In Vitro Fertilization

The difficulty of conception is a reality for hundreds of woment in the Central Texas area. Fortunately, these same women find new hope of building a family through in vitro procedures offered at Scott & White.

Every day, a simple blue line on a stick of plastic changes the lives of women around the world. It’s a symbol of failure; it’s a symbol of success. For many, the line never appears, and for others, it would not without the astounding advances in the medical field in the last several decades. For the millions of women who struggle to see the positive symbol on a pregnancy test, that little blue line can be the most valuable thing in the world.

Thomas J. Wincek, M.D., Ph.D., chief of the Section of Reproductive Endocrinology at Scott & White, wants that happy ending for everyone who seeks it. Because this is the only reproductive endocrinology program between Austin and Dallas, Dr. Wincek, Joseph Pliego, M.D., Thomas Kuehl, Ph.D., and a dedicated support staff see couples every day who are looking for help with conceiving a baby.

“Infertility is a common problem in our world today and really has an impact on the lives of many men and women,” Dr. Wincek said. “At Scott & White, we have a comprehensive program that not only allows us to evaluate couples but also assists them in finding treatment programs that increase the chance of a pregnancy.”

Infertility is defined as a disease of the reproductive system that impairs one of the body’s most basic functions: the conception of children. It affects more than six million women and their partners in the United States. Many different factors lead to reproductive problems in both men and women. In men, the most common cause is a low number of normal sperm. In women, it is a problem with ovulation. Other causes include endometriosis (a sometimes painful condition resulting in scarring and cysts) and damage to the fallopian tubes, which prevents the sperm from reaching the egg. Many infertility cases can be treated with medication or surgical repair of reproductive organs. But for others, a more drastic approach is necessary.

“In vitro fertilization (IVF) offers women who have trouble conceiving through traditional methods a chance at becoming pregnant,” Dr. Wincek said. “In vitro allows us to bypass the fallopian tubes and implant an embryo right into the uterus. We have a full-scale embryology lab in Temple where we can fertilize the egg and help develop the embryo so that it can be transferred into the uterus.”

During in vitro fertilization, eggs are removed from the ovary with a syringe and combined with sperm outside the body. After about 24 hours, the eggs are examined to see if they have been fertilized. The fertilized eggs, now embryos, are placed in the woman’s uterus.

Dr. Wincek, Dr. Pliego, and their colleagues see approximately 300 women each year who are seeking help conceiving. As part of the comprehensive program at Scott & White, each new patient is asked about important parts of her medical history and undergoes an exam to tailor the rest of the evaluation and to develop a treatment plan.

“We sit down with each person and explain all of the options to them,” Dr. Wincek said. “We want to make sure that they know from the beginning what their chances are. There is a lot of hand-holding for our patients, because for many this is a new process. And after 21 years, I still get excited when one of our patients finds out she is pregnant, but we also grieve for those who did not conceive on a treatment cycle or suffer a pregnancy loss. It’s an amazing process, and we are fortunate enough to say we have changed the lives of thousands of people, and will continue to do so.”

F or Helen and Blaine Milstead, the question of starting a family was never if, but when. Both knew they wanted children, but with busy lives and strong careers, they were waiting for just the right time.

Yet when they decided they were ready, it seemed as though the “right time” had passed. Years of unsuccessful attempts left them disappointed, angry and confused. They turned to their doctor at the Scott & White Waco Fishpond Clinic for help and were quickly referred to the Reproductive Endocrinology Section at Scott & White in Temple.

After meeting with Thomas Wincek, M.D., Ph.D., the Milsteads realized their dream might come true after all, but they knew it would take more than just luck.

“Almost immediately after we met Dr. Wincek, we knew we were in the right spot,” Mrs. Milstead said. “He told us from the beginning what we should do, and he gave us a plan to follow. He made us feel so comfortable about everything that I truly felt like I could tell him anything.”

After a thorough testing process that involved both Helen and Blaine, Dr. Wincek could not find any reason that the couple could not conceive, which happens in about 15 percent of infertility cases. So he started them on a path that was both scary and exciting, a path that would ultimately lead to the happiest day of their lives.

With the only complete reproductive endocrinology program between Austin and Dallas, Scott & White was well equipped to help the Milsteads realize their dream. Dr. Wincek first suggested that the couple try intrauterine insemination (IUI), in which the sperm are placed directly into the uterus. After four failed attempts, Dr. Wincek said the couple was ready for in vitro fertilization (IVF).

“We knew all along that we would try the IUI four times, then we would begin IVF if the other treatment didn’t work. It really helped me to know there would be something else to try,” Mrs.

Milstead said. “It was so disappointing to go through the

IUI process four times and never hear what we wanted to hear. But knowing we had one more option left helped us get through it.”

“The first disappointment was the hardest one,” Mr. Milstead said. “You know it might not work, but you always hope it will, and when it comes back negative, it’s hard to take. But it never got to the point where we wanted to give up. We wanted to keep doing whatever was necessary to give us a child.”

Unlike intrauterine insemination, IVF involves combining the eggs and semen outside of the woman’s body to create embryos, then transferring the embryos directly into the woman’s uterus.

After completing the IUI cycles, the Milsteads met with Thomas Kuehl, Ph.D., an embryologist at Scott & White who is responsible for creating the embryos. They began the IVF process in July

2003, with the accompanying ordeal of medications, shots and hormones. After the procedure, the Milsteads endured the long wait to see if a pregnancy would result. Both remember the day those results came back.

“I was an elementary school principal at the time, and I remember I was supposed to come home at lunch so we could call and find out. And a part of me didn’t want to make that call,”

Mrs. Milstead said. “Sometimes the disappointments are so hard you don’t want to do it anymore, and I didn’t want to hear that again. But I went home and we called, and they told us we were pregnant, and we both immediately burst into tears.”

“I remember that I couldn’t wait for Helen to get home so we could call, and when we found out I was so emotional. It was the most wonderful thing I had ever heard,” Mr. Milstead added.

Nine months later, on May 8, 2004, the miracle happened and Reese Daily Milstead entered the world at a healthy six pounds, 12 ounces. More than one year later, the Milsteads still can’t contain their excitement and joy, and they say Dr. Wincek and his team are the reason their miracle is here today.

“Sometimes it’s hard to believe we actually have a child,” Mrs. Milstead said. “We had the best experience at Scott & White, and we truly felt like we were the only patients they had. They took our calls at all times of the day and night, held our hands, laughed and cried with us and helped us with a dream we thought we might never have.”

After Reese was born, the Milsteads moved to Kansas City and will soon try for another child. Both say if it doesn’t happen naturally the second time, they will be headed back to Temple.

“We wouldn’t go anywhere else for this,” Mr. Milstead said. “We definitely want to have more children, and if we need to try IVF again, Scott & White is where we will come, no matter how far away it is. You can’t find that kind of attention and caring attitude everywhere, but we found it at Scott & White.”

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