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Secondary Infertility

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Written in Partnership with HRC Fertility, January 7, 2016

If you have had children, with or without fertility treatment, and are having difficulty getting and/or staying pregnant again, you may have secondary infertility. It’s not uncommon. In fact, Dr. John Norian says that more than 50 percent of the patients he sees have secondary infertility.

Age is the primary issue related to difficulty conceiving, Norian says. “Even in women who have a child, ovarian aging occurs more rapidly after the age of 33. Then particularly around age 37, we see that the slope of lower pregnancy rates gets pretty steep.” In addition, as women get older fibroids become common, leading to more uterine factor infertility, he adds.

“In men who are older, the male hormonal function isn’t as robust,” Norian says. “Sperm counts, motility and morphology will each fall slightly as time goes on.” However, unlike women, males have germ cells in their gonads that are able to replenish their sperm cells even as they age.

A fertility doctor with HRC Fertility, Norian cites a number of additional causes for the growing trend of secondary infertility:

  • Anovulation
  • Delayed childbearing issues
  • Endometriosis
  • Environmental toxins
  • Obesity
  • Uterine fibroids
  • Tubal factors

Fertility Tests for Secondary Infertility
Women who have a history of difficulty conceiving, who have any of the above conditions and women who have been trying to conceive for 6 months to one year should see a fertility doctor for evaluation.

Norian recommends an ovarian reserve assessment at the onset. A simple vaginal ultrasound with an antral follicle count looks at a woman’s eggs supply. A blood test will check AMH (antimullerian hormone) levels, and a day 3 FSH (follicle stimulating hormone) test or E2 (estradiol) level can also provide a good indicator of ovarian reserve.

In addition to ovarian reserve testing the following can help determine or rule out other causes of secondary infertility:

  • Pelvic ultrasound. A basic pelvic ultrasound can identify the presence of fibroids.
  • Thyroid screening. Women with thyroid dysfunction are at risk for miscarriage.
  • Vitamin D screening. Vitamin D plays a role in steroid formation.
  • Hysterosalpingogram or other tubal assessment. These can determine if the tubes are open.

Treatment for Secondary Infertility
Treatment for secondary infertility will depend on the individual, Norian says. “Some women may just need a boost. Women who gain weight after delivery or have a hard time shedding their baby weight may become anovulatory. Treatment for that is always better nutrition, exercise and lifestyle modification.”

The second step, Norian says, particularly if a woman is young, hasn’t been trying long to conceive and has proven fertility may be ovulation induction: Clomid, Letrozole, intrauterine insemination (IUI) or IUI with injectable fertility drugs.

Important Points about Secondary Infertility
Norian offers the following tips for women with secondary infertility:

  • Make sure you’re taking prenatal vitamins. Prenatal vitamins are not only critical to your baby’s development, but folic acid, B vitamins and iron help with ovulation.
  • Breast feeding disrupts fertility. While a small percentage of women get pregnant when they’re breast feeding, it alters the hormonal milieu and you don’t get as good follicle formation and endometrial lining development.
  • The rate of twins naturally increases as women get older. As women get older their natural FSH levels start to increase, so instead of releasing one egg, like they do when they are younger, they may release two eggs naturally.
  • Better testing may help you carry a healthy pregnancy.

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