When a first child is conceived with ease, you may feel completely off guard by the difficulty of having a second child. Secondary infertility is defined as the inability to become pregnant or to carry a pregnancy to term following the birth of one or more biological children, or the birth of the first child does not involve any assisted reproductive technologies or fertility medications.
Causes of secondary infertility vary and are sometimes unknown, but there are a number of factors that may be at play.
Advanced reproductive age: A woman’s age is one of the most common reasons for secondary infertility. A woman is born with all the eggs she will ever have and as she ages, her ovarian reserve will diminish. This means that her egg quantity and quality will decrease, while the chance of miscarriage increases. This is true whether or not she conceived easily in the past.
Structural complications: Some other important factors related to the structures in the pelvis, including the fallopian tubes. Pelvic adhesions – which may be caused by endometriosis or prior abdominal surgeries – may make it difficult for the egg to be picked up by the fallopian tube. Without a connection that functions normally, pregnancy cannot result.
Sperm quality and quantity: Just a woman’s fertility can change with time, so can a man’s. Changes in sperm quality and quantity may occur due to changes in health or new medications. A semen analysis is one of the basic aspects of the initial infertility evaluation.
Weight gain: Weight can have a huge impact on the ability to conceive. Excessive weight gain can contribute to ovulatory dysfunction. With increased weight, insulin resistance can increase as well, which leads to elevated production of testosterone from the ovaries, an occurrence that can further prevent normal ovulation. In men, excessive weight gain can also negatively affect sperm production by increasing estrogen levels.
Smoking: Cigarette smoking in both males and females can significantly impair the ability to conceive. And, smoking can seriously impact a woman’s ability to carry a normal pregnancy.
Even if you already have a child, if you suspect secondary infertility, seek help from a fertility specialist as early as possible! Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue.
Medication: Medications that are used to enhance fertility include oral medications such as clomiphene citrate (Clomid) and injectable gonadotropins. Both are used to increase the number of eggs that are available for fertilization.
Fertilization: Once the eggs are ready, the doctor and patient will determine if the best way to proceed is via intercourse, intrauterine insemination, or in vitro (in the lab). In vitro fertilization has been useful in circumventing some of the tubal and pelvic disorders that can cause secondary infertility and is helpful in increasing rates of fertilization–even if a woman’s fallopian tubes are already opened, as in the case of severe sperm-related abnormalities.
Egg donation: In the case of women who are diagnosed with severely diminished ovarian reserve with no remaining ovarian function, egg donation is an option.
It is important to remember that some couples will have an unknown reason for their infertility, and some will not. Regardless of whether or not there is a ready diagnosis, every woman struggling with questions about her fertility can benefit from a consultation with a specialist.