Secondary Infertility
Expert Advice in Getting Pregnant Again
Infertility is a concern for many couples as they think about starting a family, but once they conceive and have a successful pregnancy, worry over fertility issues is replaced by worry over raising a newborn. Yet, we have all heard stories about couples that have trouble getting pregnant for a second time. How can this be?
First, it's important to understand exactly what infertility is and isn't. Infertility is generally defined as the inability to conceive after one year of "trying," meaning having intercourse regularly with the goal of getting pregnant. Infertility affects about 10 percent of couples and can be caused by reproductive issues in both men and women. In men, low sperm count, abnormally-shaped sperm, and immobile or slow-moving sperm can be major factors. In women, known infertility problems usually involve ovulation abnormalities or blockages and scarring of the fallopian tubes. Much of the lay and medical literature indicates that up to 80 percent of infertile couples can be definitively placed in one of the above categories. However, in reality, many couples seem to have a combination of these factors causing their infertility. Additionally, many more couples than is indicated in the literature have unexplained infertility.
There are two kinds of infertility to distinguish between, which many people do not know about. Primary infertility means a woman has never been pregnant in the past, while secondary infertility means she has had a successful pregnancy but is now experiencing problems. Many think that almost all couples that seek care for infertility have never been able to get pregnant. In reality, between 30 and 40 percent of couples who seek infertility care have conceived in the past. Some have taken a long time to conceive their previous pregnancies, but many have conceived very quickly in the past.
Couples may experience difficulty getting pregnant for baby #2 for a number of reasons, but the two primary considerations are age and pre-existing conditions. It isn't uncommon to see women who had their first child in their early to mid-thirties and then cannot get pregnant in their late thirties, early forties. Additionally, age plays a factor in the success of all infertility treatments including In Vitro Fertilization (IVF). Also, fertility issues that may be relatively insignificant at a younger age can, when combined with the influence of older age, impair conception, thus making baby #2 a more challenging task as well. Similarly, conditions may have changed as a woman attempts to conceive a second child. For example, a woman may now have very irregular periods when in the past her periods were very regular.
On a more positive note, fertility changes much less over time in men, so age-related complications are less of a factor on the male side than on the female side.
The approach to diagnosing and treating secondary infertility is essentially the same as for primary infertility. Since the diagnosis of infertility is still very much a gray area in medicine, the most common approach for couples experiencing a problem is to do a rapid evaluation of the three factors that we know can cause infertility, and then direct our attention to treating the infertility. In contrast to the limited progress we have seen over the years in diagnosing infertility, treatment has improved immensely.
In vitro fertilization (IVF) is the best example of the increasing success of infertility treatment. When IVF was introduced in the United States in the early 1980's, the success rate for the best age group (women under 35) was at best 10 percent, and many embryos had to be put into the patient's uterus to achieve this low success rate. Because of the need to transfer many embryos to get any reasonable chance for pregnancy, it wasn't uncommon for patients who conceived with early IVF to have multiple births, resulting in premature babies with severe problems. Today, there are many IVF programs that have success rates of more than 50% for women under age 35. Furthermore, these success rates can be achieved with transferring only one or two embryos thus greatly improving the chance of having healthy babies, which is the goal of any infertility treatment.
As a comfort to couples experiencing fertility issues, infertility medicine has advanced at an amazing rate. For example, IVF has produced "spinoffs" that were not imagined 30 years ago when IVF was first developed in England, including:
- Oocyte donation - Women who are beyond the age of successful IVF or women who have premature menopause can obtain eggs from a younger woman, have the eggs fertilized in vitro by her husband's sperm, and then have the resulting embryos put in her uterus so she can carry the pregnancy and give birth to a child.
- Surrogate / IVF - Women who have no uterus or a uterus that cannot carry a baby can have her eggs fertilized by her husband's sperm and then have another woman carry the pregnancy. Thus, the couple can have a baby that is genetically their own.
- Pre-implantation genetic diagnosis (PGD) - Couples who are carriers of diseases such as cystic fibrosis and muscular dystrophy can go through IVF and have their embryos tested for these diseases before they are put into the woman's uterus, thus almost eliminating the possibility of having a child with the disease.
The advancements in infertility treatment that have occurred over the past 30 years show great promise for what the future will hold for this field, thus bringing even more hope and happiness to couples who long to have children but need the help of medicine to make their dreams come true.
