Avner Hershlag, MD - Endometriosis Interview

Avner Hershlag, MD - Endometriosis Interview

Endometriosis Foundation of America 2013
- Avner Hershlag, MD & Jamie Grifo, MD, PhD

Tamer Seckin, MD: Hello everyone, I am Dr. Tamer Seckin. I am an endometriosis surgeon. My passion is to treat the disease endometriosis. As you may all know endometriosis is a disease that affects females of reproductive age in their most productive years, however, causing them severe loss of quality of life, sub-fertility, infertility, is the major cause of hysterectomy and the number one cause of pain in women.

Today, I will introduce to you a series of very interesting individuals, professionals and some patients that are willing to come out and share their experience with you. Let me introduce these friends of mine, my circle, with whom we have worked together for many years who have also taught me. We have shared a lot of knowledge and that is how we work with endometriosis patients. It is a team practice.

We will have two very famous, well-known, reproductive endocrinologists and infertility specialists who will review their view on endometriosis. One is Dr. Avner Hershlag from North Shore-LIJ System. He is the Director of the Ob/Gyn program there and Dr. Jamie Grifo from New York University known for his passionate work on infertility patients.

Jamie Grifo, MD, PhD: Is there ever a perfect time to have a child? This is a decision, a question that only a woman can answer. There is no perfect time. It is a choice and the more we can help women make this choice in a way that works for them we are doing them a great service. But there is no perfect time.

Age is the single most important predictor of chance of getting pregnant for women. We need to educate women about the age effect and while they generally know it I do not think they know the extent of it. In order for women to make the best decisions about when to have a baby they need the best information and it is our obligation to help them understand that. And then also understand the options about how to work around that because the trend is to delaying childbearing.

Avner Hershlag, MD: Egg donation is an option for women who want to extend their fertility and extend having a child but are kind of running out of eggs. Sometimes a woman will be in early menopause but in many cases she will still have her periods and maybe even produce what I call the egg of the month; however, will not respond to fertility drugs and will repeatedly, if she tries, fail to conceive by the conventional way.

Egg donation eliminates the one factor that is the problem in the biological clock and that is the ovary. There is a discrepancy between the aging of the ovary and the aging of the uterus. The uterus does not age for decades to come and therefore is capable of carrying a pregnancy and helping couples where the woman is slightly older to have not only one child but a family. That is an extremely viable option and to add to that now the egg bank is a new way of doing egg donation where eggs are being frozen by an egg bank and the patient can independently get the eggs from the bank in a very similar way that men used to get sperm from a sperm bank.

Jamie Grifo, MD, PhD: Well, egg freezing is an option for patients who want to delay, on purpose, the age at which they have a child. It allows one to freeze their eggs at a particular potential for use later when the potential is much lower. The younger the eggs the better the chance although it would not make sense to freeze eggs under the age of 20 because those patients have not decided what their reproductive life is. It is a pretty invasive and expensive process. Probably we can get maximal pregnancy rates up to age 32, 33. Certainly under 35 we have very good results. As you start going over the age of 37, 38 it becomes less efficient. If one is going to choose this option one should consider at a much younger age. Unfortunately the dialogue does not exist for those patients generally, it is the 42 year old who is coming in to ask about egg freezing because they feel the clock more so than a 30 year old. The 42 year old is thinking about it the 30 year old is probably not.

We need to just educate women better about fertility and what happens with age so that they can make good decisions about how they choose to conduct their reproductive lives.

There are no guarantees in life. Egg freezing is a good technology; it is not a perfect technology. It offers a young woman her current fertility so for a 30 year old that is roughly about a 50 percent chance from one batch of frozen, thawed eggs of having a baby. If she were to bank more than one cycle it certainly would not be 100 percent, because that is not the way statistics work, but it would improve her chances. One should not freeze eggs feeling that this will guarantee their future fertility, it does not. But it does allow a woman to be her own egg donor later if she needs it because she may not, and it is one option that women can look at as a way to extend their fertility and ensure their future.

Avner Hershlag, MD: Age 35 is kind of a landmark that a woman should look at. If she had not made a decision by then about having a child she may want to start pushing on the gas rather than the brake. Age 35 is by no means the same landmark for every woman. The younger the woman, when she, for example either has a child or freezes eggs if she does not have a partner, the better.

When we deal with endometriosis patients the picture may be quite different, especially for some of them. Women who had had, for example, multiple surgeries, women who have lost part or all of an ovary may be at a compromised stage at a much earlier stage. Therefore, women, as well as their doctors, should really think of their fertility avenue as early as possible because number one, fertility may already by compromised and number two, you do not know what the day will bring. If there is further surgery, for example, for endometriosis she might even be more compromised and you want to jump on the wagon before it is too late.

Jamie Grifo, MD, PhD: Recently the American Society of Reproductive Medicine has no longer declared egg freezing experimental. They are very supportive of doing this for medical indications such as cancer and the preservation of fertility for cancer patients. They are not supportive of the concept of elective egg freezing for patients who are choosing to delay childbearing, which I do not agree with. I understand why they call it that. It is in some respects a bit of a social experiment and yet it is one more example where women can be a little bit more in control of their reproductive lives.

It is something that as advocates for women we should be supportive of that and we should be supportive of making sure they understand fully what the meaning of egg freezing is. The fact that it is not 100 percent guaranteed, that it does offer some hope. It is not a promise, it is an option. It is not something that should be an obligation; it is a choice that a woman could consider. I would even say should, because women need to make their own decisions.