Zvi Binor, M.D., FACOG, Medical Director

Rush-Copley Center for Reproductive Health is making dreams come true by offering comprehensive and advanced treatment for couples with difficulty conceiving.

It is not uncommon for couples to have difficulty conceiving a child. In fact, infertility strikes 15 percent of couples. Fortunately significant advances in infertility treatments offer couples more hope than ever before.

Rush-Copley Center for Reproductive Health
Clinic Address:
2020 Ogden Avenue, #250
Aurora, IL 60504
Practice Director: Zvi Binor, M.D.
Laboratory Director: Richard G. Rawlins, Ph.D., HCLD
Phone: 630-978-6254

* in vitro fertilization (IVF)
* egg donation
* micromanipulation
* male infertility
* artificial insemination
* recurrent pregnancy loss care
* hormonal therapy for menopause
* reproductive surgery
* endometriosis therapy
* pelvic pain management
* advanced laparoscopy
* developmental problems of genitalia

Hysterosalpingogram

The hysterosalpingogram (HSG) study takes about 5 minutes to perform. However the test is usually done in the radiology department of a hospital there is additional time for the woman to register at the facility and fill out a questionnaire and answer some questions covering her medical history.

The HSG Test is performed in these steps:

* The woman lies on the table on her back and brings her feet up into a “frog leg” position similar to the Pap Procedure position.
* The doctor places a speculum in the vagina and looks at the cervix.
* Either a soft, thin catheter is placed through the cervical opening into the uterine cavity or an instrument called a tenaculum is placed on the cervix and then a narrow metal cannula is inserted through the cervical opening.
* Contrast is slowly injected through the cannula or catheter into the uterine cavity. An x-ray picture is taken as the uterine cavity is filling and then additional contrast is injected so that the tubes should fill and begin to spill into the abdominal cavity. More x-ray pictures are taken as this “fill and spill” occurs.
* When both tubes spill dye, the woman is often asked to roll to one side or the other slightly to give a slightly oblique x-ray image which can further delineate the anatomy.
* The procedure is now complete. The instruments are removed from the cervix and vagina.
* The woman usually remains on the table for a few minutes to recover from the cramping caused by injection of the contrast.
* The results of the test can be immediately available. The x-ray pictures can usually be reviewed with the woman several minutes after the procedure is done.

Fertilized Egg

While it was initially reserved for patients with blocked, damaged, or absent fallopian tubes (tubal factor infertility), IVF is now also used to overcome infertility caused by endometriosis, male factor issues, diminished egg quality, ovulatory problems, or other unexplained reasons.

Reputable IVF clinics will usually provide a synopsis of their pregnancy success rates and their data are submitted to the Centers for Disease Control (CDC) each year. However, the CDC data is usually “dated” by two years. Most highly successful IVF clinics also submit their data to the Society of Assisted Reproductive Technology (SART) which is usually “dated” by only one year. Our infertility clinic success rates are reported regularly to the CDC and SART and are available on our Web site (IVF success rates.)

“In vitro” literally translated means “fertilization outside of the body” which is where fertilization occurs in an IVF cycle. Eggs are retrieved from the ovarian follicles and combined with sperm in a Petri dish.

IVF consists of many stages and is performed by our highly trained team of professionals including infertility specialists, embryologists, nurses, and associated staff members. Our Salt Lake City Utah IVF clinic team has extensive experience performing IVF and its associated procedures such as intracytoplasmic sperm injection (ICSI), assisted hatching, preimplantation genetic diagnosis (PGD), egg freezing, and others.

The first step of the IVF process is ovarian stimulation with injectable follicle stimulating hormone (FSH). FSH stimulates the ovaries to develop numerous follicles, each of which usually contains an egg. This process occurs naturally in each ovulatory cycle when the pituitary, under the influence of the hypothalamus, releases FSH to stimulate egg recruitment.

In an IVF cycle, ovulation induction is initiated using standard treatment protocols and dosages are adjusted based upon each patient’s individual response. IVF patients are carefully monitored at our IVF clinic using estradiol hormone levels, vaginal probe ultrasound, and physical examination. FSH should only be administered by a fertility specialist thoroughly trained, and experienced in its use to avoid potential serious side effects.

As healthy follicles mature they produce estrogen, and along with progesterone, these hormones cause the endometrium to thicken and become more vascular. This development is necessary to support a developing embryo.

IVF patients receive either a GnRH agonist such as leuprolide acetate (such as Lupron®) or a GnRH antagonist (such as Antagon® [Ganirelix acetate] or Cetrotide® [Cetrorelix acetate]) to control ovulation. These products can a block the production or release of hormones, such as FSH and LH. Ovulation cannot occur while a patient is receiving proper doses of one of these drugs. Otherwise, ovulation might occur before the eggs can be retrieved resulting in the “loss” of the ovarian stimulation cycle for IVF.

Once the eggs are mature, an injection of human chorionic gonadotropin (hCG) is administered and egg retrieval is scheduled at our IVF clinic. In a natural cycle, ovulation is stimulated by a surge of luteinizing hormone (LH). Ovulation is triggered with hCG in the same manner as LH. We discuss hCG and LH products in the fertility drugs section.

Egg retrieval is performed at our Utah IVF clinic under light sedation using ultrasound guided transvaginal egg retrieval. A small “needle” is passed through the back of the vagina and into the follicle on the ovary. The egg is gently “suctioned” and retrieved in its follicular fluid. Once retrieved the “solution” is immediately passed to the embryologist who identifies and separates the eggs and places them in specially prepared media.

The remaining “follicular structure” is known as the corpus luteum. The corpus luteum produces progesterone to help complete endometrial development. After the embryo implants in the endometrium, the placenta also produces progesterone. IVF patients receive progesterone medication to offset the effects of the GnRH agonist or the GnRH antagonist.

The male usually provides sperm by masturbation and it is washed and specially prepared for exposure to the eggs. In cases where there is a male infertility component, procedures such as intracytoplasmic sperm injection (ICSI) are performed at this point. In ICSI, a single sperm is injected directly into the egg. If there are no sperm in the ejaculate, they can often be taken directly from the testicles or the reproductive tract. This is discussed in detail in the ICSI and male infertility sections.

After fertilization, the embryos are placed in an incubator which tightly controls temperature, atmosphere, pH, and other environmental factors. The embryos remain in the incubators at our IVF clinic until mature, usually three to five days. Five day embryos have usually developed to the blastocyst stage, which is discussed on a separate Web page.

Once the embryos mature, the embryo transfer is scheduled at our Salt Lake City Utah IVF clinic. This is a painless procedure usually requiring less than ten minutes and is similar to IUI. The embryo is gently placed directly into the uterus. Patients are advised when to return for a pregnancy test (usually two weeks later).

Fellowship training focuses on the diagnosis and treatment of infertility and related disorders. This training includes experience in microsurgery, laparoscopic and hysteroscopic surgery, in vitro fertilization-embryo transfer, sonography, and ovulation induction. In addition, the physician spends a significant amount of time performing clinical or laboratory research.

Upon completion of a Fellowship in Reproductive Endocrinology, a specialist seeks Board certification, a multi-step process. To become Board certified in Reproductive Endocrinology, the physician must first obtain Board certification in Obstetrics and Gynecology. This requires successful completion of both a written and an oral examination. Board certification in Reproductive Endocrinology requires successful completion of additional written and oral examinations.

The entire certification process takes several years to complete. Only a physician who has successfully completed a Fellowship in Reproductive Endocrinology and passed the examinations can become Board certified as an infertility specialist.

High FSH levels
Reference ranges for luteinizing hormone and follicle-stimulating hormone in the menstrual cycle, expressed in international units. The scale is logarithmic.

The most common reason for high serum FSH concentration is in a female who is undergoing or has recently undergone menopause. High levels of Follicle-Stimulating Hormone indicate that the normal restricting feedback from the gonad is absent, leading to an unrestricted pituitary FSH production.

If high FSH levels occur during the reproductive years, it is abnormal. It may be a sign of:

1. Premature menopause also known as Premature Ovarian Failure
2. Poor ovarian reserve also known as Premature Ovarian Aging
3. Gonadal dysgenesis, Turner syndrome
4. Castration
5. Swyer syndrome
6. Certain forms of CAH
7. Testicular failure.

FSH is available mixed with LH activity in various menotropins including more purified forms of urinary gonadotropins such as Menopur, as well as without LH activity as recombinant FSH (Gonal F, Follistim). It is used commonly in infertility therapy to stimulate follicular development, notably in IVF therapy, as well as with interuterine insemination (IUI). (See Gonadotropin Preparations.)

Diagnostic laparoscopy

A minimally invasive outpatient surgical procedure using 2-3 small holes made through the umbilicus and abdominal wall allowing passage of a telescope camera and instruments into the abdominal cavity and pelvis while the patient is under general anesthesia. This procedure is recommended for patients who may have any number of conditions that affect the uterus, fallopian tubes, or ovaries.

If infertility has been longstanding for many years, or a woman has a medical history suspicious for an abnormality of the pelvis, an evaluation with laparoscopy may be warranted. Operative laparoscopy is more complex surgery used to restore a woman’s pelvic anatomy in order to enhance fertility, or provide access to the pelvis in order to remove or separate the fallopian tubes from the uterus prior to proceeding with IVF, as may be indicated in some women with tubal disease that may compromise implantation of a healthy embryo.