroey P, Van Steirteghem AC. Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet. 1992;4;340:17-8).

Pregnancy after embryo biopsy and coamplification of DNA from X and Y chromosomes. (Grifo JA, Tang YX, Cohen J, Gilbert F, Sanyal MK, Rosenwaks Z. Pregnancy after embryo biopsy and coamplification of DNA from X and Y chromosomes. JAMA 1992, 12;268(6):727-9).

Ovulation induction by endogenous LH released by the administration of an LHRH agonist after follicular stimulation for in vitro fertilization (Emperaire JC, Ruffié A, Audebert AJ. Ovulation induction by endogenous LH released by the administration of an LHRH agonist after follicular stimulation for in vitro fertilization. J Gynecol Obstet Biol Reprod (Paris). 1992;21:489-94. French).

First report on cumulative conception and live birth rates after IVF in relation to patient's age and cause of infertility (Tan SL, Royston P, Campbell S, Jacobs HS, Betts J, Mason B, Edwards RG. Cumulative conception and livebirth rates after in-vitro fertilisation. Lancet. 1992,6;339(8806):1390-4).

First two births from replacement of frozen embryos produced with epididymal sperm (Patrizio P, Silber S, Ord T, Marello E, Balmaceda JP, Asch RH. Replacement of frozen embryos generated from epididymal spermatozoa: the first two pregnancies. Hum Reprod 1992;7(5):652-3)

Report on using Erbium YAG laser for micromanipulation of oocytes and spermatozoa (Feichtinger W, Strohmer H, Radner KM. Erbium YAG laser for micromanipulation of oocytes and spermatozoa. Lancet. 1992, 11;340(8811):115-6).

Investigating the role of FSH in hypogonadotropic women usung the new recombinant FSH drug (Schoot DC, Coelingh Bennink HJ, Mannaerts BM, Lamberts SW, Bouchard P, Fauser BC. Human recombinant follicle-stimulating hormone induces growth of preovulatory follicles without concomitant increase in androgen and estrogen biosynthesis in a woman with isolated gonadotropin deficiency. J Clin Endocrinol Metab 1992; 74: 1471-3).

The History of IVF -The Milestones

1991

In Vitro Maturation (IVM) in an unstimulated cycle resulted in pregnancy in a donor oocyte program (Cha KY, Koo JJ, Ko JJ, Choi DH, Han SY, Yoon TK. Pregnancy after in vitro fertilization of human follicular oocytes collected from nonstimulated cycles, their culture in vitro and their transfer in a donor oocyte program. Fertil Steril 1991 Jan;55(1):109-13).

The fist report suggesting use of the GnRH antagonist, Nal-Glue, to prevent premature LH rise and progesterone in controlled ovarian hyperstimulation treatment. (Frydman R, Cornel C, de Ziegler D, Taieb J, Spitz IM, Bouchard P. Prevention of premature luteinizing hormone and progesterone rise with a gonadotropin-releasing hormone antagonist, Nal-Glu, in controlled ovarian hyperstimulation. Fertil Steril. 1991;56:923-7).

The first report on the use of a laser for Zona Pelucida drilling (Palanker D, Ohad S, Lewis A, Simon A, Shenkar J, Penchas S, Laufer N. Technique for cellular microsurgery using the 193-nm excimer laser. Lasers Surg Med. 1991;11(6):580-6).

Navot et all. confirmed that the age-related decline in female fertility is attributable to oocyte quality (Navot D, Bergh PA, Williams MA, Garrisi GJ, Guzman I, Sandler B, Grunfeld L. Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. Lancet. 1991 Jun 8;337(8754):1375-7).


Introduction of GnRH antagonist (Nal-Glu) in IVF procedures (Frydman R, Cornel C, de Ziegler D, Taieb J, Spitz IM, Bouchard P. Prevention of premature luteinizing hormone and progesterone rise with a gonadotropin-releasing hormone antagonist, Nal-Glu, in controlled ovarian hyperstimulation. Fertil Steril. 1991;56(5):923-7).

Embryo transfer catheter is visualized by vaginal ultrasound (Hurley VA, Osborn JC, Leoni MA, Leeton J. Ultrasound-guided embryo transfer: a controlled trial.Fertil Steril. 1991;55(3):559-62).

The History of IVF -The Milestones

1990

The first successful human cleavage-stage embryo vitrification followed by a successful delivery (Gordts S, Roziers P, Campo R, Noto V. Survival and pregnancy outcome after ultrarapid freezing of human embryos. Fertil Steril 1990;53:469-72).

Pregnancies from biopsied human preimplantation embryos sexed by Y-specific DNA amplification. (Handyside AH, Kontogianni EH, Hardy K, Winston RM. Pregnancies from biopsied human preimplantation embryos sexed by Y-specific DNA amplification. Nature. 1990;19;344:768-70).

First report of assisted hatching in human embryos. (Cohen J, Elsner C, Kort H, Malter H, Massey J, Mayer MP, Wiemer K. Impairment of the hatching process following IVF in the human and improvement of implantation by assisting hatching using micromanipulation. Hum Reprod. 1990;5(1):7-13).

The first report on polar body biopsy, transfer of the embryo and achieving pregnancy (Verlinsky Y, Ginsberg N, Lifchez A, Valle J, MoiseJ, Strom CM. Analysis of the first polar body: preconception genetic diagnosis. Hum. Reprod. 1990 5: 826-829).

Gonen et al proposed the use of GnRH agonist in place of hCG as a means to trigger the gonadotropic surge for IVF. (Gonen Y, Balakier H, Powell W, Casper RF. Use of gonadotropin-releasing hormone agonist to trigger follicular maturation for in vitro fertilization. J Clin Endocrinol Metab. 1990;71(4):918-22).

Gonen, Jacobson and Casper pioneered the use of combined oral contraceptives for follicle synchronization and cycle scheduling in IVF. (Gonen Y, Jacobson W, Casper RF. Gonadotropin suppression with oral contraceptives before in vitro fertilization. Fertil Steril 1990;53:282-7).

Fishel et all reported about twin birth after subzonal insemination (Fishel S, Antinori S, Jackson P, Johnson J, Lisi F, Chiariello F, Versaci C. Twin birth after subzonal insemination. Lancet. 1990 24;335(8691):722-3).

Patients Comments - 12

Dear Dr. Silber,
It has been a year this week that a doctor at the University of Chicago told us that we would never have children. As devastating as that news was, we didn't give up. And as luck would have it, God placed into our lives a doctor by the name of Sherman Silber. From the very first day we contacted your office, your staff gave us hope! Something we didn't have much of in the past.

The journey was long and emotional, but nothing worthwhile is ever easy. We are just very happy that the outcome is two wonderful children that we know in our hearts are truly miracles – special gifts from God.

Dr. Silber, I am not sure if you will ever know how much of an impact your work has on the people you serve. But I can tell you this, Gregg and I have not stopped smiling and thanking God since we found out that we were pregnant. You helped give us the best gifts we will ever receive – two children to love and call our own.

Please know that the work you do and the people you help will always be in our prayers. You are a remarkable doctor! Not a day goes by that we don't thank our lucky stars that our paths crossed and we were able to benefit from your tremendous knowledge.

We will continue to keep you updated on the progress of the Kaput twins. So far so good!

Sincerely,
Stephanie & Gregg Kaput
Plainfield, IL

Patients Comments - 11

Dear Dr. Silber,
Thank you very much for helping us conceive our beautiful twin girls, Mallory and Mariah Kortan. They are a wonderful blessing given to us through your help and assistance. We really appreciate what you have done for us. Thanks so very much.

God Bless,
Scott & Tonia Kortan
Palco, KS

The History of IVF

1989

First report on biopsy of human preimplantation embryos and sexing by DNA amplification. (Handyside AH, Pattinson JK, Penketh RJ, Delhanty JD, Winston RM, Tuddenham EG. Biopsy of human preimplantation embryos and sexing by DNA amplification. Lancet. 1989;18;1:347-9).



First report on the use of laser techniques in the field of assisted reproduction for application in gametes or embryos (Tadir Y, Wright WH, Vafa O, Ord T, Asch RH, Berns MW. Micromanipulation of sperm by a laser generated optical trap. Fertil Steril. 1989 Nov;52(5):870-3).

Gonen and her colleagues in Toronto pioneered the use of ultrasound for endometrial quality (thickness and pattern) related to IVF pregnancy. (Gonen Y, Casper RF, Jacobson W, Blankier J. Endometrial thickness and growth during ovarian stimulation: a possible predictor of implantation in in vitro fertilization. Fertil Steril. 1989;52(3):446-50).

Embryo biopsy technique was developed in mice by Professor Alan Trounson and Leeanda Wilton. (Wilton LJ, Trounson AO. Biopsy of preimplantation mouse embryos: development of micromanipulated embryos and proliferation of single blastomeres in vitro. Biol Reprod. 1989;40(1):145-52).

The History of IVF

1988

First two babies born after epididymal sperm aspiration for men with congenital absence of the vas deferens and naming of the technique MESA (Patrizio P, Silber S, Ord T, Balmaceda JP, Asch RH. Two births after microsurgical sperm aspiration in congenital absence of vas deferens. Lancet. 1988, 10;2(8624):1364).

Australia’s first IVF surrogate birth.

The first baby birth using subzonal sperm injection at National University of Singapore (Ng SC, Bongso A, Ratnam SS, Sathananthan H, Chan CL, Wong PC, Hagglund L, Anandakumar C, Wong YC, Goh VH. Pregnancy after transfer of sperm under zona. Lancet. 1988; 1;2:790).

Pregnancy was obtained from micromanipulation using zona drilling or mechanical partial zona dissection (Cohen J, Malter H, Fehilly C, Wright G, Elsner C, Kort H, Massey J. Implantation of embryos after partial opening of oocyte zona pellucida to facilitate sperm penetration. Lancet, 1988;16;2:162).

The death of Dr. Patrick Steptoe -March 21 1988. (The Washington Post ,Article: Dr. Patrick Steptoe, 74, Dies; Pioneered Test-Tube Baby Field, March 23, 1988).


The first preclinical evaluation of pronuclear formation by microinjection of human spermatozoa into human oocytes. (Lanzendorf SE, Maloney MK, Veeck LL, Slusser J, Hodgen GD, Rosenwaks Z. A preclinical evaluation of pronuclear formation by microinjection of human spermatozoa into human oocytes. Fertil Steril. 1988 May;49(5):835-42).

The History of IVF

1987

Fertilization of human oocytes by microinjection of a single sperm under the zona pellucida (Laws-King A, Trounson A, Sathananthan H, Kola I. Fertilization of human oocytes by microinjection of a single spermatozoon under the zona pellucida. Fertil Steril. 1987;48:637-42).

Patients Comments - 10

It has been a year this week that a doctor at the University of Chicago told us that we would never have children. As devastating as that news was, we didn't give up. And as luck would have it, God placed into our lives a doctor by the name of Sherman Silber. From the very first day we contacted your office, your staff gave us hope! Something we didn't have much of in the past.

The journey was long and emotional, but nothing worthwhile is ever easy. We are just very happy that the outcome is two wonderful children that we know in our hearts are truly miracles – special gifts from God.

Dr. Silber, I am not sure if you will ever know how much of an impact your work has on the people you serve. But I can tell you this, Gregg and I have not stopped smiling and thanking God since we found out that we were pregnant. You helped give us the best gifts we will ever receive – two children to love and call our own.

Please know that the work you do and the people you help will always be in our prayers. You are a remarkable doctor! Not a day goes by that we don't thank our lucky stars that our paths crossed and we were able to benefit from your tremendous knowledge.

We will continue to keep you updated on the progress of the Kaput twins. So far so good!

Sincerely,
Stephanie & Gregg Kaput
Plainfield, IL

Patients Comments - 9

After 3 years of infertility we learned the results of my husband's genetic test for azoospermia and we were devastated. We were told that our chance of conceiving was 0%. The doctor recommended we put our money towards adoption or donor sperm. The test discovered that my husband has a very rare genetic anomaly. He is a Turner’s mosaic. This means that half of his cells are XO with no Y chromosome causing him to apparently make no sperm. We were in such disbelief that we decided to get a second opinion from the other reproductive group in town.

By this point it was late 2007 and we were beginning to think that children were just not in God’s plan for us. In January 2008 after watching an episode of “Private Practice” I was searching on the internet for information on testicular sperm extraction (TESE) and if it would work for Tracy’s anomaly. That is when I came across Dr. Silber’s name. After more searching on the internet I decided to order his book, “How to Get Pregnant.” His book gave my husband and I hope again. We decided that if anyone could make our dream of having a baby come true it was Dr. Silber and his team at the Infertility Center of St. Louis.

On February 4, 2008, we boarded a plane and went to meet Dr. Silber for a consult. He was intrigued by our case and certain he could help us achieve a pregnancy and have our miracle baby. With his expertise in infertility and his routine use of ICSI he gave us a good chance of finding sperm hiding in tiny numbers in the testicle. That to us was wonderful news. A year later we boarded another plane to St. Louis and began our 2 week period of monitoring and medication leading up to retrieval and implantation.

The office staff is wonderful. They are willing to help however necessary and are very knowledgeable. They called every night to let me know how much medicine to take and answer any questions.

My husband's testicular sperm extraction was successful and Dr. Silber was able to get enough sperm to fertilize all 13 eggs and even to freeze a few extra sperm for future use if necessary. Three days later I returned to St. Luke’s to have two embryos implanted. Two weeks after the implantation we received a phone call letting us know that we were finally pregnant. We both cried in elation! On October 26, 2009, after many years of hope and devastation our miracle was born. Without Dr. Silber and his wonderful team we might have given up on our dream of having a family.

Tracy, Heather and Brayden
Omaha, Nebraska

The History of IVF

1986

Monash IVF report on the world’s first pregnancy and birth from the sperm retrieval operation performed on a patient who had a blocked sperm duct.

First description of transvaginal sector scan sonography for needle-guided transvaginal follicle aspiration (Feichtinger W, Kemeter P. Transvaginal sector scan sonography for needle guided transvaginal follicle aspiration and other applications in gynecologic routine and research. Fertil Steril 1986 May;45(5):722-5).

First pregnancy, following IVF donated oocytes, in a non-ovarian failure patient. (Rosenwaks Z, Veeck LL, Liu HC.Pregnancy following transfer of in vitro fertilized donated oocytes. Fertil Steril. 1986;45(3):417-20).

First report on pregnancy after translaparoscopic zygote intrafallopian transfer (Devroey P, Braeckmans P, Smitz J, Van Waesberghe L, Wisanto A, Van Steirteghem A, Heytens L, Camu F. Pregnancy after translaparoscopic zygote intrafallopian transfer in a patient with sperm antibodies. Lancet, 1986 7;1:1329). In parallel the goup at the RWH was involved too in studies on gamete intra-Fallopian transfer (GIFT), (Molloy D, Speirs A, du Plessis Y, McBain J, Johnston I. A laparoscopic approach to a program of gamete intrafallopian transfer. Fertil Steril. 1987;47(2):289-94).

Delivery of twins from frozen human eggs (Chen C, Pregnancy after human oocyte cryopreservation. Lancet 1986, 1,884 – 886).
Christopher Chen

Jacqueline Mandelbaum with Dan Szollosi described the microstructures of the human oocyte, which becameknown as ‘oocyte dysmorphia’ (Szollosi D, Mandelbaum J, Plachot M, Salat-Baroux J, Cohen J. Ultrastructure of the human preovulatory oocyte. J In Vitro Fert Embryo Transf. 1986 ;3:232-42).

The History of IVF

1985
Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. (Temple-Smith PD, Southwick GJ, Yates CA, Trounson AO, de Kretser DM. Human pregnancy by in vitro fertilization (IVF) using sperm aspirated from the epididymis. J In Vitro Fert Embryo Transf. 1985;2(3):119-22).

Epididymis sperm aspiration

Vaginal oocyte aspiration

Ultrasound image of follicles

GIFT procedure
Matts Wikland together with Lars Hamberger and
Lars Nilsson in Gothenburg, Sweden, described the possibility of using a vaginal sector scanner (transvaginal technique) for oocyte aspiration (Wikland M, Enk L, Hamberger L. Transvesical and transvaginal approaches for the aspiration of follicles by use of ultrasound. Ann N Y Acad Sci. 1985;442:182-94).

First report of the use of abdominal ultrasound guidance for embryo transfer. (Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V. Ultrasound guidance for human embryo transfer. Fertil Steril 1985 ;43:54-61).

The first reported birth after replacement of hatching blastocyst cryopreserved at expanded blastocyst stage (Cohen J, Simons RF, Fehilly CB, Fishel SB, Edwards RG, Hewitt J, Rowlant GF, Steptoe PC, Webster JM. Birth after replacement of hatching blastocyst cryopreserved at expanded blastocyst stage. Lancet. 1985;16;1:647).
quinn

In 1985 Quinn and Warnes published a formula entitled Human Tubal Fluid (HTF) that mimics the in vivo environment to which the embryo is exposed (Quinn P, Kerin JF, Warnes GM. Improved pregnancy rate in human in vitro fertilization with the use of a medium based on the composition of human tubal fluid. Fertil Steril 1985;44:493-8).

First ultrasound guidance for human embryo transfer. (Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V.Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43(1):54-61).

First Delivery Resulting From Gestational Surrogacy. (Utian WH, Sheean L, Goldfarb JM, Kiwi R. Successful pregnancy after in vitro fertilization and embryo transfer from an infertile woman to a surrogate. N Engl J Med. 1985:21;313(21):1351-2).

First successful egg donation in Europe. (Feichtinger W, Kemeter P. Pregnancy after total ovariectomy achieved by ovum donation. ancet. 1985:28;2(8457):722-3).

Transabdominal ultrsound guided embryo transfer (Strickler RC, Christianson C, Crane JP, Curato A, Knight AB, Yang V. Ultrasound guidance for human embryo transfer. Fertil Steril. 1985;43(1):54-61).

Navot et al. reported the possibility of artificially induced endometrial cycles and establishment of pregnancies in the absence of ovaries. (Navot D, Laufer N, Kopolovic J, Rabinowitz R, Birkenfeld A, Lewin A, Granat M, Margalioth EJ, Schenker JG.Artificially induced endometrial cycles and establishment of pregnancies in the absence of ovaries. N Engl J Med. 1986 Mar 27;314(13):806-11). Although it was published in 1986 it was first reported in 1985.

The History of IVF

The Government of Victoria established a review of IVF research and practice which led to the proclamation of the Infertility (Medical Procedures) Act 1984, the first legislation to regulate IVF and its associated human embryo research.

First surrogacy embryo transfer baby born in California

First report on pregnancy following translaparoscopic GIFT procedure (Asch RH, Ellsworth LR, Balmaceda JP, Wong PC. Pregnancy after translaparoscopic gamete intrafallopian transfer. Lancet, 1984;3;2:1034-5).

The first report on pregnancy following IVF and egg donation in a woman with primary ovarian failure. (Lutjen P, Trounson A, Leeton J, Findlay J, Wood C and Renou P. The establishment and maintenance of pregnancy using in vitro fertilization and embryo donation in a patient with primary ovarian failure. Nature, 1984;307,174 – 175).

Introduction of GnRH agonists to the IVF treatment protocol (Porter RN, Smith W, Craft IL, Abdulwahid NA, Jacobs HS. Induction of ovulation for in-vitro fertilisation using buserelin and gonadotropins. Lancet, 1984;1;2:1284-5).

A report of pregnancy following transfer of intact frozen-thawed embryos (Zeilmaker GH, Alberda AT, van Gent I, Rijkmans CM, Drogendijk AC.Two pregnancies following transfer of intact frozen-thawed embryos. Fertil Steril. 1984;42(2):293-6).

An unusual report of the possibility that abnormal spermatozoa could be enriched and give rise to healthy babies. (Cohen J, Fehilly CB, Fishel SB, Edwards RG, Hewitt J, Rowland GF, Steptoe PC, Webster J. Male infertility successfully treated by in-vitro fertilisation.Lancet. 1984, 2;1(8388):1239-40).

The first publication demonstrating HCG secretion by the human embryo (Fishel SB, Edwards RG, Evans CJ. Human chorionic gonadotropin secreted by preimplantation embryos cultured in vitro.Science. 1984, 24;223(4638):816-8).

The world's first IVF quadruplets were born on January 6, 1984, in Melbourne.

Patients Comments - 8

Dr. Silber,
I want to start by saying that Dr. Silber and all his staff are Amazing! My husband and I knew since the moment we met we wanted children. So after we were married for a year we started talking about starting our family. We figure maybe a month later we would be pregnant then nine months later we would have our baby and live happily ever after. Well after about 5 months we started to get worried and started having tests done to find the problem but we were only looking at me. After a year Robbie decided to get checked and we found out that he was born with a blockage of the vas deferens. A friend of mine told me about Dr. Silber, so I decided that we would go talk to him and get more information. I was scared to talk to Dr. Silber, because I was afraid that he was going to tell us that we would never have children.

Dr. Silber made us feel so comfortable, he listened to our feelings and never once lead us to believe that he could do something that he couldn't. Dr. Silber was very honest with us and reassured us that IVF would be the only way we would get pregnant. We loved that we never felt pressured into anything; we were given the facts and all the information and left to decide what we wanted.

Thanks to Dr. Silber and his staff we have beautiful 20 month old twins.

Thanks,
Robbie, Shanna, Cauy & Skylee Mondy
Old Monroe, MO

Pateints Comment - 7

My Story,

I am a leukemia survivor and blood stem cell transplant recipient. After treatment left me infertile, I heard about Dr. Silber and the ovarian transplants he was doing. It sounded like science fiction, but it wasn’t!

I was so lucky to have an identical twin sister. We were adopted from Korea when we were 14 months old. We thought that we were fortunate to have been adopted together—little did we know how fortunate it was! Rachel was able to donate the blood stem cells as well as the ovary. Dr. Silber did the surgery.

I began to ovulate about 3-4 months after the transplant! It was truly amazing. The road to pregnancy was still not straightforward. I had two miscarriages which were heartbreaking and so when I got pregnant for the third time, it was difficult to believe it would actually work. But after the first ultrasound that showed a strong heartbeat, and the second that showed the fetus developing normally, we started to believe it was real.

I gave birth to my son, Miles, in November 2009. He is so precious. Both my husband and I are ecstatic. Dr. Silber provides new hope to women who once thought they would never be able to give birth.

If you can dream it, Google it, and maybe you’ll find a Dr. Silber on the other end!

Nate, Anna, and Miles Heard
Washington, DC
and
Rachel Cederberg
Colorado Springs, CO

The History of IVF

1982

The first French IVF birth occurred in Clamart, France by the group of Frydman and Testart.

The first IVF birth in Sweden (Hamberger L, Wikland M, Nilsson L, Janson PO, Sjo¨ gren A and Hillensjo¨ T (1982) Methods for aspiration of human oocytes by various techniques. Acta Med Rom 20,370 – 378).

Birth of first Austrian "Test tube baby" (Twin pregnancy) (Feichtinger W, Szalay S, Kemeter P, Beck A, Janisch H.Twin pregnancy after laparoscopic oocyte recovery, in-vitro fertilization and embryotransfer (author's transl)]Geburtshilfe Frauenheilkd. 1982;42(3):197-9).

Richard Fleming

The first demonstration that GnRH agonists can be used to eliminate premature luteinization and control ovarian stimulation (Fleming R, Adam AH, Barlow DH, Black WP, MacNaughton MC, Coutts JR. A new systematic treatment for infertile women with abnormal hormone profiles. Br J Obstet Gynaecol. 1982 ;89:80-3).

The first report of the need for a delay between oocyte collection and insemination to allow oocytes collected to complete maturation (Trounson AO, Mohr LR, Wood C, Leeton JF. Effect of delayed insemination on in-vitro fertilization, culture and transfer of human embryos. J Reprod Fertil 1982;64:285-94).

Susan Lenz

Susan Lenz and Jurgen G Lauritsen demonstrated trans abdominal transvesical oocyte aspiration using an ultrasound-guided needle (Lenz S, Lauritsen JG. Ultrasonically guided percutaneous aspiration of human follicles under local anesthesia: a new method of collecting oocytes for in vitro fertilization. Fertil Steril 1982;38:673-7).

Ian Craft in London reported a pregnancy from transfer of gametes to the uterus (Craft I, Djahanbakhch O, McLeod F, Bernard A, Green S, Twigg H, Smith W, Lindsay K, Edmonds K. Human pregnancy following oocyte and sperm transfer to the uterus.Lancet. 1982, 8;1(8280):1031-3).

The History of IVF

1981
Howard and Georgianna Seegar Jones announced the delivery of the first IVF baby in the United States. This first IVF birth in the USA was achieved with the use of hMG.

Wood and his colleague introduced a foot-controlled fixed aspiration pressure control (Wood C, Leeton J, Talbot JM, Trounson AO. Technique for collecting mature human oocytes for in vitro fertilization. Br J Obstet Gynaecol. 1981;88(7):756-60).

Introduction of Clomiphene Citrate and hMG in the IVF treatment protocol (Trounson AO, Leeton JF, Wood C, Webb J, Wood J. Pregnancies in humans by fertilization in vitro and embryo transfer in the controlled ovulatory cycle. Science 1981 8;212:681-2) .

The Clamart group in France developed an LH assay (LH-SIR0 which could detect the initial LH rise in plasma allowing accurate prediction of the ideal time for the retrieval of oocytes (Testart J, Frydman R, Feinstein MC, Thebault A, Roger M, Scholler R. Interpretation of plasma luteinizing hormone assay for the collection of mature oocytes from women: definition of a luteinizing hormone surge-initiating rise. Fertil Steril. 1981 Jul;36(1):50-4).

The History of IVF -The Milestones

1979
Pez et al, began tracking the growth of follicles by ultrasound. They showed an appreciable relationship between the echographic and laparoscopic observations (Pez JP, Cohen J et al. 1979 Recherche d’une concordance entre l’e´chographie et l’observation par coelioscopie des follicules stimule´s par les inducteurs de l’ovulation. 178 soire´e gyne´co-obstricale de St Maurice le 9.10.79. Milupa. Bagnolet).

The first published use of ultrasound to identify growing follicles (Hackeloer BJ, 1977, The ultrasonic demonstration of follicular development during the normal menstrual cycle and after hormone stimulation. In Kurjak A (ed) Recent Advances in Ultrasound Diagnosis. Excerpta Medica, Amsterdam-Oxford, pp 122 – 128).

Patient Comment - 6

I wanted to write and thank you for making Mother’s Day 2010 one of the best days of my life. We celebrated with our amazing two-month-old twin baby girls and we wanted to extend our sincerest gratitude for helping us realize our dream to become parents.

We were both well over 40 and every doctor told us there was NO CHANCE. We soon found that local doctors were not willing to ‘work with us’ because of my age (42 at the time we first sought help). We changed doctors 3 times and they all prescribed the same conventional treatments and tests. This went on for a whole year while I was just getting even older. We finally figured out these doctors were trying to waste enough time to force us into using donor eggs, rather than pursue a plan that would help us try to have our OWN children. We realized that using donor eggs is a viable option for some couples but had told each doctor from the beginning that was not what we wanted. I was devastated when I realized they had basically wasted 11 precious months of our time!

Then we saw Dr. Silber. I figured if Dr. Silber was that good at thinking outside of the box, he could help a healthy 43 year old become a mother. I ‘googled’ and found out the office was only a four and a half hour drive away.

We believe that God works through people and we had a feeling we were in the right place when we noticed a ‘promise’ displayed on the wall that said Dr. Silber would work to the best of the ability God had given him to help people. Dr. Silber explained to us the odds of conceiving because of my age, now 43, but he also had a plan to give us a chance. Things seemed to keep telling us we were on the right track.

July 6th we found out we were pregnant. July 21st we found out it was twins! WOW!! I was treated like any other ‘normal’ high-risk pregnancy because of my ‘advanced maternal age’ of 43 and carrying twins. I had a very healthy pregnancy and made it to 39 weeks with what my OB described as a pregnancy better than most of her moms carrying ‘singletons’. We had beaten the odds.

Our very healthy and alert baby girls were born one week after my 44th birthday on March 8th! They continue to amaze us each day as we watch them grow and change. Brielle and Lillian bring such joy to our lives and we have not stopped smiling. We are so blessed.

We cannot thank you enough for your willingness to extend your expertise to successfully treat the infertility issues which older couples face.

Forever Grateful,
Dan & Lorelei Andedo
Rock Island, Illinois

Patient Comment - 5

In 2003 we were a typical military family of four. With our daughters ages 11 and 5 we felt extremely blessed and for the most part, fulfilled. After 11 yrs in the military we decided it was time to move on to the civilian world. So with logic over shadowing the deep hidden desire for a bigger family we went ahead and had a vasectomy. The gloom of making such a big mistake and not ever being able to have more children really put a black cloud over her head.

Then one evening we caught a special on television about a gifted doctor performing special miracles for people like us. It gave us hope. So we contacted Dr Silber's office after a couple weeks of debating the pros and cons for a vasectomy reversal, after all we didn't want to make another HUGE mistake.

So in the early summer of 2006 Dr Silber performed his magic. We stopped trying so hard and decided to let things take their natural course. Within a month we were pregnant again!! On September 27th, 2008 my wife gave birth to a very healthy baby boy. Tanner was 7lbs 12oz and 21inches long and ready to take over the house. Our house finally had a happy atmosphere again, my wife felt fulfilled, we had a son to pass on the name, things couldn't be more perfect.

Then at the beginning of 2009, to our surprise, we were pregnant again. Then a few weeks later another surprise, TWINS!!! Then a few months later another surprise IDENTICAL GIRLS!!!! We wanted a big family and we got it. On 28 October 2009 our twin girls Jessica and Gracie Lynn were born at 5lbs 5oz each and 19 inches long. Now we are beyond fulfilled and are comfortable with saying our family is big enough.

Thank you Dr Silber and all your team members for giving us the chance to become ONE BIG HAPPY FAMILY!!

Branden, Angel, Danielle (17), Kailey (11), Tanner (14mths), Jessica (1mth), and Gracie Lynn (1mth)
Cedar Hill, MO

Front page of the Sunday New York Times agrees with Dr. Silber on octuplets issue

It was the last piece of advice Thomas and Amanda Stansel wanted to hear. But their fertility doctor was delivering it, without sugarcoating.

Reduce, or you will lose them all, he told them.

For more than a year the Stansels had been relying on Dr. George Grunert, one of the busiest fertility doctors in Houston, to produce his industry’s coveted product — a healthy baby. He was using a common procedure called intrauterine insemination, which involved injecting sperm into Mrs. Stansel’s uterus after hormone shots.

But something had gone wrong. In April, an ultrasound revealed that Mrs. Stansel was carrying not one but six babies, and Dr. Grunert was recommending a procedure known as selective reduction, in which some of the fetuses would be eliminated.

The Stansels rejected Dr. Grunert’s advice and, since then, their vision of a family has collapsed into excruciating loss: the deaths of four children after their premature births on Aug. 4, including one who died late Sunday night. The two other infants remain in neonatal intensive care, their futures uncertain.

“I feel like we bonded with all of them, the short time they were here,” Mr. Stansel said. “We were able to hold them before they passed away.”

The birth of octuplets in California in January placed the onus for large multiple births on in vitro fertilization, a treatment in which eggs are joined with sperm in a petri dish and returned to the womb for gestation.

But the procedure the Stansels used is actually the major cause of quadruplets, quintuplets and sextuplets — the most dangerous pregnancies for both mother and children. While less effective than IVF, intrauterine insemination is used at least twice as frequently because it is less invasive, cheaper and more likely to be covered by insurance, interviews and data show.

Multiples can occur when the high-potency hormones frequently used with the procedure overstimulate the ovaries and produce large numbers of eggs. Parents are then left with the kind of tough choices the Stansels faced: whether to eliminate some of the fetuses or keep the babies and face extraordinary risks.

Microsurgical vasectomy reversal is not just vasovasostomy

Vasectomy reversal is often incorrectly thought of as simply a reconnection of the severed vas deferens. In fact, the term many doctors mistakenly use for the reversal of vasectomy is “vasovasostomy”. But vasovasostomy just means reconnecting the vas. Simply “reconnecting the vas” is not enough to restore fertility to most vasectomized men. The reason for so many failures of vasectomy reversal, even with “microsurgery”, is that in over 80 per cent of cases the pressure buildup inside the vas (caused by the original vasectomy) results in microscopic “blowouts” and “concretions” in the more delicate ductwork closer to the testicle (called the “epididymis”) which is where the sperm leave the testis on their way to the vas. If this complex, truly more delicate pathway, the epididymis, is not microscopically bypassed, the vasovasostomy will not work, because the sperm still cannot get to the site of the vas reconnection. They are blocked from even reaching the vasovasostomy site because the more delicate ductwork closer to the testicle remains blocked. So the routinely performed vasovasostomy was destined never to work no matter how accurate the reconnection.

The reason for this most commonly practiced error is that repair of the epididymis is very difficult, and requires years of very specialized practice and experience. Most urologists would be lost in the epididymis. So they might very earnestly apply what they think are “microsurgical skills” to perform a vasovasostomy, just hoping that there are no proximal blowouts in the epididymis. They might even tell the patient that they saw “sperm” in the vas fluid at the time of the vasovasostomy, increasing their hope that vasovasostomy is enough in their case. They will do anything to avoid trying to repair the usually obstructed epididymis because it is so difficult for the less experienced.

The problem is that there will always be creamy thick fluid in the vas deference on the proximal side of the vasectomy site, which has been stored in that obstructed site for years, and there might even be decayed old dead sperm or sperm parts in that fluid, and so it might be mistaken for epididymal continuity. But if the vas does not have translucent fluid with normal intact motile sperm, then you can be sure that no fresh new sperm have reached this area for many years, because of epididymal blockage more proximally. So you might leave the clinic with “wait and see” advice from the doctor even though there is no chance of the “vasovasostomy” working. It may not be until a year later with consistently negative semen analysis results, that you realize you had the wrong operation.

This problem of epididymal blowouts is much more common now than 20 or 30 years ago, and occurs much earlier after vasectomy, as early as 6 months even. The reason is that urologists are performing the original vasectomy much more tightly, allowing no leaks whatsoever of sperm. Therefore, it is important for the microsurgeon to perform this more delicate vasoepididymostomy procedure in over 80 per cent of cases, when there is secondary epididymal blockage.

After 25 Years of IVF, Couple Finally Conceives

After more than 20 years and nearly $200,000 worth of failed infertility treatments, Monique and Neil Ward of Stafford, England, have finally became the proud parents of twin boys, Britain's Press Association reports.

The Wards' 25-year struggle to become pregnant -- even though ultimately it was through the use of donor sperm and donor eggs -- raises a question many infertility specialists and aspiring parents face: Does there come a point when a couple should give up on trying to conceive?

After 15 failed attempts with various types of assisted reproductive technology since 1986, some might say the Wards were operating on blind optimism when they signed up for another $20,000 round of in vitro fertilization (IVF) with donor eggs and sperm last spring. An earlier round with this technique had failed five months before.

But against all odds, Monique Ward finally became pregnant. On Dec. 29, at the age of 46, she gave birth to two healthy twin boys, Walker and Benjamin.

Vasectomy Reversal Pitfalls?

nfortunately, there are many patients who receive poor microsurgical care by physicians who do not have the proper expertise and who commercialize vasectomy reversal for easy profit. So there are many traps to watch out for when choosing a doctor to perform your reversal.

For example, some doctors will offer a “money back guarantee,” but patients rarely get their money back after a failed procedure despite promises to the contrary. We have operated on many patients whose previous vasectomy reversal attempts at “money back guarantee centers” had failed, and none of these patients have ever gotten their money back. There was always some fine print wording that allowed the clinic to keep their money despite the “money back guarantee.”

In most so-called “centers,” the only procedure performed to reverse the vasectomy is “vasovasostomy” to try to reconnect the severed vas. However, in most cases there is also “epididymal” blockage (closer to the testicles) created by the pressure build-up after vasectomy. Thus, there is no chance for most cases of “vasovasostomy” to be a success, because there is also blockage in the more delicate duct closer to the testis, and this would have to be bypassed also with a very tricky-to-perform “vasoepididymostomy” in order to have a successful result.

What makes the Y chromosome, with its confounding repeats, polymorphisms, and degenerating regions, such an interesting study object for male infertility?

The answer lies in the evolutionary history of the X and Y chromosomes. Over the course of the past 240-320 million years of mammalian evolution, the X and Y chromosomes have evolved from what was originally a pair of ordinary autosomes (Figure 5). During that evolution, just as most of the ancestral X genes were decaying on the Y because of the lack of meiotic recombination, genes which control spermatogenesis arrived on the Y from autosomes. Once on the Y, these formerly autosomal genes amplified into multiple copies, and achieved greater prominence through a process called “gene conversion.” Spermatogenesis genes that arrived on the Y, but came originally from autosomes, include the DAZ (from autosome 3) and CDY (from autosome 6) genes that are among the seven gene families located in AZFc (Figure 6). Other spermatogenesis genes on the Y, such as RBMY, have persisted in their original position as on the X. The ancestral gene that remained on the X chromosome (RBMX) retained its widespread cellular functions, whereas RBMY, which persisted on the receding Y chromosome, evolved a male-specific function in spermatogenesis. Male benefit genes have thus arrived and accumulated on the evolving Y chromosome over many millions of years.

This evolution of the modern X and Y chromosomes was initiated by the emergence of a male sex-determining gene (now known as SRY) on what was originally an ordinary pair of autosomes (Figure 5). Genes associated with the non-recombining SRY region that were specifically beneficial for male function or antagonistic to female function, flourished on the evolving Y chromosome despite the deterioration of more generalized genes which lacked the DNA repair benefits of meiosis.

What are the genetic causes of male infertility?

Chromosomal abnormalities in males, such as translocations and inversions, which can be found with routine karyotyping, are found in approximately 1% of azoospermic males. However, the most common chromosomal abnormalities in azoospermic men are abnormalities involving the sex chromosomes, which are found in approximately 4% of these men. Klinefelter’s syndrome, in which patients show a 47,XXY karyotype, is the most frequent form. Even in these cases, we can usually find a few rare sperm adequate for fertility using ICSI.

However, the percentage of male infertility that can be explained by karyotyping alone is low, this being mainly due to the low resolution of routine cytogenetic studies. It was not until the development of modern molecular techniques such as polymerase chain reaction (PCR) that we could study the genetic causes of male infertility with much greater detail. Since then, many more genetic abnormalities, such as micro-deletions and point mutations, have been described in infertile males, with most research focusing on the role of genes on the human Y chromosome. We have shown that the long arm of the Y chromosome contains not one but many distinct deletion intervals and at least 60 genes belonging to nine gene families whose exclusive function is in spermatogenesis.

In fact, the deletion frequency of one or more of these regions on the Y chromosome in men with azoospermia or severe oligozoospermia is approximately 15% (Figure 1). After our initial report, many laboratories throughout the world have reported on these sub-microscopic deletions of the Y chromosome in azoospermic and severely oligozoospermic men. In fact, deletion screening of the Y chromosome is now considered standard practice for severely oligozoospermic and azoospermic patients undergoing assisted reproduction in most countries in the world.

Y chromosome In Humans and Apes

Comparing spermatogenesis in humans, chimpanzees and gorillas has always been fascinating. Chimpanzees, which weigh only about 100 pounds have enormous 8 centimeter diameter round (not oval) testes with sperm counts of over a billion per ml. Yet gorillas, which weight as much as 600 pounds or more, have tiny testes, very poor spermatogenesis, and in the sparse literature on gorilla testicular histology, in the majority of cases have what appears to be Sertoli cell only. Humans, the closest living relatives to chimpanzees and gorillas, fall somewhere in between.

The generally accepted reason for this massive discrepancy in spermatogenesis between these three closely related species lies in their differing mating patterns. Chimpanzees congregate in troupes of 30 to 40 in an extended family wherein any female who goes into heat is instantly mounted by every single male in the troupe. Therefore, there is an intense “competition” between the sperm of the different males to see which one will fertilize the females’ eggs. It is far more likely that the male with the highest sperm count, and the biggest testicles, will become the father of the male offspring, because of the high degree of “sperm competition” in chimpanzees.

In gorillas, it is the opposite. Any female is permanently attached to just one single silverback alpha male, and if she ever gets pregnant, it will have to be with his sperm only. So in gorillas there is no sperm competition. That results in small testes with very low sperm counts in these otherwise huge, very macho animals. But why is that? The answer lies in the peculiar instability of the non-recombining Y chromosome.

The multiple nucleotide sequence direct and inverted repeats (amplicons and palindromes) are where all the testis specific spermatogenesis genes on the Y are located. These areas are prone to frequent deletions caused by non-homologous, or “illegitimate” homologous recombination with itself, resulting in drop-outs of often huge chunks of DNA, making the concentration of spermatogenesis genes on the Y chromosome have a very fragile existence. So without sperm competition, sperm counts over eons of time are likely to go down.

Most intriguing is to compare the human Y chromosome to the chimpanzee Y chromosome, both of which have been fully and accurately sequenced. Unfortunately, the gorilla Y has not yet been sequenced. Nonetheless some interesting differences are noted between the human Y and the chimpanzee Y. Firstly, the chimpanzee Y has many more amplicons and palindromes than the human, and nonetheless, much fewer ampliconic genes (25 compared to 60). Furthermore, the chimpanzee Y is missing a gene (PRY) that is present on AZFc in the human, but completely absent in the chimpanzee. Furthermore, this gene has also been found to be absent in rare humans who have incredibly high sperm counts, approaching half a billion. Thus, comparing the super fertile chimpanzee Y chromosome to its less fertile human cousin, can help us understand better the genetic control of spermatogenesis in our infertile male patients.

What is Y chromosome and male infertility?

Along with the development of ICSI in 1993, our center was the first to study the Y chromosome and male infertility, and why tiny amounts of sperm are often found in the testes of azoospermic men previously thought to be making no sperm. You have probably heard a lot about the Y chromosome. It is what determines that a male is a male. We discovered with our first scientific paper on this in 1995 that the Y chromosome contains many genes that are involved in spermatogenesis, and deletions involving these genes are often found in infertile males. There has been a great deal of unknowledgeable discussion about our discovery of these sperm producing genes on the Y and a lot of misinformation. So in this page, I will try to clear up the confusion so you will understand better the genetics of male infertility. Our sequencing the DNA of the Y gives us a deep perspective about infertility genes that are widespread throughout the genome and which are also involved in transmitting infertility to future generations. A benefit of understanding the Y chromosome is it will help us to comprehend why men who are seemingly azoospermic usually have some residual tiny amount of spermatogenesis that can be used for successful ICSI. More importantly, it will expose the futility of trying to increase sperm count with drugs or varicocoele surgery.

Until two decades ago, there were no treatment options for infertile couples when the male had severely impaired spermatogenesis. In fact, there are still no clinical therapies to correct deficient spermatogenesis. Since the introduction of ICSI by us and the Brussels Dutch-Speaking Free University in 1992, however, there has been a revolution in our thinking about male infertility. Infertile couples with the most severe cases of male infertility, even with apparently 100% abnormal morphology and even just rare spermatozoa in the ejaculate, can now have pregnancy and delivery rates not apparently different from conventional IVF with normal sperm.

In 1993, we were the first to introduce microsurgical epididymal sperm aspiration (MESA) in conjunction with ICSI for the treatment of obstructive azoospermia. A few months later, TESE (testicular sperm extraction) was also found to be effective for the majority of cases of non-obstructive azoospermia as well. The reason is that approximately 60% of azoospermic men with presumably no sperm production actually do have a minute amount of sperm production in the testis that is just not quantitatively sufficient to spill over into the ejaculate, but which is adequate for ICSI. Thus, even men with spermatogenesis so deficient in quantity that no sperm at all can reach the ejaculate, could now have children with the use of TESE-ICSI.

What do you mean by Tubal Ligation Reversal?

A common dilemma many individuals face if they've previously had a tubal ligation is whether they should undergo a microscopic tubal ligation reversal vs. an In Vitro Fertilization (IVF) procedure. While a tubal reversal does require more skill than an IVF procedure, a tubal reversal is actually the better option for most patients. A tubal reversal requires one operation to restore fertility, enabling the patient to have as many children as she wants, whereas an IVF procedure offers a lower, 20% to 35% chance of success for each try and can be much more costly in that it could take several attempts before becoming pregnant. Our success rate with microsurgical tubal reversal is about 95%. (We actually were the first to develop this procedure in the U.S., and therefore have the largest experience with it.) The procedure involves a relatively small incision and only one day in the hospital. There is very little pain, and you can go back to work within a week. However, the microsurgery must be performed very expertly and delicately.
The fallopian tube is a tiny passageway that begins at the fimbrial end where the egg is picked up from the surface of the ovary, and leads through a microscopic opening into the uterus. As long as the fimbrial end has not been destroyed we can achieve an excellent micro-anatomical reconnection.

If a large amount of tube was destroyed by your original sterilization, that will not interfere with our achieving an accurate surgical reconnection. However, your chance for pregnancy is related to the length of the tube. If at least one-half of the tube is still intact, the chances for pregnancy will be over 90%. If there is a shorter length of tube, the chances for pregnancy will be less. As the amount of tubal length diminishes, the chance of pregnancy diminishes despite an accurate reconnection. Pregnancy can never be promised. However, a good microscopic operation is necessary to give you the best chance of restoring your fertility.

The diameter of the tube varies in different sections. Because your tubal sterilization has destroyed a certain segment of your tube, the two ends to be reconnected will most probably be of different size. Through the use of microsurgery we can beautifully reconnect these ends of the tube even when there is a difference in size. It is technically possible to connect the relatively large diameter near the fimbriated end to the tiny almost invisible cornual end. However, it is important to microscopically tailor such a reconnection to be as smooth as possible. This minimizes the risk of "ectopic" pregnancy. An ectopic pregnancy occurs when the egg, which is fertilized in the tube, gets stuck at the site of reconnection instead of passing into the womb to begin its growth into a baby. This risk is greatest when the site of reconnection is not a smooth, even transition.

The benefit of using the microscope for this surgery is that we can see the tiny inner opening of the tube clearly, and thereby accurately reconnect it. A meticulous microsurgical technique is necessary, and this, of course, requires considerable experience. We have performed over 8,000 microsurgical operations to reverse sterility in men and women, after developing these exacting microsurgical techniques on over 2,000 laboratory rats. It requires this kind of extensive practical experience to obtain the best results.