18:26 23rd July 2019 | Fertility Treatment
You have done this before. You have conceived, carried, and birthed a baby. Perhaps you have never even thought about the process of conception at all. You just got pregnant when you wanted to, or maybe even by accident.
Now it’s a year or two later and you want to grow your family again and it’s just not happening. Why not? You barely tried before, why should putting a bun in the oven be any different this time around?
You are not alone.
While primary infertility is higher in other regions of the world, secondary infertility is more common in Africa, and secondary infertility rates are very complicated to determine. In Nigeria specifically, a study has found that secondary infertility may be why 66% of Nigerian women are unable to get pregnant, and fibroid being the cause in 21.8% of the women.
Secondary infertility is defined as being unable to become pregnant or to carry a full-term pregnancy, following the birth of one or more children without the use of assisted reproductive technology.
Causes of Secondary Infertility
• Advanced Reproductive Age: Women are born with all of the eggs (oocytes) they will ever have. As women age, their ovarian reserve diminishes, which means that their egg quantity and quality decreases with time. A year or two between children can greatly affect a woman’s fertility.
• Complications of the Reproductive System: Pelvic adhesions, endometriosis, intrauterine adhesions, and/or fallopian tube abnormalities can impact the structures of your reproductive system making it more difficult to achieve a healthy pregnancy. These fertility issues can be preexisting or develop after a previous pregnancy.
• Male Factor Infertility: Time isn’t something that only affects a woman’s fertility. Sperm quality and quantity decrease in men as they age. A change in health or medication usage may also affect male infertility.
• Lifestyle Factors: Weight gain can affect both male and female infertility. Excessive weight gain can contribute to ovulatory dysfunction in women and a decrease in sperm production and increase in erectile dysfunction in men. Smoking also affects the fertility of both men and women.
• And More: Secondary infertility can be caused by any of the factors above, a combination of them, or unexplained. Just like primary infertility, secondary infertility can also be diagnosed with an unexplained factor. Basically what this means is that the doctor can’t really pinpoint the cause. How often does this occur? About 20% of all cases are identified as unexplained infertility.
As you can see, time plays a huge factor in infertility, so it is important to be proactive about seeking medical treatment from a fertility specialist. A general rule of thumb is if a woman is 35 or under and has been trying to conceive for one year without a successful pregnancy or over 35 and trying to conceive for six months it is time to seek advice from a reproductive endocrinologist.
Why Can't I Conceive This Time Around?
This is the biggest question in the minds of those experience secondary infertility. Secondary infertility may strike when...
• You're older: if you had your first child at 35, and you’re trying for a second at 38, your fertility has naturally declined significantly.
Age is a major cause of secondary infertility.
• You're with a new partner: it could be your new partner has an undiagnosed infertility problem. But it’s also possible the one with kids from a prior relationship has developed a fertility problem.
Either situation can occur.
• An underlying fertility problem has worsened: it’s possible you always had endometriosis, or you always had subclinical PCOS. Maybe your ovarian reserves were already on the downslide, but you had no idea.
Time has passed, and things have worsened. It happens.
• You have gained weight: You’ve gained weight: fertility is affected by weight. Being over or underweight can cause ovulation problems in women, and possible impact sperm health in men.
New parents often gain weight (partially from the pregnancy, partially from the stress and lack of sleep.) This may be enough to push you to the infertile side.
• You have a new health problem: perhaps you or your partner has developed diabetes. Maybe he's taking medication for high blood pressure. Or, perhaps you’re suffering from depression.
Any of these illnesses may impact your fertility or require medication that can impact your fertility.
• The last pregnancy or birth caused a fertility-related problem: pelvic infection or multiple D&C procedures may cause uterine adhesions or blocked fallopian tubes.
If you had a C-section, you may develop scar tissue, which can impact your fertility.
• There's no clear reason why this time is different: Many times, no one can tell you why your particular fertility issue didn’t stop you from conceiving last time.
There’s a lot about fertility that we don’t understand. No one has all the answers.
When Should You Seek Help?
If you are under than 35 years old, you should seek help if you don’t conceive after one year of trying.
If you are 35 years old or older, you should get help after six months. However, no matter how old you are if you experience two consecutive miscarriages, you should get help.
Please don’t put off getting help. Some causes of infertility worsen over time. Delaying help may reduce your odds of pregnancy success.
Emotional Aspects of Secondary Infertility
Many people struggle with the emotional aspects of secondary fertility. They feel as if they already have a baby (perhaps even a few) and should be happy with the family they have. Well, it is okay to still dream of having a larger family. Everyone has an idea of what his or her perfect family looks like. For some, those dreams may include siblings who play with each other in the backyard and support each other throughout their lives, while others may be content with having a single child. Each family is unique, as are their hopes and dreams.
Despite already having a child, secondary infertility can be just as painful as primary infertility. It is normal and justifiable to feel a sense of sadness, frustration, and yearning. You do not have to feel guilty for feeling sad.
Secondary Infertility Treatment Options
It is a common misconception that fertility treatment automatically means in vitro fertilization (IVF). The truth is that there are a variety of fertility treatments for primary and secondary infertility that range from infertility medications to intrauterine insemination (IUI or artificial insemination) and beyond. Learn more about fertility treatment options.
• Infertility Medications: Common oral medications include Clomiphene Citrate and Letrozole which are used to stimulate ovarian follicles to trigger the release of more eggs. Injectable medications such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are also commonly used to produce multiple eggs in a single reproductive cycle. Both are often used in conjunction with intrauterine insemination (IUI).
• Intrauterine Insemination (IUI): A semen sample from a partner or donor is concentrated and then placed directly in a woman’s uterine cavity during ovulation. This places sperm as close as possible to the fallopian tubes where fertilization occurs.
• In vitro fertilization (IVF): Eggs are combined with sperm outside of the body to create an embryo which is then implanted directly into the uterus.
We all like to feel like we have some control over our lives and our baby-making plans. Secondary infertility can be a big surprise in that way and can be difficult to cope with.
The beautiful thing is that today there are many ways to get what our heart wants. So hang in there, and know that you are not alone on your journey in wanting a second child.
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