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RE of the Month: Avner Hershlag
The Center for Human Reproduction
North Shore University Hospital
Manhasset, New York
Dr. Avner Hershlag is the Medical Director of Assisted Reproductive Technology at the Center for Human Reproduction at North Shore University Hospital in Manhasset, New York, where he is also the director of its donor egg program and fertility labs. We recognize him as FertilityAuthority Physician of the Month for his interest and work in new and cutting-edge technologies that will advance ART, and for the spirit in which he works with his female patients, encouraging and enabling them to choose the course of treatment that’s right for them.
Age, the Enemy of Fertility
Dr. Hershlag may be a reproductive specialist, but interviewing him is somewhat like speaking to a rabbi, a comedian and Gloria Steinem all at once.
“God could not have been a woman,” he began, “because a woman’s design is all wrong.” He explained, “Women are at their most fertile when they are 20 week-old fetuses. They have six million eggs!” He continued, “When they are born, they have 1.2 million and have already lost most of their eggs!” At puberty, “they have 800,000 eggs.” And so on. And so on.
Men, on the other hand can reproduce until they die. “Posthumously, in fact!” Hershlag declares.
“Age is the main obstacle females face today,” he says. At the middle of their lives, women have lost their reproductive capacity.
He’s got a point, no?
A somewhat ironic fact is that while a woman’s eggs get on a fast train heading south, her uterus is unaffected by her age. Hershlag says a woman’s uterus has a similar capacity in her 20’s as it does in her 40’s or 50’s. That’s why, he explains, egg donation is the main option for perimenopausal women who want to get pregnant.
Donor Egg Dilemma
“Most patients are hesitant about using donor eggs but they ultimately go through what I call a ‘conversion,’” Hershlag says. Each and every time he talks to a woman about using a donor he has to “get inside her head” and see “her point of view.” “It takes a lot of effort on my part and there is an art to it,” he says, but using a donor egg allows women “to have that maternal experience of carrying their baby and have their partner contribute their baby’s DNA.”
That said, Hershlag respects the fact that “many decisions” about a course of treatment, “have nothing to do with doctors.” “I don’t make decisions for patients. I am a fertility consultant,” he notes. “In fact, I tell patients not to make a decision in my office.”
Why is the process so emotionally difficult? “Part of the problem is that when women who are 40 or 50 get pregnant, they do not divulge whether the sperm or egg is from a donor.” Ironically, he points out “celebrities will talk about using a surrogate, but not a donor egg.”
He doesn’t believe the hush-hush nature of using donor eggs will change until “there’s a reality show about it.” And he’s not joking.
New Treatments Improve Egg Quality
According to Dr. Hershlag, there are many reasons to be hopeful about the growing number of ways to treat infertility, “We are in a very exciting time when it comes to reproductive science. It is developing with leaps and bounds.” He compared advancements in reproduction today “to the introduction of penicillin” in the time infectious diseases were rampant.
Hershlag is particularly excited about two new treatments that are still in the experimental phase: nuclear transfer and cytoplasm transfer. These treatments involve transferring part of one woman's egg into another's.
In simple terms, the healthy portion of a donor egg is used to supplement the defective portion of a recipient's egg to help it survive and make one good egg. In cytoplasm transfer, cytoplasm from a donor egg is injected into an older egg. The resulting egg is then fertilized with sperm and implanted in a womb, usually that of the woman who provided the recipient egg and nuclear DNA. In Nuclear Transfer the DNA from an older egg in injected into a young donor’s egg.
Viva la Egg Freezing!
Hershlag also believes egg freezing is about to revolutionize and liberate women from their ticking biological clocks. “It is only in the last three years that we’ve really honed our egg freezing skills and we’re finally showing good statistics.”
A woman’s ability to freeze her eggs will 1) combat reproductive aging and 2) start “showing true equality between men and women.” When told he sounded like a feminist, Hershlag declared, “Well, I am a feminist! Everyone around me in my life – my patients, my family – is a woman!” (Indeed, it was his sister’s struggles with infertility that led him into his career.)
With egg freezing, women will finally have “personal freedom,” Hershlag claims. “They won’t need to rush into a relationship because they need a man to fertilize their egg.”
“Soon, for a woman in her 20’s, investing in an egg bank will be a better investment than Citibank.”
Let’s just close with that one!
Avner Hershlag, M.D., is Director of the Donor Egg Program and Fertility Laboratories as well as Medical Director of the In Vitro Fertilization Program. Dr. Hershlag completed his undergraduate training in his native country, Israel, and graduated from the Hadassah Medical School in Jerusalem. While in medical school, Dr. Hershlag was elected Director of Medical Education of the International Federation of Medical Students Society. Following three years of a General Surgery residency at Hadassah, Dr. Hershlag moved to the United States in 1984. Here, he completed his OB/GYN residency at the George Washington University Medical Center and a fellowship in reproductive endocrinology at Yale University School of Medicine. Dr. Hershlag is an Associate Professor of Obstetrics & Gynecology at New York University School of Medicine.
Dr. Hershlag is the author of over sixty original papers and 25 book chapters. The recipient of several awards, he is actively engaged in multiple research projects.