Bringing Life Through Technology
By John B. Clayton
or most couples, the birth of a child is one of life's greatest miracles...
and one of life's greatest mysteries. Nearly all new parents are amazed by the most basic
of human abilities - to reproduce - to create life.
Yet for
couples who face the challenges of infertility (an estimated 20 percent of the
population), this basic human ability becomes an extremely complex series of medical
tests, treatments and procedures using some of the most powerful tools science offers.
At the
Reproductive Specialty Center - home of world - renowned infertility experts Charles H.
Koh, M.D. and Grace M. Janik, M.D. - technology comes full circle. Here, the
miracle is not just sophisticated equipment but the ability of these physicians to combine
technology with knowledge and compassion to offer many infertile couples a chance to
fulfill one of life's most basic desires: the chance to have a child.
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The vast majority of the surgeries performed at the
Reproductive Specialty Center are laparoscopic. By using a laparoscope or a
microlaparoscope the incision size is minimal and recovery time dramatically reduced.
Doctors Koh and Janik are one of the few referral centers in the country for advanced
laparoscopic surgery of endometriosis and tubal disease.Photo by J&J Images |
"Our philosophy is to provide patients with the most efficient, most cost-effective
way to become pregnant, not necessarily the most high-tech or the most involved,"
says Grace Janik, M.D. "Sometimes just doing things well is all that's needed. But
most importantly, we provide very personalized care to treat the whole person - not just a
particular disease."
With this
approach, Drs. Koh and Janik have proven themselves as leaders in this country and
throughout the world with a success rate that has remained steadily high since starting
their IVF program in 1990. According to a December 1994 article published in U.S. News
and Report, their Reproductive Specialty Center is the third most successful invitro
fertilization program in the United States - with a 1994 pregnancy rate nearly double
the national average. (Based upon data submitted to and audited by the Society of
Assisted Reproductive Technology - SART.)
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Doctor Koh and Dr. Janik are innovators in the area of
laparoscopy and teach the newest and most complex techniques to surgeons all over the
world.Photo by J&J Images |
To what
do Drs. Koh and Janik contribute their success? "Many of our outcomes are higher than
the national average not necessarily because we have protocols that are different,"
says Dr. Janik. "I believe we've been successful because we pay such close attention
to detail. If every aspect of care is considered and addressed appropriately, the desired
results are much more likely to be achieved."
In
addition, these physicians have become well-known and respected among their peers for
contributing not only to advances in infertility treatment, but also in highly
specialized, minimally invasive gynecological surgery. (See "Microlaparoscopy:
The Non-Bandaid Surgery".)
"We
push our service to achieve national and world class standards - so that the patient can
be confident that the treatment they recieve is not only the best locally but
internationally," states Dr. Koh. Their excellence has been recognized, as
demonstrated by the physicians who visit from all parts of the world to observe and learn
the techniques they have pioneered.
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Endometriosis causes both pain and infertility. Advanced
laparoscopic techniques are used to sucessfully treat endometriosis even on bowel and
bladderPhoto by Greg Nowak |
Both
physicians agree that their practice is unique in comparison to other fertility programs.
"We're strong surgically as well as in the areas of fertility work-up and assisted
reproductive technologies." What does that mean for patient care? Unlike many other
fertility clinics, which specialize in only one aspect of infertility treatment, the
Reproductive Specialty Center offers top-level treatment in all aspects of care - assisted
reproductive technologies, reproductive surgery, and gynecological needs.
What this
allows us to do is apply the best treatment available for the patients individual
condition, rather than routing every patient through just one specialty area," says
Dr. Koh. "One of our biggest strengths is that we are not just an 'IVF Shop' where no
matter what your problem is, you're offered IVF. We are a full-service fertility center.
Patients can come to us with any problem. We not only diagnose it right here, but also
treat it with the most advanced techniques."
"In
caring for all spectrums of the reproductive life span we can offer everything that's
needed," adds Dr. Janik, "Therefore we don't feel compelled to push patients in
one way or another."
As a
tertiary referral center, the Reproductive Specialty Center primarily serves patients who
have worked with other doctors to address infertility issues. In addition, the practice
offers non-surgical treatment for problems such as menopause as well as specialized
reconstructive and gynecological surgery. With recent advances in laparoscopy, nearly all
of the surgeries performed by Drs. Koh and Janik use minimally invasive techniques, some
of which have been pioneered by these leading physicians themselves. In addition, the
practice is one of fewer than 10 in the nation offering advanced radical endometriosis
surgery including the removal of bowel and bladder lesions and repair of the ureters.
Referrals are made from throughout the U.S. for this highly specialized surgery.
Over the
past six years it has been careful attention to detail, as well as complete attention to
the latest techniques available worldwide, that has allowed Drs. Koh and Janik to help
more than 2,000 couples achive pregnancy.
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The Reproductive Specialty Center provides all aspects of
infertility and gynecological care from diagnosis to treatment. Special emphasis is placed
on detail. By having facilities for specialized laboratory testing and ultrasound on site,
the clinic can ensure the highest quality and individualized care. Photo by Greg Nowak |
Leading the Way in Offering Many New Techniques
With 60
to 70 percent of their practice dedicated to infertility treatment, Drs. Koh and Janik
have become well known among both patients and colleagues for helping those who are unable
to concieve or carry a pregnancy. They are also well respected for pioneering many
innovative laparoscopic techniques for both fertility and non-fertility and non-fertility
gynecological concerns.
Beyond
their applications for diagnosing problems, laparoscopy and laparoscopic microsurgery now
offer reduced pain, hospitalization, and recovery time for many surgeries including
hysterectomy, sterilization reversal, repair of damaged fallopian tubes, and freeing of
scar tissue, as well as treatment for endometriosis, tubal disease, urinary stress
incontinence and prolapse of the vagina or uterus. Doctors Koh and Janik are known
throughout the world for their work in advancing many of these surgeries and lecture
extensively about the various microsurgical techniques they have perfected.
The
Reproductive Specialty Center is recognized as the only center in the world to offer
laparoscopic sterilization reversal - with a success rate higher than many of the best
centers in the nation where an 'open' technique is used. The procedure was first done in
1992 by Drs. Koh and Janik who have recently developed a series of new instruments (Koh
Ultramicro instruments) to further improve the technique. In August, Drs. Koh and Janik
offered the world's first course in laparoscopic microsurgery, teaching 150 doctors
from around the world.
These
leading physicians are also known for their success in performing the nation's first
laparoscopic microsurgical procedure to rejoin the ureters after the removal of diseased
tissue. Opening of blocked fallopian tubes, another procedure traditionally done through
open microsurgery, is now performed via laparoscopic microsurgery by Drs. Koh and Janik
with a success rate nearing 50 percent. Similar success rates, among the highest in the
nation, are being reported by this physician team for new laparoscopic microsurgery
techniques to free pelvic scar tissue.
Combining laparoscopy and microsurgery techniques to address infertility caused by
endometriosis, Drs. Koh and Janik report a pregnancy rate of nearly 60 percent - again
mirroring the nation's best rates. Traditional 'open' endometriosis surgery generally
requires a four to five day hospitalization with recuperation extending up to six weeks.
By utilizing the advanced laparoscopic techniques perfected by Drs. Koh and Janik,
patients are discharged from the hospital in just one day and return to full activity in
under one week.
Another
procedure commonly performed through an open abdominal incision is now offered by Drs. Koh
and Janik using laparoscopy. Hysterectomy, one of our nation's most frequently performed
surgeries, is done vaginally in only 30 percent of cases, the rest have typically been
done with open laparotomy because of adhesions, scarring, endometriosis, or other
complications. Now, by replacing the five inch incision with a few small 'band-aid' cuts,
most patients return home in one day - with one of Dr. Koh's patients leaving the hospital
in just two hours!
When
laparoscopic hysterectomy was first introduced in 1990, it was very slow and difficult to
perform," says Dr. Koh. "Last year, however, I was pleased to introduce the Koh
Colpotomizer cup which has since been patented and FDA approved. This reduces surgery time
to just 60 minutes and can decrease hospital costs by up to one half."
Doctor
Koh and Dr. Janik will teach the technique using the Koh Colpotomizer in April at the
annual meeting of the International Society for Gynecologic Endoscopy. The team has also
recently started a multi-center trial to study its effectiveness.
In
another clinical trial, the Reproductive Specialty Center has been selected as one of 10
sites in the U.S. to study Albunex - a plasma protein injected into the uterus to enhance
transvaginal ultrasound. "This protein enables the uterine cavity to fill out so we
can diagnose defects and problems," says Dr. Koh. "It can also assist in
determining if a fallopian tube is open - a problem which can now only be diagnosed by
laparoscopy or hysterosalpingography. With Albunex, diagnosis of blocked fallopian tbes
becomes safer and easier for the patient because repeated exposure to radiation can be
eliminated."
Through
involvement in clinical trials and lecturing worldwide, Drs. Koh and Janik continue to
advance themselves and their profession. "We feel it's important to keep ourselves
up-to-date so that we can offer our patients the latest and the best," says Dr. Koh.
"Through advanced laparoscopy and microsurgery, we also hope to teach other doctors
how to become more refined - and therefore more successful - with regard to fertility
treatment and complex gynecological surgery."
Infertility Treatment: Going Beyond the Test Tube
The Reproductive Specialty Center
offers a full spectrum of fertility services including invitro fertilization (IVF) and
gamete intrafallopian transfer (GIFT), a procedure in which the sperm and egg are placed
directly in the fallopian tube. In addition, through techniques to gather and freeze
sperm, eggs, and embryos, the center can help preserve the chances of fertility for those
who undergo cancer therapy or surgery.
Many
advances have been made in infertility treatment since the birth of this country's first
'test tube' baby in 1981. "to go from the first baby born in this country to a nation
with a very large number of specialty IVF programs with very good results in 15 years is
amazing," says Dr. Janik who joined Dr. Koh in 1990 to start their IVF program. Both
physicians predict that the specialty area will continye to benefit from rapidly expanding
technology to serve the more than 6 million people who are affected by infertility each
year.
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Since the inception of the program in 1990, results for
ART (IVF/GIFT) have been consistently double the national average. The clinic's results
were ranked third in a December 1994 U.S. News and World Report story.Photo by J&J Images |
"As
a program, our philosophy has always been to be at the cutting edge," states Dr. Koh.
"However, we don't always necessarily want to be the first to offer any new unproven
technique because there are some technologies which prove to be passing fads. But as soon
as a technology has proven itself, we incorporate it into our program."
One such
technique now offered by Drs. Koh and Janik is intra-cytoplasmic sperm injection or ICSI.
This innovative procedure, developed in Belgium just two years ago, allows doctors to
isolate one sperm and inject it directly into a woman's egg in the laboratory. This is
beneficial for men who have a very low sperm count or have abnormal sperm which are unable
to penetrate an egg.
ICSI's
results, with pregnancy rates of nearly 50 percent, have been extremely encouraging,
especially for those whose only options previously have been donor sperm or adoption, says
Dr. Janik. The procedure is currently offered in conjunction with Highland Park Hospital
in Highland Park, Illinois.
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Assisted Reproductive Technologies are one option for
some infertility patients. Photo by Greg Nowak |
With
assistance from Dr. Douglas Dewire, a reproductive urologist in practice with Drs. Koh and
Janik, ICSI can be performed using sperm taken directly from the testicle or epydidymis.
This allows men with blocked or absent vas deferens (or similar problems which result in
an absence of sperm in the ejaculate) an attempt at pregnancy.
"By
offering the services of a reproductive urologist we demonstrate our commitment to provide
a full-service program," says Dr. Janik. "In working with Dr. Dewire, all
information about both male and female is in one chart in one office - ensuring a
coordinated and often more effective approach."
In
another expanding area of infertility treatment, Drs. Koh and Janik were the state's first
physicians to perform oocyte donation. Designed for women who are unable to conceive due
to natural or early menopause, this procedure involves the donation of eggs by another
woman, fertilization in the laboratory and implantation into the uterus of the menopausal
woman.
To
address the very common problem of multiple miscarriages the center offers complete
work-ups to diagnose and treat all causes of recurrent miscarriage including immune
incompatibility. Doctors Koh and Janik have recently teamed up with a select group of
physicians throughout the country to study the effectiveness of a drug called
immunoglobulin in the treatment of multiple miscarriages. This monthly infusion can be
effective for men and women who are immunologically incompatible.
Regardless of their problems, all patients benefit from the support and counseling of a
psychologist who worls in conjunction with Drs. Koh and Janik. "This is a very
difficult time for nearly all of our patients," says Dr. Janik. That's why we work
with each couple as a whole - as a unit - realizing that they have a personal life, a job,
a marriage and other things to balance during this very stressful time."