Trying for Another Baby
Posted 8/10/2017 by UHBlog
When couples achieve their first pregnancy easily, they may falsely believe they’re immune to infertility. But the truth is, 10 to 15 percent of all couples have difficulty conceiving – whether they’re trying to start a family or add a second or third child to their home.
“Secondary infertility means a woman has had a pregnancy in the past – whether it resulted in a birth or not – but, for whatever reason, can’t conceive again,” says reproductive endocrinologist Rachel Weinerman, MD. "Factors that cause infertility in the first place change over time, so a woman who was fertile in the past may have secondary infertility.”
Many factors may contribute to secondary infertility, and they aren’t all attributable to the woman.
According to Dr. Weinerman, difficulties may arise from:
- Aging eggs. A woman’s egg quality decreases as she gets older. Even if she had no issues getting pregnant in her late 20s, she may experience difficulties in her mid-30s.
- Tubal disease. This may be caused by infection or scar tissue from endometriosis or major abdominal surgery.
- Endometriosis. This occurs when tissue grows outside of the uterus instead of inside. Endometriosis worsens if left untreated.
- Fibroids. These tumors, which are usually noncancerous, sometimes develop in the lining of the uterus. They start off small but grow as a woman ages, potentially blocking efforts to conceive.
- Scarring in the uterus. “It can be from a previous delivery or another procedure to the uterus,” Dr. Weinerman says.
- Ovulatory disorders. These include irregular ovulation (irregular periods) or polycystic ovary syndrome (PCOS). PCOS is a condition causing hormonal imbalances that may lead to menstrual issues and infertility.
- Low sperm count. A man’s sperm count may decline as he ages or from exposure to radiation, chemotherapy or other chemicals. Smoking can also reduce sperm count.
- Changing partners. A woman who had no problem conceiving with one man may find it difficult to achieve pregnancy with another partner.
- Lifestyle factors. Fertility issues may arise if a woman experiences any of these changes since her last pregnancy:
- Drinking alcohol excessively
- Smoking cigarettes
- Taking new medications
- Having irregular periods
- Undergoing major surgery
- Suffering from a severe pelvic infection
- Cramping intensely, which could signal endometriosis
- Her partner adopts unhealthy habits or starts new medication
- Unexplained reasons. “In at least a third of cases, we don’t have a reason why the couple has difficulty conceiving,” Dr. Weinerman says.
If a woman is under age 35 and is unable to get pregnant after trying for one year or is age 35 or older and hasn’t conceived after six months, it’s time to see a doctor. The doctor will perform a physical exam and look at her medical history. In addition, the physician may order tests to evaluate the woman’s hormones and check her uterus and fallopian tubes. The man’s sperm may also be analyzed.
In most cases, help is available for secondary infertility. Dr. Weinerman says treatments include:
- Medication to treat hormonal imbalances
- Surgery to repair blocked fallopian tubes or issues with the uterus
- Medications to induce ovulation, such as Clomid or Femara
- Injectable hormones to induce multiple eggs to grow in a single cycle
- Intrauterine insemination, or injecting the man’s sperm into the woman’s uterus during ovulation
- In vitro fertilization, or fertilizing the sperm and egg outside the body (i.e., in a test tube) and injecting it into the woman’s uterus
“It’s important for couples to understand that fertility treatments are not always expensive,” Dr. Weinerman says. “Usually, the work-up is covered by insurance and we have a whole range of treatments that are not that invasive and are more affordable.”
Rachel Weinerman, MD, is a reproductive endocrinologist and infertility specialist in the University Hospitals Fertility Center at University Hospitals Ahuja Medical Center. You can request an appointment with Dr. Weinerman or any other doctor online.