Sherman Silber is the medical director of the Infertility Center of St. Louis at St. Luke's Hospital in St. Louis,
Missouri. He pioneered such infertility treatments as microsurgical vasectomy reversal, testicle and ovarian transplantation, modern
approaches to successful in-vitro fertilization, and the sperm aspiration and intracytoplasmic sperm injection technique for previously
hopeless cases of male sterility.
Silber states that his "view is very, very strong that women should be allowed to make up their mind about anything they
want to make up their mind about in the reproductive field." He emphasizes the importance of age in female fertility, sharing research
data that shows lower conception rates over time. Pregnancy, delivery, and the effectiveness of IVF all decline with age. The two most
influential factors that affect fertility are a woman's age and egg supply.
According to Silber, neither the insurance companies nor the drug companies really have a rationale for when they pay for
infertility treatment. For the most part there is no
insurance coverage. If there were consistent and rational coverage for infertility, there would be a ten-fold increase in services.
Ninety percent of women who need infertility treatment cannot get it because they cannot afford it. Most are
women who pay the usual huge premiums through their employer for health insurance. Despite having laid out all that money for health
insurance, they still have to pay separately and privately for infertility treatment. Silber asserts that there is no rationale for who
is covered and who is not.
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