What is an “Endometrial Scratch”?

A new technique is on the market for those women who have had repeatedly unsuccessful IVF, called an “endometrial scratch.” So what exactly is this?

Mostafa Metwally, a consultant at Jessop Fertility in England, explains, “We think that by using some very mild form of endometrial trauma—that’s taking a small biopsy from the lining of the womb—it might actually improve their chances of getting pregnant. It’s a very minor process and simply involves putting a small tube through the neck of the womb into the uterus that’s attached to a syringe-like structure. When you pull that syringe it creates negative pressure which takes a few cells from the lining of the uterus.”

Another English doctor, Nick Raine-Fenning, said, “The best description came from a patient who said it was a bit like exfoliation—the problem with that is that when you have a period all the endometrium goes anyway, but with a bit of exfoliation hopefully the next endometrium which grows is going to be better.” Yet doctors are still figuring out what “better” actually means: perhaps the womb is more receptive, or the environment is more conducive to an embryo implanting, or there is more blood supply and the embryo develops more healthily.

As of yet, there is no concrete evidence of just how effective this procedure is. A study conducted of women in Brazil showed that among those who had the procedure, there was an increase of pregnancy rates of about 20%.

Talk to your doctor about if he or she would recommend this procedure and whether it is right for you. Do not give up hope that you could have a child!

Posted in Blog, Endometriosis, Improve your Fertility

Unfair Laws on Surrogacy

To the Editor:

Re “Surrogates and Couples Face a Maze of Laws State by State” (“Pregnancy for Pay” series, front page, Sept. 18):

Childless women who don’t have a uterus, have an abnormal uterus or have a major medical condition that makes it impossible to conceive need a compassionate legislature.

The current law in New York State allows only surrogacy by a friend or a relative that does not involve payment. This clearly presents discrimination between patients who are lucky enough to have someone close to them carry their pregnancy, and those who do not.

Read Dr. Hershlag’s letter to the Editor in full at The New York Times.

Posted in Avner Hershlag, Blog, News, Surrogacy

Baby Shower Etiquette

Being pregnant and having a child is one of the most exciting things a person can go through. For those who are unable to have a child, however, it can be particularly painful to watch friend after friend accomplish this lifelong dream.

If you are pregnant and are unsure how to lovingly deal with a friend who has been unable to have a child, your best bet is to be open with her about it. Sometimes women think not inviting that friend who has struggled to get pregnant is the best option, since it could be painful for her to be reminded of her situation. Rather than not inviting her at all, though, call her up or meet her in person to find out how she is feeling. Tell her you would love to have her attend, but of course understand if she doesn’t want to. You may be surprised—your friend might still be thrilled to celebrate you.

If you are the woman whose friends are all pregnant and you have been unable to conceive, allow yourself to process through the feelings that come with that. Do not feel guilty about being sad, angry, depressed, or unsocial. Talk to other women who have been in the same situation or attend a support group. If you are invited to a baby shower but feel it would be too painful to attend, talk to your friend who is pregnant and explain your situation.

Infertility can be very difficult to work through. Luckily, there are people available to help you, whether through support groups or medical professionals who will do their best to help you get pregnant. Talk to your doctor today about achieving your dream of having a child.

Posted in Blog, Depression, Infertility

Happy Birthday, Dr. Hershlag


Posted in Avner Hershlag, Blog

Fertility Preservation Benefits Young Male Cancer Patients

A study led by St. Jude Children’s Research Hospital investigators has found the chemotherapy dose threshold below which male childhood cancer survivors are likely to have normal sperm production. The study appears in September 17 edition of the journal Lancet Oncology.

Read more of this story from Sys-Con Media.

Posted in Blog, News, Study

Ashkenazi Jews Encouraged to be Tested for BRCA Genes

DW In-HershlagThe high frequency of the BRCA 1 and 2 genes reported in cancer-free Ashkenazi Jews, (“Study of Jewish Women Shows Link to Cancer…” Sept 4), calls for urgent action that should save many lives. The chance of an Ashkenazi Jew to carry a BRCA 1 or 2 genes exceeds 1 in 50. That frequency is already higher than many genes currently included in the “Ashkenazi Jewish Genetic Panel.”

Since the great majority of women with the BRCA gene will develop breast or ovarian cancer (and men – prostate cancer), finding the BRCA gene will allow them to take preventive measures and reverse their genetic misfortune.

BRCA 1 and 2 testing should be added to the routine Ashkenazi Jewish genetic panel. Since just 3 mutations are responsible for over 90% of affected cases, BRCA testing for Ashkenazi Jews is significantly cheaper than that of the general population. While the cost of the panel is expected to rise, the benefits of preventing potentially fatal cancer far outweigh the costs.

Read more about this health study, as reported in the New York Times, by Roni Caryn Rabin.

Posted in Avner Hershlag, Blog, BRCA, breast cancer, News, Women's Health

Docs and Research Support Single Embryo Transfer

DW In-Tomer logoThe increased risk of multiple births has been known for decades. In the past several years there has been a significant decline in the rate of higher order multiple births, partly, thanks to revised ASRM guidelines for the recommended number of embryos to be transferred in an IVF cycle.

Single embryo transfer is rapidly gaining grounds in most programs, especially for younger patients. However, a significant proportion of embryo transfers in the US in 2014 still involve the transfer of more than one embryo. This is more common with older patients, especially given the high rate of chromosomally abnormal embryos (which rises exponentially beyond age 40).

A second culprit is the fact that IVF is not covered by many insurance providers. The significant out-of-pocket expense of IVF drives patients to pressure their physicians to transfer two embryos (or more) to increase their chances of becoming pregnant.

The good news is that the solution is within reach and should focus on four aspects, which we have been practicing at Lenox Hill Human Reproduction and the Center for Human Reproduction at North Shore-LIJ Health System:

  1. Having continuous dialogue with law makers and insurance providers to promote coverage for ART procedures, and especially for IVF with an emphasis on single embryo transfer.
  2. Encouraging patients to freeze their eggs in their early 30′s when most eggs are “healthy,” which will allow for single embryo transfer later in life when they are ready to conceive (even if they are in their late 30′s or early 40′s).
  3. Improving egg and embryo freezing techniques in the lab, which will allow all IVF centers to be able to offer single embryo transfers while saving the surplus embryos for potential future transfers.
  4. Promoting genetic testing of embryos prior to their transfer back to the uterus – a technique called PGS (Preimplantation Genetic Screening) and transferring a single, chromosomally normal embryo (free of Down’s Syndrome and other abnormalities), thus reducing multiple birth rate with its exorbitant cost to healthcare, and increasing the chance of delivering healthy babies, one at a time.
Posted in Blog, egg freezing, Fertility Treatments, IVF, News, Tomer Singer, Twins


If you’re tired of legal thrillers written by lawyers, read this amazing medical thriller written by Dr. Avner Hershlag who not only knows his stuff, but also knows how to write. Combining a little science fiction with a lot of science fact, Hershlag takes us on a scary journey through the fields of genetics and into the near future. Misconception delves deeply into a subject no less important than the mystery of life itself.

Nelson DeMille, author of The Gold Coast

Posted in Avner Hershlag, Blog, News

If You Hate Needles, There’s Good News on the Way!

As part of undergoing in vitro fertilization (IVF), a woman must take hormone shots which encourage her body to ripen and release more than one egg at a time. These many eggs are then collected and used for fertilization in a laboratory setting. For women who don’t like needles, this can be a difficult, painful, and stressful experience. Luckily, this may soon change.

Currently, the IVF procedure requires 7 to 10 days of hormone injections. However, “pharmaceutical companies have produced longer acting gonadotropins that last for a week. A longer acting gonadotropin may help decrease the number of shots a patient takes during the IVF process. Studies are now under way to test for efficacy, side effects, and risks for ovarian hyperstimulation syndrome (OHSS) during IVF.  The American Society of Reproductive Medicine Practice Committee states that this new preparation of gonadotropin holds promise for improving patient satisfaction while maintaining efficacy.”

This could mean that patients may need to only take one or two shots to stimulate their ovaries, rather than 7 to 10 shots. This is great news for those who don’t like needles!

Talk to your doctor about what medication is available for you; be open about what procedures you are comfortable with. Do not let a fear of needles or procedures stop you from becoming a parent.

Posted in Blog, Fertility Treatments, IVF

BPA Damaging to Ovarian Function

DW In-RauschRecent studies appear to show damaging effects of normal exposure to BPA to several reproductive areas in mice. Although there is still much we need to learn about the effects of plastics on fertility, especially in humans, I think most of us who have read about it agree that there is a reason to be concerned. As of a few years ago, I know that I and most colleagues stopped microwaving our food in plastic containers, and were sure to check our children’s bottles for the ‘no-BPA’ signs.

As the evidence accumulates and seems to be supporting the theory that BPA is toxic to ovarian function, it’s just common sense to take the simple precautions to eliminate this potential threat.

Read more, Deborah Blum of the NYT writes about chemicals and the environment.

Posted in Blog, Infertility Contributing Factors, Mary E. Rausch, News, Study