Ep 296: Cracking the Code on Aging Eggs with Dr Sherman Silber

 Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. Featuring Dr. Sherman Silber, MD, founder of the Silber Fertility Institute in St. Louis. This episode features Dr. Sherman Silber, an internationally recognized pioneer in infertility treatment who has dedicated his career to helping patients overcome the challenges of female aging and diminished ovarian reserve. Dr. Silber shares how minimal stimulation protocols—using very small doses of gonadotropins combined with daily Clomid—can offer new hope for women with decreased ovarian reserve or premature ovarian insufficiency. He explains why HCG plays a crucial role in egg maturation, particularly for women with very low egg numbers, and why using lower amounts of medication may actually improve outcomes. Dr. Silber also looks to the future, discussing cutting-edge research that may enable the transformation of fibroblasts into eggs and sperm—an innovation that could redefine fertility treatment within the next 10–15 years. With decades of groundbreaking work behind him, Dr. Silber offers both practical guidance for today and visionary insights for tomorrow. This podcast was sponsored by IVF Florida 

Transcript

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Carrie Bedient MD (00:22)

Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am one of your co-hosts, Dr. Carrie Bedient from the Fertility Center of Las Vegas. And I am joined by my two zingy zazzy zen-like co-host Dr. Abby Eblen from Nashville Fertility Center. Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (00:38)

Hey everybody.

Susan Hudson MD (00:42)

Hello everyone.

Carrie Bedient MD (00:43)

And we are joined today by Dr. Sherman Silber, who is the founder of the Silber Infertility Center of St. Louis. And so we are delighted to have him with us today because he has stories beyond what any of us could imagine. And that applies both to the fertility world and the outside real world as well. And so before we launch into our topic, which is talking about IVF after 40, Dr. Silber, when we were chatting ahead of time, we had been told by a little birdie that you had recently come back from Africa and that you had stories about that trip. And then we started talking about all of your work with endangered species. And so now I don't know how to prompt you because I really want to hear all of these.

Sherman Silber MD (01:29)

I could talk to you forever actually. I enjoy schmoozing with you even before the show. But we've been going to Africa for almost 30 years, videoing and getting very, very up close and personal with animals. I'm really interested in wildlife and it started with wildlife reproduction, but now it's with endangered species and the whole aspect of wildlife. And so we're very familiar. Well, actually it's mostly East Africa.

Abby Eblen MD (01:40)

Wow.

Sherman Silber MD (01:53)

Oh, we had some amazing experiences this trip, because we get very up close and personal. And I love the elephants. They have such a peaceful family life because it's all women. I mean, the young adolescent males, they do this play fighting. They're preparing for the future. But once they get a little more than adolescent, the matriarch, who is the boss, kicks them out. And these guys are all alone.

And they have to find some elephant in another herd to inseminate when she goes into heat. But that's it. But basically, if you look at the elephant family, there are some immature males that are kept in line by the matriarchs, but it's all females otherwise. It's a family. You can get very close to them, and as long as they sense that you're not out to harm them, they could step on you and finish you off just like that when you're that close. But you're part of the family.

Abby Eblen MD (02:45)

So since I had a little technical difficulty and I didn't get to smooth at the beginning, what role do you play as a reproductive endocrinologist? Are you there just for fun and entertainment, enjoyment, or are you actually doing something to help the animals reproduce?

Sherman Silber MD (02:46)

Well, both actually. The zoos all over the world, we've operated in the St. Louis Zoo, the Amsterdam Zoo, San Diego Zoo, Pittsburgh Zoo, Tulsa Zoo, and in terms of being the fertility doctor. So yes, I really like to help out the endangered species that are in the zoo. And elephants are very interesting because, most of the animals in the zoo will live longer in the zoo than in captivity. They live longer than out in the wild for obvious reasons. Not true of elephants. Elephants have a tremendous lesson for us in terms of longevity. They live about 60 years in the wild, but only 40 years in the zoo. And I've talked to the zookeepers who probably know more about the biology of these animals than the doctors and the veterinarians or people like me. So I learned a lot from them.

And in the wild, course, elephants walk hundreds of miles every day. They have to do that because all their, there's 12,000 pound animals, their nutrition is wood and leaves. I mean, that's it. That's all their eating is, wood and leaves, and they grow to 12,000 pounds. And to really get to the really juicy leaves, they often have to just knock down the trees, which they do with ease.

So they could destroy an ecology very easily if they just had a limited habitat. But they don't. They wander for hundreds of miles every day. They're always walking and eating. ⁓ So that's why they live longer. In the zoos, it's impossible. They have to be fed their food and they don't have anywhere to walk, really. mean, they can walk the equivalent of a couple of blocks, but...

That's it. These animals cover more ground than any other animals. And I think what's happening is we all have stem cells for all of our somatic tissue and the nuclei and the stem cells divide very, very, very slowly. They're like the hard drive. don't divide quickly because then they'd have mutations and we wouldn't live very long. So they remain the permanent hard drive and they do so by their nuclei rotating, the stem cells in our body rotate. Resting eggs in your ovaries, the nuclei are also rotating. And when they stop rotating, and that's strictly related to tissue pressure, when they stop rotating, they're recruited, as you know, 30 a day or a thousand a month are recruited from the resting phase to developing for the next four and a half months and then finally become sensitive to gonadotropins four and a half months later in the end of the ovulatory menstrual cycle. So our ovarian longevity is very much like our longevity. So if you want to live longer, you got to be like the elephant and walk hundreds of miles every day.

Abby Eblen MD (05:45)

Hopefully pedaling on the peloton will accomplish that too.

Sherman Silber MD (05:48)

Tissue pressure which causes the nuclei in your stem cells to rotate and so they don't.

Susan Hudson MD (05:57)

Dr. Silber did something interesting happen with the elephants on this trip?

Sherman Silber MD (06:01)

Yes, I'm glad you brought that up. We thought that they really liked us because I mean, we weren't bothering them. I was videoing, I must have 50 hours of video. And the matriarch finally thought we were just too close with her trunk. And of course she could have just squatted us and killed us with her trunk, but she would never do anything like that, nasty. But she squirted us with about 20 gallons of muddy water. And I have it on video.

Abby Eblen MD (06:10)

That is hilarious.

Carrie Bedient MD (06:28)

That's awesome. Now, I remember being at the San Diego Zoo in their reproductive biology labs and seeing some of the devices that they use to help collect the sperm to inseminate the elephants. I mean, it was huge, like enough to fit a couple of scientists underneath it as they were trying to milk the sperm out. And have you had to do any of that hands on or have you just been more of the biology component of it?

Sherman Silber MD (06:52)

The keepers do all the difficult stuff like that. I've got some funny orangutan stories related to that. The keepers really know the animals and most zoos, they are very intimate with these animals. But the elephant penis is very difficult to manage. I wouldn't want to have to do that.

Abby Eblen MD (06:58)

Can we quote you on that?

Sherman Silber MD (07:12)

When we were doing a work with orangutans years ago, we wanted to take the orangutans that resulted from the pure breeds like Borneo and Sumatra and then put them into a gestational surrogate that was a hybrid because the hybrids really thought they were orangutans because they weren't hand raised in the zoo. They weren't considered valuable, but the pure ones were hand raised and they didn't think they were.

They didn't think they were orangutans. They thought they were people. It's like, know, like Kyla Lorenz's, you know, imprinting things. So when ⁓ Ingrid Porton, she doesn't mind mentioning her name. She was one of the great orangutan zoo biologists at St. Louis Zoo. And when she would come in to get a specimen for our project from this orangutan, who was a, he really thought he was a human being because he was a purebred and had been handbred. As soon as she walked into his area, he would get a huge erection and he would get so excited. He was in love with Ingrid

Susan Hudson MD (08:17)

That is so funny.

Carrie Bedient MD (08:18)

So on that note, Susan, do we have any listener questions about orangutans or elephants for this week? Or humans over 40, you know.

Susan Hudson MD (08:25)

We don't have any about animals other than humans. I did take a question having to do with diminished ovarian reserve as our subject today is IVF over 40. This is a little bit on the extreme side, but I think it's a very important question.

Susan Hudson MD (08:44)

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Susan Hudson MD (09:47)

So our question for today is, hi, I love the podcast. I was recently diagnosed with POI, which is premature ovarian insufficiency.

This has been a heartbreaking diagnosis for me. I started listening to all your episodes on DOR and POI after receiving the diagnosis and I'm not sure if I truly have POI. I'd love your thoughts. I'm 28 years old, AMH 0.6, FSH 19, estradiol 34, follicle count is 9 to 10. I still have a light period every 21 to 23 days.

Is POI a correct diagnosis if I'm still cycling? Maybe I'm in the denial part of grieving, but I'd like to feel a little more hope if it's diminished ovarian reserve instead of POI. I'd love some uncensored opinions. Based on my situation, do you think IUIs are worth it? Is IVF a good option?

Sherman Silber MD (10:43)

Well, IUI is a total waste of time for you because you don't have very much time left. So IVF is the only option. But let me tell you a little bit about ovarian longevity and POI. Notice we no longer call this POF. We used to call it premature ovarian failure. But we know that in any ovary, as the number of eggs goes down, as the ovarian reserve goes down, the rate of primordial follicle or resting follicle recruitment goes down.

And so at some point when it looks like you're completely out of eggs, there are a few eggs still left. And if you're young, which premature ovarian failure implies that you're young, then the eggs will be good eggs. But there will be some eggs hiding in the ovary, you might say, almost trapped in the ovary, because the rate of primordial follicle recruitment goes way down as the number of eggs actually goes down.

For a while that was a mystery, but now I think we figured it out that recruitment is related to tissue pressure gradient. And as the number of eggs goes down, then the ovarian cortex, which is where all the resting follicles are located in the outer membrane, gets stiffer and more tissue rigidity because it's not loaded with eggs. I mean, I would make an aside that'll make it clear. The embryologically, that outer membrane of the ovary where all the eggs are located is the same as the tunic albigenia of the male testes, which is the toughest membrane in the body. It's tougher than the inguinal ligament or the Achilles tendon. It's been studied by some morbid anatomists that put it on a tensiometer and the last tissue to break under any pressure would be the tunica albigenia of the testes.

I'm a urologist as well as a gynecologist. And so the tissue pressure is really what's controlling this. So as you have less eggs, the tissue pressure is greater and so you have a slower rate of primordial follicle recruitment. So What this amounts to is we can still find a few eggs in many women who have POI, even POF, because sometimes it's total failure is diagnosed because the woman stops menstruating. But if she stopped menstruating relatively recently, there will still be some eggs trapped there in that really super dense ovarian cortex. We're excited. Last week we got the 10th egg out of a woman, she's going to go public on this. I can't mention it on this program because I didn't bother to get a HIPAA release from her, but she is going to go public on it. She's a young girl. She's 23 years old. Came to us originally with her parents when she was 20. Very lovable person. Everybody in our whole program fell in love with this young girl and she's really intelligent and she's planning on going to medical school next year. But she had leukemia when she was five years old, had a bone marrow transplant.

Never had fertility preservation. So she basically had what they call POF. And they just called us out of just thinking, well, maybe there's something you can do. Well, I said, I doubt that we're going to be able to get eggs, but let's just try. And you just follow for all, can put them on what I call a mini IVF protocol, which is what I really prefer for a low ovarian reserve.

And eventually you see a follicle. You wonder there can't be an egg, it's got to be an empty follicle. But the very first time we did this, which was three years ago for her, we actually got a beautiful M2 oocyte, 20 year old oocyte. So we know it's going to be, it's a good looking oocyte. You know it's likely to be very fertile. And we've been doing that whenever we've been monitoring, like she's out of town. She's not in St. Louis.

And so she would get her estrogen drawn maybe once or twice a week when she was in college. And if the estrogen was starting to go up, maybe every four or five months, she would call us. She'd fly to St. Louis. We'd finish the cycle. And so we got her 10th egg just last week. She was crying. Her father was with her. He was crying. It's just a wonderful feeling.

Abby Eblen MD (14:45)

Wow, it's amazing.

Sherman Silber MD (14:52)

But 10 eggs from a woman who was in her early 20s is really good.

So our answer to this nation is don't give up at this point on your own eggs. Now I'm not against donor eggs. I can give a whole lecture on what an enthusiast I am for donor eggs. But that's not what people want, at least as a first choice. And so don't give up on that. I think we could tease out some eggs really. And you're obviously under 40, so that could be

be a pretty good egg.

Carrie Bedient MD (15:22)

Would you do a minimal ovarian stimulation cycle on someone with a follicle count of nine to 10? I mean, that's, she's got diminished reserve by an FSH of 19, but that's still a very solid egg count. I mean, I would think that a count like that would probably respond well to a fairly traditional gonadotropin cycle.

Sherman Silber MD (15:41)

I will shock you with this answer because you're very sophisticated REIs, but I would do minimal stimulation cycle on anyone, whether it's a good ovarian reserve or a bad ovarian reserve. And I'll explain to you why.

Susan Hudson MD (15:56)

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Abby Eblen MD (16:36)

How do you define a minimal stimulation?

Sherman Silber MD (16:39)

Oh, okay. It's not just low dose. There are four aspects to it that are very important for ovarian stimulation. And this may sound radical to you. It's based on our work with in vitro gamete genesis with a Hayashi in Japan. We've been working with Hayashi for 10 years. We developed our IVM system based on what he found in the mouse. He's been able to make competent oocytes from mouse skin cells and baby mice or pups from those skin cells that came from the mouse's tail rather than from the mother's ovary. Every day you have eggs that have exited the resting phase and the inert phase and are becoming sensitive to gonadotropin. And at any given time they've had maybe five days exposure, one day exposure, 12 days, 20 days exposure to gonadotropin, these eggs. And if there's, and this is the way the ovulatory cycle works, cutting to the quick, I think the only reason for ovulation or making a follicle is to get the egg out of the ovary. Because otherwise maturation of the egg occurs perfectly well in the absence of making a follicle.

The purpose of the follicle is to be able to retrieve the eggs. But you need very, very little stimulation for recruiting eggs. We found at least in the animal, and it's true in most of the animals studied, that less than seven days exposure to gonadotropin, this is within vitro gametogenesis, less than seven days of exposure to gonadotropin and the oocyte will not mature. More than 12 days exposure to gonadotropin, and it's usually not a very good oocyte and it may degenerate even, but it's not very good. So there's a sweet spot. And what we find is that anytime we do a dissection of ovary tissue, which we do if we're going to do say ovary tissue freezing, and we dissect it, in the spent media, we find GVs of course, and just exposing, culturing in hCG for anywhere from 36 to 48 hours results in conversion to M2 almost always 30 to 40%. The average is consistently 33 % in all cases, no matter what the ovarian reserve is. So that represents that sweet spot of oocytes that have had more than seven days exposure to gonadotropin and less than 12 days exposure of gonadotropin. That's the sweet spot, 30 to 35%, sometimes as high as 40%. And it's nothing magic. You can do it in your clinics. You don't have to have any special research interest in IVM. Really all you have to do is expose those GVs that you get from the ovary to hCG.

There's nothing fancy about it. It's really easy. But if you gave them FSH to prime them, or hCG to prime them, you won't have those same good results. You will mess the whole thing up.

So you just want to unstimulated, no prior priming, just retrieve those GVs and 33 % on average are going to mature in the presence of hCG or LH, but hCG is easier. So based on that, what we want to do is the first part of the mini IVF is to make sure we suppress them with birth control pills. Not just for timing the cycle, which is very convenient, but...and I know Bruce Shapiro was doing this for many years. I don't think he was thinking about improving the egg quality. It's just that he was one of the first to really time cycles for the convenience of the patient and the lab. And so we want to get rid of all the developing eggs so that when we start stimulating, the only eggs that are there are eggs that that day that we started stimulating, that's the same day they became sensitive to gonadotropin because otherwise you'll have eggs that have had too much exposure to FSH, whether it's a high dose or a low dose. And what we found is we get the same number of eggs with a low dose as we would get with a high dose.

Abby Eblen MD (20:40)

And what's your dose that you usually start out with?

Sherman Silber MD (20:42)

Well, if they're really low ovarian reserve, it's 150 every other day. It could be 75 a day, but since it's almost a two day half-life, we just give them less shots by giving them 150 every other day instead of 75 a day. But it doesn't matter, 75 a day would be just exactly right. And a woman like this with POI, actually, this is ironic, but you get better egg yield than if you pound them with 450 or 600 IU of gonadotropin. And so we're talking about mini IVF. One aspect of it is you've got to suppress with birth control pills first. And we found it has to be a minimum of 18 days. Now you can over suppress them for two years if you want continuously, but you really need at least 18 days to get rid of all those developing follicles that aren't going to be any good anyway when you stimulate them. And then we give a low dose of FSH because that's all you need. And then we add Clomid. Why do we add Clomid? Well, microdose hCG, you need something like we all use, well, not I anymore, but we use Menopur because it has microdose hCG in it. Or you could just use straight microdose hCG.

It's not as good as LH because it causes apoptosis. It is good for maturation, but it has a contradictory effect of apoptosis. LH is better, but we can't give LH. It's got a one hour half-life and you don't make it anymore because it didn't work. But if you give Clomid and not a high dose, high dose can be contradictory. Just 50 milligrams of Clomid a day, you'll get that LH boost.

So we suppress with birth control pills or any, or you can do it with ganirelix too, but you suppress with birth control pills just to synchronize the stimulation. And you make sure to add Clomid because you want LH. You use a low dose of FSH. Now there's one fourth aspect of this. You know how with Clomid we normally give it to them for five days and stop it so that the uterine lining will recover?

Abby Eblen MD (22:47)

Correct, yeah.

Carrie Bedient MD (22:47)

Yeah.

Sherman Silber MD (22:47)

If you keep giving the clomid till you do the trigger, it's an anti-estrogen and it will premature ovulation. So you don't have to slam them with Ganirelix to prevent premature ovulation. Just give the clomid. Cause I think that slamming it with Ganirelix and dropping the FSH can be a problem. So we don't do that. Now, if we get worried, cause it's over a weekend or something you always get a warning that LH begins to rise a little bit. In 10 % of cases, it will escape the clomid. But so we give them a third a dose of Ganirelix, a tiny dose. It doesn't really do very much except that tiny dose of Ganirelix at the end of the cycle will prevent you're being fooled. If you monitor LH every single day, you'd be able to detect when they're escaping.

It's a long answer, but those are the four reasons why I think what I call the mini IVF protocol is good for any age and any ovarian reserve, particularly good for for PCOS. Sorry.

Abby Eblen MD (23:48)

Fascinating.

Carrie Bedient MD (23:51)

So is this your default protocol for everybody who comes in over 40 in your office or do you mix it up with higher dose gonadotropins or different protocols at all?

Sherman Silber MD (24:00)

No, this is, it started out only for women over 40 or with low ovarian reserve in 2003. And we've gradually increased the use of it in other cases and now we use it in virtually every case.

Abby Eblen MD (24:13)

Wow.

Susan Hudson MD (24:13)

It definitely cuts down on the price of your stimulation.

Abby Eblen MD (24:16)

Sure does.

Sherman Silber MD (24:16)

It cuts down on the cost. The women prefer that. They don't want to go through hormonal swings. And if they've got a high ovarian reserve, like PCOS patients or young women, we get a lot of eggs. It's just amazing. A little touch of Clomid and FSH and you get a lot of 15 eggs from them. Okay, we're not going to get 40 eggs or 50 eggs, but we don't want that because then most of these aren't very good anyway.

The number of eggs we get depends basically on the ovarian reserve. Now, not the extreme number, but we don't want the extreme number.

Carrie Bedient MD (24:49)

Do you normally see the percentages of aneuploidy that you would anticipate for someone who's you're doing this protocol on who's 35 versus 40 versus 43?

Sherman Silber MD (25:01)

Percentage of aneuploidy, it was shown by a doctor named Bart, woman named Bart from Holland a long time ago, that the percentage of aneuploidy is related to the dose of the FSH. It was also shown by John McCurry in San Antonio, where we're going to have our ASRM meeting next month, that ⁓ increasing the dose of gonadotropin increases the imprinting errors.

Yeah, in terms of aneuploidy and imprinting, that higher dose is harmful.

Abby Eblen MD (25:31)

So is there anybody that you would give gonadotropin to over 150 total or everybody gets 150 pretty much or less?

Sherman Silber MD (25:39)

Right question, because there's always an exception. You're dealing with a woman who's got a high BMI and there's low absorption from subcutaneous tissue and ⁓ we'll raise it to 225, even 100. But her level of serum FSH isn't going up that much more. We're just dealing with ⁓ poor absorption.

Abby Eblen MD (25:41)

Yeah.

Susan Hudson MD (25:59)

What do you think about adjuncts like CoQ10 or growth hormone in your patients over 40 doing IVF?

Sherman Silber MD (26:07)

Well, I certainly am totally against metformin. I don't see infertility as being a result of insulin resistance. And I think metformin is a really miserable drug. Everybody goes off metformin if they're. DHEA has been shown by randomized controlled trials, not to help at all. And I worry about increasing the testosterone concentration.

In general, I'm against the supplement industry because in 1996 they passed this bill that doesn't allow FDA any regulatory control.

So we give everybody prenatal vitamins, or if they have MTHFR, we'll give them folic acid, but we have to do that. But other than that, I'm really...very much afraid of supplements.

Abby Eblen MD (26:54)

So not even CoQ10, huh? Everybody loves CoQ10, I thought.

Sherman Silber MD (26:58)

I take them off of everything.

And if they want to live to 100, they've got to start exercising.

Susan Hudson MD (27:07)

Do you feel that the rate of aneuploidy in women over 40 is more closely related to what you were mentioning, the FSH dose as compared to ovarian aging?

Sherman Silber MD (27:20)

⁓ No, no, definitely not. Ovarian aging is the major cause of aneuploidy. No question about it, But an additional cause of aneuploidy is that overstimulation.

Abby Eblen MD (27:23)

Yeah.

So Dr. Silber, I have a question that's a little off topic, but since you're such a pioneer and you've done so many pioneering things, I'm sure you were probably at ASRM a couple years ago and you alluded to it with your friends in Japan that the goal somewhere down the road would be not to even have to do an egg retrieval where we could actually ask or get fibroblasts from the forearm, make them into stem cells and then make eggs and sperm. What's your crystal ball say in terms of when we're gonna be doing that? And do you think that's reality for us at some point?

Sherman Silber MD (27:59)

Well, just say that I've worked closely with Hayashi for over 10 years and with Amander Clark for about the last seven years. She's in UCLA. He's in Osaka. Originally he was in Kyushu, but it's so big what his projects are now that he needed a big university with, as he said it, a lot of hands because it's a lot of work. These Japanese...post grads are in the lab till midnight and they get to lab at six in the morning and it takes that kind of work ethic to do. So all I'm going to do is just tell you what Dr. Hayashi says. He believes he's at the stage now where we'll be able to, well for sure now we can make PGCs from 55 year old women's skin bile, primordial germ cells. We've got that, we've published that, papers by the type of Pandolfi et al with Amander Clark. And so we just know in the humans we can make primordial germ cells. But then how do you go from primordial germ cell to competent oocyte? Well, you need fetal granulosa cells. We know from the mouse work that you can't use adult granulosa cells. You have to incubate those PGCs in fetal granulosa cells, which is easy to obtain in the mouse but definitely would be a stumbling block in the human. So the next step, which they've succeeded in the mouse as a prelim to doing it in the human is to find the transcripts necessary in a different culture for converting stem cells into fetal granulosa cells. Now, mind you, all these cells that we create from stem cells are basically fetal cells. They're extremely young. We're just recreating embryology.

Sherman Silber MD (29:43)

And the goal would be to create the fetal granulosa cells from stem cells in a separate culture. Well, they've done that in the mouse. The paper is Yoshino et al from a couple of years ago with Hayashi's group. And ⁓ then you incubate the PGCs that you've obtained in one culture with the fetal granulosa cells, you obtain another culture, all coming from stem cells.

You incubate them together, you get competent oocytes and healthy baby mice. So now it's just a matter of, that's the landmark in the human to make human fatal granulosa cells. So Dr. Iosha, feels that he'll have that pretty well figured out in five years.

Carrie Bedient MD (30:27)

So looking at other influences of eggs, how do you feel about growth hormone? Because that's not a supplement, that's monitored by the FDA, Omnitrope. And how do you feel that has an impact?

Sherman Silber MD (30:37)

Yeah.

Well, I think it makes no sense at all. Yeah, I know it's very popular, it makes no sense at all. Growth hormone is really good for kids that need to grow. ⁓ And I know it's anabolic and all that, but getting above normal levels of growth hormone is not really healthy. That's been done actually since the 70s. There was a paper in the New England Journal of Medicine, which was totally false, saying that you put men on testosterone and growth hormone and you can make them live longer and, and be stronger. But that was just testosterone effects. It's been proven that that was wrong. The growth hormone, if anything, is resulting in problems earlier, Lewy body dementia and, ⁓

So I think the growth hormone is potentially dangerous. Now for the stimulation cycle, it's only for a cycle. So it's probably not going to be harmful, but I don't think it's done any good. I think for older women, there are two crucial things. One is the stimulation protocol I mentioned, and the other is to communicate psychologically and let them know that you understand that everybody wants their own DNA. If they can't have their own DNA though, if it doesn't work, they need to take a different look at donor eggs than they may be. So we tell them you can easily monitor your appearance and background. What we can't monitor is what you really care about mostly. And you think that's the issue. Five things, personality, character, intelligence, emotional stability, and bonding with you as mother. But those, we've been using donor eggs since 1986 and watching the kids grow up, because I have a strong interest in early childhood development. And I have always been impressed since I was young with Lorenz's work with imprinting. I'm not talking about genetic imprinting.

Well, actually imprinting with orangutans, because this orangutan thought he was a man.

Abby Eblen MD (32:39)

A male!

Sherman Silber MD (32:40)

He an erection every time that Ingrid came in to get her husband. So I think that imprinting in the Conrad Lorenz sense is really crucial. So those five characteristics are not in the DNA. They arise from how you interact with a baby in the first two or three years of life.

And that doesn't mean you can program the baby like a computer, because you'll get it all wrong. You don't know the algorithms for character. But if it's a loving interaction and just a healthy interaction, then the baby turns out in ways you may not predict. But those five features become very favorable. So I try to convince women that I know you want your own eggs, but if it doesn't work, then you shouldn't deny yourself what you want and it'll be your baby. And I've challenged some of them because I've been doing this for a long time and their kids graduate from medical school or law school and they're very proud. We get a card or a Christmas card.

When I challenge them, I say, you realize this is not your DNA, right? What are you talking about, doctor? Who cares if it's my DNA? It's my baby. So I think it's very important that.

Abby Eblen MD (33:44)

Yeah. I know that's funny how that works.

Sherman Silber MD (33:48)

Now we will have the alternative. It won't be five years from now because regulation is going to take another five or 10 years. It could be 15 years from now. But about this, in 15 years, a 38 year old woman would be better off having a skin biopsy than an egg retrieval. Because the skin biopsy will yield very young, extremely fertile eggs until a higher success rate from her skin biopsy than from an egg retrieval. That's what I'm predicting in 15 years.

Abby Eblen MD (34:14)

Dr. Sherman Silber says we're going to be doing no more egg retrievals and we're going to be doing skin biopsies. We'll mark, we'll remind you of that in 15 years. 2040,

Sherman Silber MD (34:21)

We could theoretically do it in 2030, at least that's what Dr. Hayashi feels and I trust him, but regulatory review and studies, we're not going to be able to do that until 2040.

Carrie Bedient MD (34:34)

Now it's only a real prediction if it gets on an episode of The Simpsons.

Now, are there any patients that you would tell, just go straight to donor? Don't spend the time and the money and the emotional effort on trying to get your own eggs. Is there any group of people where you think it's just reasonable to go straight to donor?

Sherman Silber MD (34:51)

Yeah, of course, but I ask them what they want to do. You got to ask them, what do you want to do? We've got a 1 % chance you're getting pregnant if we use your eggs. What do you want to do? 1%. It's like Jim Carrey, remember in that movie Dumb and Dumber. is a chance. So you absolutely have to go with what they want because they have to have their own sense of ready.

Abby Eblen MD (35:10)

There's a chance.

Carrie Bedient MD (35:08)

You're saying there's a chance…

Carrie Bedient MD (35:17)

That's, thank you so much for giving us an insight and a window into a world that even us as REIs don't look into nearly as frequently. ⁓ And for sure patients don't get a view into this world that is shaped by somebody who's been practicing since before really the birth of IVF and how all these technologies have come into play.

⁓ I see why you and my partner, Dr. Shapiro, are good buddies and that he raves about you. So thank you so much for coming on and talking to us today.

Sherman Silber MD (35:51)

Thank you very much and give my love to Bruce. He's an amazing guy.

Carrie Bedient MD (35:56)

Absolutely. To our audience, thank you so much for listening and subscribe to Apple Podcasts to have your next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Susan Hudson MD (36:10)

Visit fertilitydocsuncensored.com to submit questions and sign up for our email list. Pick up your copy of the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore. Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Abby Eblen MD (36:25)

And as always, this podcast is intended for entertainment and not a substitute for medical advice from your own physician. Thank you guys. Bye.

Carrie Bedient MD (36:32)

See you next week, bye.