Q from U: Why am I struggling to get pregnant with my second baby?

July 3, 2013Carole 1 Comment »

I recently had a question from a reader who got pregnant easily with her first child  but hasn’t been able to conceive on her own since the first successful pregnancy and birth. She wanted to know, “How is this possible?”

We tend to think of infertility as an on or off switch or a label. We are fertile or we are not fertile. But it doesn’t work like that. It is a better analogy to think of fertility as a continuum, ranging from zero barriers to conception to many barriers to conception. . Each of us have some combination of personal factors, issues or conditions that work for or against us when we want to have children. Somewhere along this continuum, we can accumulate too many negative factors and have trouble conceiving.

What are some negative factors that can arise over time that may cause secondary infertility ?

  • Abnormal body mass index (BMI):  Becoming obese or morbidly obese over time can affect hormonal regulation in women and sperm quality in men. While being underweight can also have a negative impact on fertility, most of us typically struggle with weight gain, not loss, as we age.
  • Exposure to workplace hazards like extreme heat (decreases sperm production in men); pesticides (toxic effect on sperm), radiation (effects on both sexes), toxic chemicals (can affect both sexes)
  • Abdominal adhesions (can cause Fallopian tubes to become blocked or ovaries become stuck to other tissues, blocking function): Scarring or adhesion formation can occur  from previous abdominal surgeries, appendicitis, worsening or undiagnosed endometriosis,  or pelvic inflammatory disease (PID) from untreated STD infections such as chlamydia.
  • You have gotten older: Advanced maternal age is associated with decreased egg number and egg quality. Although there is evidence of some egg stem cells in women, they are rare and do not normally function to continually renew germ cell number. For all intents and purposes, females are born with all the eggs they will ever have. Over time, this number declines. Newer studies suggest that the chromosomal integrity of sperm also declines as men age.
  • You have developed a new medical condition such as hypothyroidism  or insulin resistance which negatively affects fertility
  • Smoking: Smoking is simply a personalized method of toxin delivery to all your organs- including your ovaries . Numerous studies have shown that smoking is a negative factor for fertility for both men and women.
  • Use of recreational drugs, including alcohol, to excess is bad for reproductive health.

Because our health status, our exposure to environmental toxins or infectious agents, and our previous surgical or other medical history changes as we live our lives and get older, this balance of factors also changes, sometimes tipping us into the less fertile or infertile end of the continuum. Because conception is a partnership- troublesome negative fertility factors can arise from either the male or female side- or both. So given this landscape, it is less difficult to understand how someone who became pregnant easily the first time they had unprotected sex might have trouble conceiving the next time, even after experiencing a successful pregnancy and birth.

 What options do couples who suffer from secondary infertility have?

The good news is there are many options to treat secondary infertility. The first step is to seek help from a infertility specialist if you are not getting pregnant.  The American Society of Reproductive Medicine (ASRM) recommends seeking medical help  after 12 months of unprotected, properly timed sex without conception if the woman is under 35 years of age. If maternal age is greater than 35, ASRM recommends getting help sooner- after six months of trying. But if you have known factors or suspect that there might be issues, you’ll want to get a fertility check-up sooner rather than later, regardless of your age. Time is not your friend when it comes to fertility. We all become less fertile with age.

An infertility work-up (male or female) usually involves a review of past medical history- both reproductive and general health history. Lab tests may be ordered for both male and female to look for hormonal problems. A semen analysis should be done on the male’s semen sample to look for low sperm count, poor swimming ability or abnormally shaped sperm, all of which negatively impact fertility.  If blocked Fallopian tubes or other structural problems  in the female (fibroids, cysts, adhesions) are suspected, imaging tests could be ordered to get a look at the tubes, ovaries and uterine cavity.

Depending on the issues discovered, some treatment options may include:

  • Modifying lifestyle factors to improve fertility (eg. normalize weight, stop smoking and treat alcoholism or drug addiction.)
  • Treat chronic medical conditions like hypothyroidism and insulin resistance to restore normal function.
  • Treat any reproductive system infections.
  • Surgery to remove adhesions from reproductive organs or to remove fibroids from the uterus.
  • Minimize workplace exposures to the maximum extent possible by employing all protective gear or modify job duties if possible.
  • Use of ovarian stimulation medications to regulate ovarian function and ovulation.
  • in vitro fertilization (IVF) to bypass blocked tubes or maximize the fertilization potential of rare or poor-quality sperm. ICSI, in particular, can help men father children who have barely sufficient viable sperm for the number of eggs their partner produces.
  • Egg or sperm donation
  • Gestational surrogacy to bring an IVF embryo to term if the intended mother can not carry a pregnancy.

Secondary infertility is not rare at all. As we live longer, we seem to spread our child-bearing or fathering years over a longer part of our lifespan, offering up more opportunities to accumulate negative fertility factors as we age. The good news is that there are lots of treatment options available today compared to 30 years ago so be informed about causes of infertility and seek help sooner rather than later.

© 2013, Carole. All rights reserved.

One response to this entry

  • Ila Calderon Says:

    Secondary infertility has the same guidelines for seeking help as infertility . If a woman is under 35 and has been having regular, unprotected intercourse without a pregnancy for a year, she should see a specialist. If a woman is over 35 and has tried for six months without success, she should make an appointment. Of course if you know that there are risk factors, like recurrent miscarriage (defined as three or more miscarriages) or a known low sperm count for the man, the couple should see a specialist sooner rather than later.

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