If you are having trouble conceiving baby number two or three, you are not alone. Many women are shocked to find that they can’t get pregnant with a subsequent baby when they had no problem conceiving their first child.
Secondary infertility is defined as the inability to get pregnant following any prior pregnancy or the birth of one or more children. This condition is much more common than most people think. At Olive Fertility, 30 percent of the patients we see are experiencing secondary infertility and according to the Center for Disease Control, it affects approximately 12 percent of women trying to conceive a second child.
Along with the rollercoaster of trying to conceive, the social isolation can be particularly painful for women with secondary infertility. Couples or single parents shouldn’t give up hope. There are several different treatment options, and the good news is: if you’ve had one child, your chances of success with fertility treatments are higher than if you have never had a child.
When should you talk to a doctor?
The most important message is to get your fertility checked sooner rather than later, as age is the number one reason for fertility issues. Talk to a family doctor and get referral to a fertility specialist if:
• You have been trying for four to six months.
• You have a history of Polycystic Ovary Syndrome (PCOS), pelvic inflammatory disease, painful periods, miscarriage, endometriosis, ectopic pregnancy, difficult caesarian section and/or irregular cycles.
• Your partner has a low sperm count
Causes of secondary infertility
Many things can change after the first pregnancy, including the age of the parents, weight and even scarring that can be the result of an ectopic pregnancy, infection or a caesarian section.
Factors that can contribute to secondary infertility in women and men include:
• Advanced maternal age (age 35 and older)
• Impaired sperm production or low sperm count
• Damaged fallopian tubes
• Endometriosis
• Uterine conditions
• PCOS
• Weight gain in both men and women
• Lifestyle factors including smoking, marijuana use and heavy alcohol use
• Certain medications
Finally, secondary infertility—just like primary infertility—can be diagnosed as unexplained. As many as 50 percent of cases of secondary infertility are identified as unexplained.
Treatment options
The first step is to have a complete fertility workup to try and identify the underlying cause. Your fertility specialist will go over the results of your tests with you and discuss an appropriate treatment plan.
Treatments for secondary infertility are like those offered for primary infertility which include:
• Superovulation, where you take oral or injectable fertility medications, to stimulate your ovaries to produce multiple eggs increasing the chance of fertilization.
• Intrauterine insemination (IUI), during which sperm is placed inside the uterus to promote fertilization. IUI can increase the number of sperm that reach the fallopian tubes, which increases the likelihood of successful fertilization.
• In vitro fertilization (IVF), which involves combining egg and sperm outside the body and then transferring an embryo back into the uterus.
Advances in technology increase IVF success
The chances of having chromosomally abnormal eggs increases significantly in women over 35 and is one of primary reasons for IVF failure. But advances in Assisted Reproductive Technology are increasing the success rates of IVF.
A test called Preimplantation Genetic Testing for Aneuploid (PGT-A), allows us to screen the IVF embryos for chromosome imbalances and determine which ones are the most likely to result in a successful pregnancy.
Studies have shown that IVF with PGT-A can achieve:
• Implantation rates of 70 percent
• Miscarriage rates as low as 10 percent
• A low risk of chromosomal problems such as Down syndrome (diagnostic accuracy is about 98 percent)
In British Columbia, consultation with a fertility specialist and most fertility testing and surgery is fully covered by MSP with a referral from your family doctor or a doctor at a walk-in clinic. IVF funding may also be available depending on family income.
