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Secondary Infertility

by Dolores Hoffman

You thought getting pregnant the first time was a breeze.  In fact, you thought the second time would be just as easy.  That’s not always the case for some couples who find themselves dealing with secondary infertility.  Secondary infertility is when a woman is unable to conceive or carry a pregnancy to term after having one child already.  More than 3 million women are affected and the symptoms are like those of primary infertility.

Risk Factors

• Pelvic or uterine scarring: Pelvic scarring, which may be caused by endometriosis or prior abdominal surgeries can make it difficult because adhesions may have developed around the fallopian tubes.

• Weight gain: Weight can have a major impact on the ability to conceive. Excessive weight gain can contribute to ovulatory dysfunction. With increased weight, insulin resistance can rise which leads to elevated production of testosterone from the ovaries. This goes for men as well. Excessive weight can also negatively affect sperm production by increasing estrogen levels.

• Advanced reproductive age: A woman’s age is one of the most common reasons for secondary infertility. It is important to understand that a woman is born with all of the eggs she will ever have. This means that her egg quantity and egg quality will decrease. The ideal age to conceive is between ages 18 and 30, with a drop-off occurring at 30 and a dip at 35. Many women are delaying first-time pregnancy until after 35 which means more chances of running into problems.

• It’s a man thing: Just as a woman’s fertility can change with time, so can a man’s. A man may have a decrease in the concentration of his sperm. It is estimated that one in 20 men has some kind of fertility problem with low number count. This increases with age.

Treatments

Fertility treatments have a very good success rate. Even if you already have a child, if you suspect secondary infertility, early assessment is critical since treatment options may be limited as time passes.

• Medication: Medications that are used to enhance fertility are always improving. Many are used to increase the number of eggs that are available for fertilization.

• Fertilization: The biggest key to successful fertilization is timing. Once the eggs are ready, the doctor will discuss the best way to proceed whether it be via intercourse or in the lab. In vitro fertilization has been useful in avoiding some of the problems caused by scar tissue and adhesions.

• Egg donation: In the case of women who are diagnosed with low ovarian function, egg donation is an option.

• Laparoscopic Surgery: Surgery to remove scar tissue and adhesions have had some success, although proper healing does take time.

Secondary infertility can be surprising and stressful, not to mention difficult to accept. Don't try to cope alone. Seek support from your partner, family and friends as you talk to your health care provider about the next steps.

 

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