Secondary Infertility (Part 1)

Kemi Ailoje

Most people will have the strong desire to conceive a child at some point during their lifetime and the society places a high premium on the size of the family be it nuclear or extended. The reason most couples go to seek medical assistance for conception may be because they want more babies or they are not able to have a live birth even though they often get pregnant.

World Health Organisation (WHO) 2017 has defined “Infertility as a disease of the reproductive organ characterised by the failure to achieve a clinical pregnancy after 12 months of regular, unprotected sexual intercourse.”

There are basically two types of infertility which are primary and secondary.

Primary infertility: Simply means a woman has never been able to bear a child, either because she can’t get pregnant or because she is not able to carry pregnancy to a live birth.

Secondary infertility: When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth, she would be classified as having secondary infertility

 

Emotional aspects of secondary infertility  

In a traditional family setting especially Africans, having an only child may be almost as stigmatising as not having any and the sex of the only child may even make matters worse e.g. having a boy as an only child may be more acceptable than having an only girl. For some couple it may just be those dreams which may include siblings who play with each other in backyard and support each other throughout their lives. Despite already having a child, secondary infertility can be just as stressful as primary infertility for some patients. It is normal and justifiable to feel a sense of sadness, frustration and yearning. You do not have to feel guilty for feeling sad. It is important to appreciate the fact that you are already a mother or can actually get pregnant. It isimportant to seek help as quickly as possible and not dwell in guilt.

Generally  rule of thumb is, if the woman is 35 years old or under and has been trying to conceive for one year without successful pregnancy or over 35 years old and trying to conceive for six months it is time to seek advice from a reproductive Endocrinologist/Fertility specialist.

 

Causes of Secondary Infertility

Why would a woman who has previous gotten pregnant and had a live birth suddenly not be able to conceive again? This can be so worrisome to couple. Below is a list of the possible causes of secondary infertility:

·      Advance Reproductive Age:  women are born with all the eggs (oocytes) they will ever have in their life time resting in their ovaries. As a woman ages they experience what is referred to as diminished ovarian reserve, which means that the egg quality and quantity of a woman decreases with time.  A year or two between children can greatly affect a woman’s fertility.

 

·      Complications of the reproductive system: pelvic  adhesion, endometriosis 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 offer previous pregnancy.

 

·      Male factor infertility: Time is not something that only that affect a woman fertility, sperm quality and quantity decreases in men also as they age. Change in health or medication usage may also affect male fertility.

 

 

·      Lifestyle:

Ø Weight gain affects both male and female infertility excessively.

Ø weight gain can contribute to ovulatory dysfunction in women .

Ø Can also contribute to decrease in erectile dysfunction in men.

Ø Smoking also affects the fertility of both men and women.

·      Others include:

Ø Impaired sperm production or sperm delivery in men.

Ø Fallopian tube damage

Ø Ovulation disorders e.g. polycystic ovarian disease/Syndrome

Ø Endometriosis

Ø Medical Conditions in both men and women

Ø Complications related to prior pregnancy or surgery.

Ø Risk factors changes for you or your partner such as age and use of certain medications.

 

 

Secondary infertility can be caused by any of the factors above, a combination of them or unexplained. Just like primary infertility, secondary in fertility can also be diagnosed, however the cause of infertility may sometimes remain unexplained. Basically what this means is that the doctor can’t really pinpoint the reason why you are not able to get pregnant again, this is seen in about 20 per cent of all cases.

Generally  rule of thumb is, if the woman is 35 years old or under and has been trying to conceive for one year without successful pregnancy or over 35 years old and trying to conceive for six months it is time to seek advice from a reproductive Endocrinologist/Fertility specialist.