Second time unlucky
You fell pregnant so easily before, so how come it's not happening this time? The truth is that infertility can strike at any time.
The first time you got pregnant, you let out a secret sigh of relief: you weren't one of those unlucky women who had trouble conceiving, who had to endure the heartache of failed attempts and fertility treatments.
After your first child was born and you settled into life as a parent, you and your partner began making plans for a little sibling to join the family. But after many months of trying, you began to realise there was a problem. Could infertility really strike now, when everything seemed to work so well the first time around?
It most certainly can. It's a condition that the experts call secondary infertility or sometimes, sub-fertility.
"There are absolutely no guarantees about falling pregnant at any time," says Dr Devora Lieberman, gynaecologist at Sydney IVF. "It's interesting that people think because they've been fertile in the past it will continue in the future."
There are no accurate figures to show how often secondary infertility occurs as it's often not reported, possibly because couples can more readily accept the situation if there's already a child in the picture and they decide not to pursue fertility options.
But doctors say it's a problem that does affect many couples, particularly when you consider that one in about six couples will experience infertility at some time in their reproductive lives.
"It is fairly common," says Dr Lieberman. "It's not an unusual story and we recognise the profound frustration because it was so easy the first time."
Emotionally and psychologically, secondary infertility can be particularly gruelling, as the situation is often not fully understood or recognised by other people. There may be a lack of sympathy given the couple already have one or more healthy children or they may have trouble finding a doctor who will take their concerns seriously instead of just urging them to "keep trying". They may also feel guilty that their situation isn't as dire as for couples who can't conceive even one child.
What's to blame
What could possibly cause things to suddenly stop working? Age is one of the biggest factors. "As people get older, they do face an age-related decline in egg quality," says Dr Lieberman.
With many women waiting until 30 or later before having their first baby, they may be close to 35 or older when they try for a second child. And it's at this time that egg quality starts to rapidly decrease.
The quality of a man's sperm can also decline with age. "About 40 percent of infertility has to do with the male factor," says Dr Lieberman. "Male fertility doesn't decline to the same extent that female fertility does with age, but there can be a variability in sperm and semen quality over time."
Also consider if your lifestyle has changed since your first pregnancy. Along with ageing, you may have put on weight or you and your partner may be drinking or smoking more. All these factors can reduce fertility.
"It doesn't take much to reduce your monthly chances of conception," says Dr Lieberman. "You might be dealing with several mild factors."
In some cases, the first pregnancy and birth may have caused a problem that affects the possibility of conceiving again. An infection after the delivery can lead to adhesions that can affect proper functioning of the fallopian tubes. Or there may have been a pre-existing condition and you were just incredibly lucky to conceive the first time despite it. Such conditions can include polycystic ovarian syndrome, pelvic inflammatory disease or fibroids.
There are several other infertility causes that can develop any time, even after successfully conceiving one or more children. Endometriosis, in which uterine tissues are located outside the uterus, making conception more difficult, can develop at any time.
"Endometriosis can take a normal 15-20 percent chance of falling pregnant down to five percent," explains Dr Lieberman.
Secondary infertility can also fall into the unexplained category of infertility, where doctors can find no obvious cause. Unexplained infertility covers about a third of all infertility cases, but the good news in these cases is that one-to-two thirds of couples with unexplained infertility will fall pregnant within three years if they keep trying.
When to worry
How long should you keep trying to conceive before you start seeking help? With a first attempt, doctors usually recommend that couples try having regular, unprotected sex for at least a year before investigating problems.
But that may not be the case if you've already had a successful pregnancy. "If you're 23 and haven't gotten pregnant in six months, you might actually think about doing some straightforward tests," says Dr Lieberman. Likewise, if you're in your mid-thirties, you may not want to wait a year and risk your egg quality deteriorating further.
"People should be proactive and if things aren't happening as fast as they like, then get some basic studies done," she says. "A simple semen analysis and ultrasound … can be very reassuring to find out everything is normal."
In terms of investigations, doctors will want to test the male partner's sperm to confirm the quality and quantity. For women, blood tests can confirm if a woman is ovulating, whether she has polycystic ovarian syndrome or if there is an underlying pituitary or ovulatory disorder. They may do a laparoscopy to check for blockages in the fallopian tubes. This is an operation that requires general anaesthetic but can also be used to diagnose endometriosis and ovarian cysts. No operation is ever completely without risk, but complications with this surgery are minimal.
Treatment options
The treatment options for secondary infertility are exactly the same as those for regular infertility. "We approach it on a case-by-case basis and try and individualise treatments as much as possible," says Dr Lieberman. Depending on individual circumstances and what investigations reveal, fertility specialists will advise on the best options for treatment. In some cases it may be a matter of treating a condition like endometriosis, a blocked fallopian tube or fibroids with minor surgery.
If the trouble relates to your ovulation patterns, doctors may recommend charting your temperature and testing your LH levels (luteinising hormone, the hormone responsible for stimulating your body to ovulate, known as the LH surge) with a store-bought kit to pinpoint your exact time of ovulation. When you have that worked out, you can have sex accordingly.
In some cases, women may be injected with hormones or fertility drugs to stimulate egg growth and ovulation. In others, your only option may be in-vitro fertilisation (IVF).
All material is © Mother & Baby: Making Babies
Home