You got married about four years ago and barely a month afterwards you were already pregnant with your first child. The child was not even quite a year old when you and your spouse decided you wanted another. At the time, it didn’t seem overconfident to think of this as a decision and not merely a hope. But here you are, almost six years later still waiting and hoping for the magic of conception to happen again.
You easily conceived and carried your first child only to face a shocking diagnosis: secondary infertility. For no particular reason or explanation, your dream of another pregnancy has remained a distant reality and you cannot understand why? You have done everything and consulted high and low. Yet no luck. Even before you were referred to the fertility specialist, you have been wondering what could be the problem. Doctor, we cannot get pregnant again! It is an all so common scenario when couples want to have another baby, but pregnancy is stubbornly elusive.
You have asked questions over and over, but no answers are satisfactory, even though you have a valid argument. If you were able to conceive without problem the first time around, why should it be so hard to get pregnant again? However, one of the lessons in human biology is that fertility is not always within your control.
Medically, secondary infertility occurs when after a previous successful pregnancy and birth, you are unable to conceive another child after 12 months of unprotected intercourse. An experience of recurrent miscarriage is part of the issue, but the result is the same. There is a blank space in a family where a child is longed for. It is a surprisingly common problem.
One of the best-kept secrets of the fertility industry is that nearly a quarter of couples seeking treatment are already parents. A rule of thumb is that in fertility, past success is no guarantee of future success. You may have had trouble conceiving the first time, so you already know what you’re up against when you try again. But many others are stunned to learn that they are infertile the 2nd or 3rd or 4th time around.
If you are suffering secondary infertility, you are only half as likely to seek treatment as those facing primary infertility. This reluctance stems from emotional denial. Previously fertile people tend to think if they do all the right things it will just happen naturally. Though such measures as lifestyle changes undoubtedly enhance general health, they won’t cure infertility.
To complicate matters, there may be assumptions that there’s no medical reason when a couple that has previously demonstrated fertility takes an unusually long time to conceive. Unfortunately, such a wait-and-see approach can allow an untreated problem to become an untreatable one.
The No.1 cause for the decline in fertility between a first and a hoped-for second pregnancy can often be attributed to age. A woman’s most fertile years are between ages 15 and 30, with a drop-off occurring at 30 and a quite precipitous plunge at 35. In fact, by 36, it is not unlikely that almost 25 per cent of women may already be infertile.
As a woman you may be unaware of this reality and delaying your first-time pregnancy until 30 or beyond is not advised at all because it means you would be even older when seeking a second. Your eggs are as old as you are and it is known fact that your eggs suffer chromosomal damage as they age; the older your eggs, the more damaged they are, and the less likely they are to become fertilised or become babies.
Passing time also means that other conditions, not specifically age-related, can develop where they didn’t previously exist. Hormonal shifts or other endocrine problems can crop up, altering your body’s delicate balance. Endometriosis is a big issue. It is an ailment in which the uterine lining attaches itself to other pelvic organs, worsens over time if left untreated, creating tubal blockages that prevent conception or cause ectopic pregnancies (when the fertilised egg implants itself somewhere other than the uterus).
Male-factor causes such as low sperm count or poor sperm motility are the culprit in about 40 per cent of infertility cases. Occasionally, the change in a man’s fertility can be traced to a chronic illness such as hypertension or diabetes. More often, though, the reason for the change simply can’t be pinpointed, making the diagnosis especially bewildering. Hidden scars are another possible cause. Untreated infections (after a D&C, or childbirth) can leave abnormal tissue in the uterus. These adhesions may prevent a fertilised egg from implanting properly or create scarring in the fallopian tubes, which keeps an egg from reaching the uterus.
Infection can develop without you realising it. Even if you have never had a baby before, you could be completely unaware of how much postpartum pain or bleeding is normal, and may have symptoms of infection you never report. This may diminish your fertility and it won’t be discovered until you try to conceive again.
But the most common diagnosis by far, in as many as 20 per cent of all cases, is simply unexplained infertility. There’s no diagnosis at all. It’s not clear whether some factor has been in existence all along and you were just lucky or whether the factor has become pronounced over time. Because it is so vague, the “no known cause” verdict can be particularly hard to accept, more so as you already have living proof of your fertility.
So how long should you wait? This is subjective because even at the peak of fertility, your chances of conceiving during any given cycle are about 25 per cent. If you are under 35, give it 12 months; if you are over 35, you should try for six months. If you’ve had no success after six to nine months of treatment, see a specialist.
As hard as it may be to believe, the emotional effects of secondary infertility are identical to those of primary infertility. Being treated for secondary infertility is just as depressing for women as it is for those who don’t have a biological child. Worse still, as a secondary-infertility patient, you are bound to cope with emotional issues not faced by childless patients.
You are in a kind of no-man’s land. On one hand, you are a parent, on the other, you are still aspiring. As a parent, you’re shunned by the infertility world because you already have a child. As an aspiring parent for another conception, you feel alienated from the fertile world because you cannot conceive again. Sometimes you feel guilty because you’re told that you should be grateful for the child you have. You are grateful, but that doesn’t take away the longing for another child. The desire is just as urgent, just as desperate and all-consuming as it was the first time around. The good news is that secondary infertility is more likely to be treatable than primary infertility. If you act promptly, consult with a specialist, and faithfully follow the prescribed treatment plan, you have every reason to feel confident that eventually, you’ll have another baby.
If you conceived through IVF the first time, you will likely need it again if you want another child –and the odds are better the second time around. If you had a successful live birth following IVF, you have up to 8o per cent chance of delivering a second baby following three cycles of IVF although this decreases with your age. Almost half of the couples who have previously had an IVF baby return to try again and those who need more than one cycle are more likely to return.
Dr. Ajay is MD of Nordica Fertility Centre
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