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On Monday, August 27, Ashley Perkins got the news she feared most: The lump that surfaced on her neck this summer tested positive for lymphoma. The 23-year-old Perkins will need immediate chemotherapy, but first her oncologist suggests she consult the highly esteemed Dr. Sherman Silber.
So it is on this last Friday morning of August that Perkins, a graduate student at Missouri State in Springfield, finds herself curled up in a chair inside St. Luke's Hospital in Chesterfield. At 9:30 a.m. a nurse enters the room where Perkins and her mother, Cynthia, wait in anxious silence. In an operating room down the hall, Sherman Silber and his team are ready for surgery. If all goes according to plan, Perkins will wake 50 minutes from now with no visible changes to her body, save for a slight incision below her waistline. The cancer wrapped in a stranglehold around her throat will still be there, but in a sense Perkins will have a new lease on life.
In a procedure that a few years ago might have seemed as outrageous as the cryogenic freezing of Ted Williams' head, Dr. Silber and his assistants will remove one of Perkins' two ovaries, dice it into sections no bigger than a thumbnail, and store it in liquid nitrogen. Years later after Perkins has beaten cancer and is ready to have children doctors will attach the thawed slices of organ onto her remaining ovary. The frozen tissue will recharge the ovary that's been rendered sterile from chemotherapy. Following the transplant, Perkins should begin ovulating normally within a few months. What's more, the amount of ovarian tissue Silber plans to freeze today will theoretically allow Perkins to become pregnant far past the age most women become infertile.
"I've had patients tell me in hindsight they're glad they got cancer because now they control their biological clock," offers the 5-foot-5-inch Silber, whose diminutive stature belies his towering reputation in the field of fertility treatment. "In 2022, if Ashley wants to have a child at the age of 38, her ovary will still be that of a 23-year-old."
At 9:33 a.m. Perkins enters the fluorescent glow of the operating room. Minutes later, her pale blue eyes surrender to the anesthesia. Silber's nurses swoop in to bathe her belly in yellow iodine. An "X" drawn in black ink above her pubic hairline marks the spot where attending physician Dr. Jorge Pineda will make the two-inch-wide incision needed to extract her ovary. For the next five minutes the only sound in the room is the staccato clicking of the electrocautery scalpel as it singes and tears the flesh revealing skin, fat and muscle in layers, defined as sedimentary rock.
An inch deep into his carving, Pineda discards the scalpel and plunges his fingers into the open wound. A minute later at 9:51 a.m., out plops one of Perkins' two ovaries. The silvery-white orb clings for a fleeting moment to the thread that is the fallopian tube until snip a pair of forceps forever severs the organ from its life source.
Poets may rhapsodize of the human ovary as a flower pistil, its honeyed nectar the source of all mankind. In reality, the ovary is a mollusk, a slimy little bivalve the size and shape of a freshly shucked oyster. But it's not enough that the oyster is removed from its shell. Silber must now peel the slippery organ of its outer skin. It is a delicate surgery that requires a nurse to pinch the tissue with tweezers as Silber slices the ovary broadside and painstakingly shaves out the organ's superfluous inner core.
"It's almost as though the ovary was designed perfectly by God for cryogenic freezing," observes the 65-year-old Silber, a Frontenac resident and father of three grown sons. "Everything we need all the eggs are in the outside lining."
At last Silber shapes the organ to a shallow disk as smooth and flat as a 50-cent piece. As Dr. Pineda sutures Perkins' wound, Silber cuts the tissue into eleven tiny slivers and places each piece into a plastic vial for freezing. Transplanted onto her existing ovary, each slice of ovarian tissue will provide Perkins with approximately three years' worth of eggs. Once the transplant runs its course, surgeons can attach another piece of frozen tissue onto her ovary and again kick-start menstruation. In total, the slices of tissue harvested this morning could provide Perkins with 33 years of fertility, making it possible for her to have children well into her late fifties and beyond.
At 10:20 a.m. Perkins is rousing from her slumber when Silber walks her samples to an adjacent laboratory. In a short while a nurse will place the ovarian tissue in a vat of liquid nitrogen that already contains similar samples from a dozen other women. Like Perkins, most of the women come to Silber because cancer or some other medical calamity threatens to render them sterile. But that's not always the case.
Suspended in time at negative 196 degrees Centigrade is the ovarian tissue of at least four women who've seen Silber out of fear they will lose their fertility before they're ready to have a child. Some of these women have put off childbirth to concentrate on careers or education. Others simply have no intention of settling down any time soon and want to ensure they can have children if and when the moment arrives. Silber's willingness to treat women for these so-called "lifestyle reasons" has raised more than a few eyebrows in the nuanced field of fertility treatment.