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The Egg Man

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Joan then shoots up from her slumber. "I bet you'd be surprised," she says. Thirty-two years later and Silber has become one of foremost experts in fertility treatment — and his expertise does not apply solely to humans.

A few years back, Silber published a paper explaining his theory on why dinosaurs became extinct — atmospheric changes caused the giant reptiles to have babies all of the same sex. More recently, Silber has turned his attention to primates. Spread across his desk on the seventh floor of St. Luke's Hospital last month were dozens of slide specimens of gorilla testes. He collected the biopsies this summer from a silverback at the Pittsburgh Zoo. The research, he hopes, will help shed light on man's struggles with infertility.

"Yeah, Sherman is a bit of a mad scientist," confirms Dr. Michael DeRosa, a St. Louis obstetrician and gynecologist who assists Silber in the operating room. "But by that I mean he's always finding new and innovative ways of doing things. If you look at the number of medical firsts he has, it's just staggering. He's just got just an incredible drive to learn and an uncanny knack for knowing what's going to work and what won't. He's like no other."

Like many patients, Manju Rentala discovered Dr. Sherman Silber through www.infertile.com, his Web site. Rentala, an emergency-room physician in California, had recently turned 40 and had become gravely concerned about losing the opportunity to have a child.

"I guess I'd always expected to find a partner and have children by this point in my life, but things just didn't work out like that," says Rentala, who cites a hectic work schedule and three decades of schooling as a few of the factors contributing to her current single status. "Suddenly there was this feeling that I was running out of time. I found Dr. Silber online and scheduled a consultation last November. I found out I was right. Time was running out."

Rentala's antral-follicle count revealed just five to seven mature eggs in her ovaries. Women in their late teens, by comparison, typically have 20 to 30 mature eggs in their ovaries at any given time, indicating a far greater number of total eggs in reserve. The low number of mature eggs in Rentala's ovaries revealed she'd already begun transitioning toward menopause, making her an unlikely candidate for ovarian-tissue freezing.

"Dr. Silber recommended I freeze my eggs, and he suggested we begin right away," recalls Rentala. Now Rentala gives herself a shot of hormones each day to stimulate her ovaries to drop multiple eggs. When she's about to ovulate, she flies from San Francisco to St. Louis, where Silber and his team harvest her eggs for freezing. After three such trips, Rentala says she's produced six suitable eggs for freezing and spent nearly $50,000.

"A lot of my friends are in the same position I am," adds Rentala. "They're getting older and want to have children. They have money to afford something like this, but they'd rather hope for the best — that they're able to have children in the late thirties and early forties — instead of doing something about it."

Still, given the money and effort she's spent on egg freezing, Rentala admits she remains a bit skeptical. "This procedure hasn't been studied a lot, and it will probably be another ten to twenty years before it really catches on," she muses. "Until then, you can't help but wonder if it's worthwhile."

Silber hopes his latest breakthrough may help dispel some of those fears. In July one of his patients became perhaps just the fifth woman in the world to become pregnant from frozen ovarian tissue. Silber believes the pregnancy proves unequivocally that the science behind ovarian-tissue and egg freezing works. Silencing the critics, however, will likely take more time.

"When I first came out with vasectomy reversal, people cried that it was immoral," recounts Silber. "Then along came IVF and people cried it was unethical and immoral. But sooner or later they'll realize this is a great technique and the opposition will melt."

When that day comes it's likely Silber won't even notice. He'll have moved on to the next innovation.

This past January, Silber again made history when he became the world's first surgeon to successfully transplant an entire human ovary. The complicated, three-hour surgery required Silber to connect the ovary to the microscopic arteries that feed the organ.

"It's a surgical tour de force," marvels Roger Gosden, an internationally recognized biologist with New York's Center for Reproductive Medicine and Infertility. "You need an extremely steady hand and great confidence when you're dealing with vessels less than a millimeter in diameter. Dr. Silber has a tremendous gift, especially when the stakes are high."

Scientists are now working on techniques that would allow for the freezing of whole ovaries for future transplantation. Such a procedure could theoretically eliminate the multiple operations required when ovarian-tissue grafts run out of eggs and have to be replaced. But Silber isn't convinced that's the direction the field should be heading.

"I'm not going to push it," he says. "It's an extraordinarily complex surgery and requires a serious incision. Sure, the whole ovary may last longer, but gosh. If we're getting just three to five healthy grafts from an ovarian-tissue operation, that's enough to restore the biological clock for a long while."

So, if not ovary freezing, what's next for the sexagenarian Silber? "I'm not sure, but I plan to be part of it," he says. "I'm going to die with my scrubs on." Remove ovary. Slice, dice and freeze in liquid nitrogen. Thaw and replace. Dr. Sherman Silber has a fertility recipe even a cancer

survivor can love.

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