First-time pregnancy is an exciting journey, and it causes many couples to heave a big sigh of relief, “whew! So glad we are able to get pregnant on our own…none of that infertility drama for us!” Then, the second (or third, or fourth…) attempt to get pregnant can be quite a shock. Month by month, quarter by quarter, and even more than a year later, couples who got pregnant easy-peasy the first time around may find that’s not the case down the road.
In our line of work, this is called secondary infertility. In addition to difficulty conceiving, secondary infertility might also show up in the form of repeat miscarriages (recurrent pregnancy loss).
What causes secondary infertility?
Simply put, secondary infertility is the inability to conceive or carry to term after naturally conceiving and delivering one or more children. Understandably, it is incredibly frustrating. At the same time, it can be very enlightening because it guides fertility specialists as they look more closely at certain infertility factors.
Some of the most common causes of secondary infertility include:
- Advanced maternal age. The older you are, the lower your ovarian reserves and the more diminished your egg quality will be.
- Issues around ovulation. Have irregular periods been the norm for you lately? Age, lifestyle changes or other factors might be altering your ovulatory rhythm.
- Other health conditions. Any changes in your overall health can have an effect on fertility.
- Lifestyle changes. Do you drink more? smoke more? Have you gained quite a bit of weight since the last time you tried to get pregnant?
- Anatomical changes since the first pregnancy. Scar tissue (the result of an infection, endometriosis or a C-section) or fibroid tumors can alter the pelvic landscape in a way that makes it more difficult to conceive, for a fertilized egg to implant and/or for a fetus to develop full-term.
- Hormone imbalance. You may be going through menopause earlier than you anticipated, which can affect your ability to conceive. Other hormone imbalance issues can also make it more difficult to ovulate regularly, which affects your ability to conceive at home.
- Immunological concerns. Sometimes, your own immune system will recognize the sperm or the fertilized egg as an invader, activating killer cells that fight off the very thing you are trying to foster. This immunological response might not have geared up in time to affect your first pregnancy (thankfully!) but it’s ready and raring to go by the time the second one tries to come to fruition.
- Changes in your partner’s sperm quality. Any changes in your male partner’s well-being can potentially affect sperm production and/or sperm quality, so a semen analysis should be performed along with the mother’s routine infertility testing.
For a secondary infertility consultation, the specialist will run through a complete personal and family medical history, perform a complete physical, and then perform the battery of diagnostic tests in order to establish the most likely cause of your secondary infertility.
As with all infertility diagnoses, sometimes fertility treatments work and sometimes they don’t. Your greatest chances of success rest on your own ability to keep an open mind when it comes to various treatment options.
It’s always a good idea to prepare your body for pregnancy, and that might require making lifestyle changes that promote conception and pregnancy health.
Sometimes, treatment will be as simple as a surgical procedure to remove scar tissue, cysts or fibroids making it more difficult for conception and pregnancy to move forward smoothly.
IUI or IVF
In cases where sperm quantity/quality is an issue, the specialist may recommend IUI, which gives us more specific control over the quality of the sperm used to conceive the baby. If egg quantity or quality is a concern, the doctor might recommend jumping straight to IVF, after which we can use PGS or PGD and choose the healthiest embryos for transfer.
Donor eggs or donor sperm
This time around, you might need to be open to outside donor help. In cases where egg reserves are completely diminished or egg quality is compromised such that IVF chances are lower, we recommend being open to the use of a donor egg. Donor eggs come from young, healthy women – so using a donor egg for your IVF treatment gives you the same success rates as women in the same age bracket as your donor. This is also a good option for women who have eggs carrying chromosomal abnormalities.
Similarly, if your partner has an exceptionally low sperm count, or sperm morphology/motility is low – we might recommend the use of donor sperm. If both you and your partner have an infertility diagnosis, you will even have the option of using a donor embryo.
Don’t wait too long to investigate secondary infertility
Couples who already have a child or two often wait much longer to seek infertility assistance than couples without children. However, the same rules hold true for you as they do for your childless counterparts; women 34-years and younger should always schedule an infertility appointment after 12-months of unsuccessful attempts at getting pregnant, sooner if you’ve experienced more than one miscarriage; women 35-years and older should look into it after 6-months. The sooner you’re diagnosed, the better chance we have at finding the best fertility treatment method.
Are you having a hard time getting pregnant this time around? Do you suspect secondary infertility might be a problem? Schedule a consultation with RRC as soon as possible so we can get to the bottom of things. Our physicians, Dr. Celeste Brabec and Dr. William Phipps have decades of experience treating secondary infertility and they look forward to helping you make your second, third or fill-in-the-blank dream come true.
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RRC has over 200 years of combined experience. As a leading reproductive health, infertility, and in-vitro fertilization (or IVF) center based in Kansas City, we're proud to have the highest level of expertise available to our patients.