Is twice as nice ?

Secondary infertility is inability to conceive or carry ahead the pregnancy again after a woman has once conceived earlier. There are broadly two type of couple here, one who already have a baby and fail to achieve a pregnancy second time around, and secondly, couple who conceive but the pregnancy does not carry forward for any medical reason.

These couples suffer for a trauma and emotional stress not very well appreciated. Difficulty in conceiving a second child may come as a shock to the couple, particularly if no problems were experienced before. The reaction that some couples face “ be happy you have one” can be very depressing for a couple desperately trying for a child.

The average incidence of secondary infertility is 20-30 percent of the general infertility population.

The main causes for secondary infertility are similar to those of Primary infertility like tubal block, endometriosis, fibroid uterus, altered sperm parameters with the added burden of age and lifestyle issues.

Maternal Age: The mother’s age is one of the most common reasons for secondary infertility. Couples plan the first pregnancy late and often delay trying for another child because they believe that conception will occur without difficulty. The natural decline in ovarian function is the single most important factor in fertility. It is important to realize that women are born with all of the eggs they will ever have. As a woman ages, the egg quality decreases, and the chances of miscarriage increases.

Pelvic/tubal factors: Pelvic infections, surgery, endometriosis and a history of ruptured appendix can lead to pelvic adhesions that interfere with the ability of the egg to be picked up by the fallopian tubes. For example, if there were complications during a prior delivery and a woman developed a uterine infection, or if she underwent a difficult pelvic surgery, she may be at risk for a condition known as Asherman’s syndrome (intrauterine scarring after uterine surgery), or adhesions around the fallopian tubes which prevent the tube from capturing the ovum during ovulation.

Male factor: Changes in sperm quality or quantity may occur due to changes in health, or beginning certain new medications. I continue to be amazed, for example, at the number of couples I see in which the male was given testosterone supplementation by a family practice doctor. The effect of such treatment decreases male sperm production dramatically and can often take months to get back to normal. Smoking, alcohol consumption and or recreational drugs can decrease the sperm parameters gradually.

When the woman is young her eggs can counter these minimal effects, but as the woman’s age increases, couple find it that much difficult to conceive.

Life style issues: Factors such as weight can have an impact on the ability to conceive. Excessive weight contributes to ovulatory disorders. As a woman’s weight increases, insulin resistance may increase as well, leading to elevated production of male hormones, such as testosterone, which affect ovulation. For men, excessive weight can increase male estrogen levels which can negatively affect sperm production. Cigarette smoking can also impact egg quality and increase complications during a pregnancy.

Further we often in our practice encounter patients who conceive but miscarry repeatedly. These patients undergo a trauma not comprehendible by general population.

Secondary Infertility couple needs special care, complete evaluation of their fertility potential and even more so from multiple angles! A woman who repeatedly does ovulation studies to assess fertile period but does not undergo tubal patency test as she conceived easily first time, is probably loosing time and money!

Each pregnancy can lead to a complete change in the scenario for the further conception. 

Another thing these couples cannot afford to do is waste time, for the egg reserve is a finite parameter. The best years to conceive are on the right side of thirties!

Sometimes things can change so drastically, especially around approaching forties that the only option remaining is a donor egg!