Written By Dr Anne Poliness – Jolimont and MD
Baby number one came relatively easily, and now you have decided to focus on having another baby but it’s just not happening. Unfortunately, this is a relatively common story I hear, immediately followed by “but why?”.
Secondary infertility is defined as the inability to conceive a child or carry a pregnancy to full term after previously giving birth.
There are several reasons why infertility might strike you second, third or even fourth time around and here are some of them:
Causes of secondary infertility
- Maternal Age: Maternal age is a significant factor and often the most important indicator of a woman’s chance of conceiving as egg quantity and quality begins to decline as we age. Conception rates for healthy couples are, at best, 20-25 per cent per menstrual cycle. Once a woman reaches the age of 30, her fertility begins to decline, more so after the age of 35. By age 40, it is estimated that her conception rate is in the range of 8-10 per cent per month and at age 43, the pregnancy rate is thought to be as low as 1-3 per cent per month.
- Other Female Factors:
– Irregular menstrual cycles may suggest a problem with ovulation and result in difficulty conceiving. The average length of the menstrual cycleis 28 days, but can range between 25-35 days. The female menstrual cycle is determined by a complex interaction of hormones, so any hormone imbalance can make your period irregular. While in most cases, irregular cycles are not dangerous, it is important to determine what is causing the irregularity. Pinpointing your precise ovulation dates is crucial too.
– Endometriosis can develop over time and cause issues with
blocked fallopian tubes or an inflammatory environment. If the egg can’t meet the sperm, normally due to a blockage, conception will be very difficult.
- Male Factor: Poor sperm function resulting in not having enough moving sperm per ejaculate can impact conception. Unfortunately, having a previous pregnancy is not proof that this is the case. Developing and transporting mature, healthy, functional sperm depends on a specific sequence of events occurring in the male reproductive tract. Many disturbances can occur along that path, preventing cells from maturing into sperm or reaching the woman’s fallopian tube where fertilisation occurs.
- Lifestyle: Weight is a common factor affecting fertility success. For women, ovulation can be impacted by being either underweight or overweight, and studies have shown that bringing BMI within the normal range can assist ovulation to occur normally, thus increasing the chances of pregnancy. It’s also very important for men to ensure a healthy BMI, and studies have consistently
linked obesity to a lower sperm count because testosterone levels drop while oestrogen levels rise in men who are overweight.
- Unknown: Unfortunately, there may be no reason found for trouble getting pregnant the second time around. It is estimated that roughly ten per cent of infertility remains unexplained even after complete medical evaluation. Although testing may not have found a cause treatment options are still available.
What are the options available if you are experiencing secondary infertility?
As always, you should seek the advice of a fertility specialist after 12 months if you are under 35, or after six months if you are over 35, and have not fallen pregnant.
Following a thorough investigation to try and determine the cause of secondary infertility, these are some of the more common treatment options I often recommend on a case-by-case basis:
- Ovulation Induction: This involves the use of medication (Letrozole or follicle stimulating hormone) to stimulate the ovaries and encourage or regulate ovulation.
- Ovulation induction can be combined with Intra-Uterine Insemination – a procedure in which sperm is directly inserted into a woman’s uterus in order to improve the likelihood of fertilisation.
- Surgery: For some women, surgery can improve their chances of conception when the cause of infertility is due to fibroids, endometriosis and other tubal or uterine issues.
- In Vitro Fertilisation (IVF): IVF is used to treat infertility that has failed to respond to other medical or surgical interventions, or where other treatment options are not going to be helpful. IVF involves the fertilisation of the egg by the sperm in an incubator outside the body, and transfer of the embryo back into the uterus.
- Intracytoplasmic Sperm Injection (ICSI): This method is used in IVF treatment for more severe forms of male infertility. It involves the selection and direct injection of a single sperm into the substance (called cytoplasm) of the egg.
- Healthy lifestyle Encouraging the adoption of a balanced lifestyle where patients maintain a healthy weight, eat well, exercise, minimise stress, limiting caffeine and alcohol intake, stop smoking and drug use.
