Dr. K and her Patients in the News
Waiting to Have Children
Teresa and David Pinyon
News 24 October 24, 2003 Video
Houston Business Journal - Executive health and Fitness - December 13, 2003
Many women, marrying later and focusing on their careers, are delaying starting families.
They’re part of a better educated, stronger, healthier generation. With both contraception
and fertility medical technology available, they plan on having babies later in life,
following the examples of women such as Joan Lunden, Madonna and Brooke Shields.
The harsh reality, however, is that the longer a woman waits, the more her fertility declines
and the less likely she is to get pregnant without help. A woman’s prime reproductive years
are between the ages of 20 and 30. By the mid-30’s, a woman’s ability to reproduce has
reduced significantly. By 40 it can be at a standstill. Waiting longer requires more
technology and medication, which can be costly.
Teresa and David Pinyon of Houston are typical of many professional couples. Busy with their
careers in the telecommunications field, they were in their mid-30’s when they met and
married. After their first year of marriage, they decided to start a family.
Teresa Pinyon, who was 37, decided to see an infertility specialist immediately rather than
waiting. She was right, they needed in vitro fertilization. They were successful their first
attempt and four months ago delivered a healthy little boy, who they named David. Knowing
that the clock is ticking, they plan to start working on a little brother or sister for
David this month.
A COUPLE PROBLEM
One is five Houston couples will struggle with infertility. Statistically, a third of the
infertilities occur in women, another third in men and the last third is a combination of
both or unexplained.
In a couple’s initial work-up, the male should undergo comprehensive semen testing. It is
crucial to process this test shortly after collection since sperm deteriorates quickly
and should be performed at an Andrology lab. If the specimen shows a low count or motility,
the healthiest sperm can be isolated and prepared for introduction to the uterus or retrieved
egg. If no sperm is found, a urologist can determine if newer sperm aspiration/biopsy
procedures might produce them.
A recent review in the Journal of American Medical Association and Britain’s equivalent,
the Lancet, shows that the commonly performed varicolectomy, the removal of dilated veins
in the scrotum (thought to be a cause of low sperm and/or motility) has not proven to
increase pregnancy rates.
This unproven surgical procedure required a six- to 12-month waiting period to see if an
increase of the sperm count or motility occurred. This waiting period may cause women to
miss their window of opportunity, particularly older women. Intrauterine insemination and
IVF with intracytoplasmic sperm injection can immediately overcome low count or motility
issues and have proven high success rates.
HOMEWORK
A woman attempting to conceive is advised to see a board certified reproductive
endocrinologist infertility specialist if she is under age 35 and hasn’t conceived in
one year, between the ages of 35 and 39 and hasn’t conceived in six months, age 40 or
older and has not conceived in three months, or at any age if she has long or irregular
cycles or a history of a pelvic infection/injury/disease.
The REI’s individual success rate is a good indicator. However, each woman should keep in
mind that her experience may be different due to her unique infertility problem and be
wary of unusually high or low success rates.
Clinics stating very high IVF success rates may be pre-selecting, accepting patients with
a high likelihood of success while encouraging those with lower likelihood to use an egg
donor. While using an egg donor definitely offers a high degree of success rate, a patient
should be able to try IVF with her own eggs after full counseling on the probable success
and costs of both options.
Some patients need this for closure, while others look at the end goal of having a child in
the shortest or most cost efficient way regardless of biological connection.
The clinic with moderate success rates may be the better clinic if it taking patients with
more challenging problems. A person considering infertility treatment should:
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Check for board certification of lab personnel, embryologists and andrologists. Onsite
PhD-level supervision is preferred.
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Look for a supportive, comfortable convenient environment. Infertility treatment is
time consuming and stressful.
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Consider counseling.
“Coping with infertility can be as stressful as the loss of a relative, a diagnosis of
cancer or divorce,” says Kathy Stern, PhD with Southwest Surrogacy Arrangements Inc.,
specializing inn infertility stress counseling.
New technologies allow medicine to accomplish things today that were considered miracles
only a few years ago. But doctors cannot stop time. Those who want a healthy baby should
act sooner rather than later.
Sonja Kristiansen, MD is medical director of the Infertility Center of Houston
(www.drkristiansen.com).