The Latest Innovations in Infertility

Dr. Zvi Binor: Welcome to this afternoon's chat session on Innovations in Infertility Treatment. I am Dr. Zvi Binor, medical director of the Rush-Copley Center for Reproductive Health. Please feel free to ask any questions you may have.
Jennifer: What advances have been made to prevent repeated miscarriages?
Dr. Zvi Binor: We approach this problem systematicall by analyzing the anatomical aspect of the uterus looking for polyps, fibroids, scar tissues or septum, utilizing ultrasound, MRI, and other radiological means. Endocrine aspects of miscarriages are evaluated by analyzing quality of ovualtion. This is done by assessing estrogen per follicle level, timing of LH surge, and luteal phase hormones that support implementation.In addition, infectious disease and genetic evaluation are done. Newer methods have included immunological factors, evaluating autoantibodies (anticardiolipin antibodies, lupus anticoagulant and antithyroid antibodies). In addition, level of NK cell (natural killer cells) in blood and endometrium to be analyzed. Once these testings are normal, we evaluate the patient during her early pregnancy looking for reappearance of antibodies and assessing the placenta takeover of progestrone production.
North52: If a man has a low sperm count, can his good sperm be saved up to inject into a woman?
Dr. Zvi Binor: When we have low sperm count, we analyze the blood for level of FSH hormone. If the level is low or low/ normal we treat the male with clomiphene citrate 100 mg x's three a week We analyze the FSH a month later to see if the treatment is raising this hormone. If elevated we continue the treatment. if we fail to elevate the FSH, we stop the treatment and we have to work with what we have. The recovery of sperm following cryopreservation depends on the original sperm motility.
iwantgirl: How can I increase my chances for having a girl?
Dr. Zvi Binor: The only significant medical methodology that has been reported is from the Genetic Institute in Fairfax, VA, in which by immunological means, all the Y sperm are killed. The problem is that this can create an infertility problem that originally may not have existed. There have been other reports of different techniques that have shown to be inconsistent. You still have a 50/50 chance of having a girl.
paula: Can your practice offer embryo donation? If not, do you think you will?
paula: Can your practice offer embryo donation? If not, do you think you will?
Dr. Zvi Binor: Cryopreserved embryos are available nationally for adoption. Our office can provide you with these embryos banks. The embryo then are shipped to our labratory and are transferred to the patient in an natural/assisted cycle based on the physiology of their menstrual cycle.
Mary: What is the latest medical advancements dealing w/severe uterion fibroids?
Dr. Zvi Binor: it would be nice to understand all of the activation of genes responsible for fibroids. In that case, we will be able to switch off the gene responsible for fibroid growth. This thought will be realized in the next three generations. In the meantime, we are left with surgical or radiological means of treating fibroids. In order to understand the number, size and location of fribroids, MRI testing of the uterus will provide very accurate information. Based on the location of the fibroid, and abdominal or uterine appproach will be decided. For patients that have finished their reproductive life, an embolization technique is available for reducing the size of fibroids together with temporary medical treatment of depolupron.
twins: My husband really wants twins. Is there any way to make sure this will happen?
Dr. Zvi Binor: Some patients have relatively small uterus and in these cases, twins can result in significant premature labor. It would be appropriate to evaluate the uterine anatomy prior to any decision making process. Twins will increase the risk of having an abnormal child and complications in pregnancy. It can not be considered a win-win situation. Usage of fertility drugs is the only medical way to increase the odds of a multiple pregnancy, but in my opinion, it should not be used unless necessary.
R&M: What do you recommend to someone dealing with cystic ovarian syndrome (COS)? We're currently on our second round of Clomid. My wife also has irregular periods (which I think has to do with the COS).
R&M: What do you recommend to someone dealing with cystic ovarian syndrome (COS)? We're currently on our second round of Clomid. My wife also has irregular periods (which I think has to do with the COS).
Dr. Zvi Binor: Polycystic ovararian syndrome has been linked to insulin resistance. The usage of insulin-enhancing drugs should be considered in cases when this resistance has been documented. Clomiphene Citrate works in PCO patients for induction of ovulation. However, we have to remember that its mechanism of action is by being an antiestrogen. one would expect poor cervical mucus that may require insemeniation and delayed LH surge that may require HCG injections to assure egg release. Many patients are labeled as polycustic ovary and one needs to show evidence of high male hormones (testosterone, androstendione, and DHEAS).
North52: Who would prescribe the medication to boost the man's sperm count? Would it be you as a specialist, or a urologist?
Dr. Zvi Binor: Both a reproductive endocrinologist and a urologist can address this issue. The latter can also examine for varicucele condition that may be linked to low count. (by ultrasound doppler test)
CC: Does being overweight effect the quality of eggs and ovulation?
CC: Excess fat in adipose tissue contains an enzyme called aromatase. This enzyme converts male hormones to estrogen (estrone). The result is excess estrogen in the body that reduces the pituitary production of hormones (FSH) resulting in poor quality of ovulation.
M.R.: I have heard that being overweight can affect fertility. Can you be on a healthy diet while you are trying to conceive?
Dr. Zvi Binor: Excess fat in adipose tissue contains an enzyme called aromatase. This enzyme converts male hormones to estrogen (estrone). The result is excess estrogen in the body that reduces the pituitary production of hormones (FSH) resulting in poor quality of ovulation.
Dr. Zvi Binor: Diet can be part of infertility treatment however, carbohydrate metabolism performance should be assessed for the possibility of usage of insulin-enhancing drugs as part of the treatment. Once pregnant however, patient has to consult her obstetrician for specific diet and avoid taking the above medication.
paula: What are the costs associated with embryo donation? Do you have any patients willing to donate one?
Dr. Zvi Binor: Patients with excess embryos in our program are given an option of donating them, however so far, I haven't seen any patient willing to do so. As I am not involved directly with the embyro banks, I am not in the position to quote their prices, but information to communicate with them is available in our office.
Dr. Zvi Binor: Are there any more questions I can answer at this time?
M.R.: Does having trouble conceiving have any correlation with having a high risk pregnancy?
Dr. Zvi Binor: In the first trimester, we see higher incidences of pregnancy losses related to quality of ovulation, immunological abnormality and production of hormones by placenta (progesterone) and for that reason, we monitor our patients up to nine to ten weeks of pregnancy. Mid-trimester premature labor can occur as a result of uterine anomalies or pathology. Toxemia of pregnancy has been linked to some immunological abnormalities but are not directly linked to infertility. Overall, my experience is that due to "precious baby syndrome," patients are monitored closer.
Dr. Zvi Binor: Thank you all for joining us. If you would like more information, please call 630-978-4995.