What is secondary infertility?
Secondary infertility is the inability to conceive a child or carry a pregnancy to full term after previously giving birth. To classify as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization. Secondary infertility typically is diagnosed after trying unsuccessfully to conceive for six months to a year. A related condition is recurrent pregnancy loss where patients and couples are able to conceive but are unable to carry to term.
How common is secondary infertility?
Secondary infertility is just as common as primary infertility.
Symptoms and Causes
Are the causes of secondary infertility in the woman or the man?
Secondary infertility can be traced to either partner or both partners. About one-third of cases originate in women and about one-third originate in men. In the remaining one-third, the cause is due to a combination of factors or isn’t known. Increased age, complications from a prior pregnancy or surgery, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse, and smoking are all examples of secondary infertility in women and men.
What are the causes of secondary infertility in women?
Causes of secondary infertility in women include:
- Problems in the quantity or quality of eggs: Women are born with a limited supply of eggs and are unable to create new eggs after birth. As women approach their 40s and beyond, the numbers of eggs left in their ovaries decrease, and the remaining eggs have a higher chance of having chromosomal problems. For women where age isn’t a concern, there are other reasons that they might have a low number of good quality eggs, including autoimmune or genetic conditions and prior surgery or radiation.
- Problems with the fallopian tubes: The fallopian tubes, which carry eggs from the ovaries to the uterus, can become blocked due to pelvic infections such as chlamydia or gonorrhea.
- Problems with the uterus: There are many conditions related to the uterus that can cause secondary infertility. Scarring can occur during a dilation and curettage (D&C) or Cesarean delivery that can create adhesions inside the uterus that interfere with future pregnancies Fibroids or polyps are benign (non-cancer) growths inside the uterus that can impair pregnancy. A retained placenta can cause infection and uterine scarring.
- Endometriosis: Endometriosis is a condition where tissue that normally grows inside the uterus grows elsewhere in the body, such as on the ovaries or bowel surfaces. While endometriosis is common, not all endometriosis causes infertility.
- Polycystic ovary syndrome: This is a hormonal disorder characterized by longer-than-normal or infrequent menstrual periods. A woman with this condition has an excessive number of male hormones, and the ovaries fail to release eggs regularly.
- Breastfeeding: If a woman feeds her baby only by breastfeeding, her body stops ovulating or releasing eggs for potential fertilization.
- Weight gain or other lifestyle changes: Weight gain can lead to ovary dysfunction in some patients. Certain diets may effect fertility. Medications may also effect fertility.
What are the causes of secondary infertility in men?
Causes of secondary infertility in men include:
Reduced testosterone level.
Testosterone plays a key role in sperm production. Testosterone levels can decline due to aging, injury to urinary or genital organs, or certain medical conditions. These conditions include:
- Genital infections.
- Thyroid diseases.
- Blood diseases.
- Benign tumors.
- Emotional stress.
- Myocardial infarction.
- Respiratory failure.
- Congestive heart failure.
- Sepsis, which is a potentially life-threatening reaction to infection.
- Surgery in the genital tract.
- The presence of mycoplasma, which is a type of bacteria.
This is an enlargement of veins in the scrotum, or the sack of skin encasing the testicles. This condition is a common cause of low sperm production and infertility in men. About 30% of infertile men have testicular varicocele.
Semen is the fluid that carries sperm. After age 40, the quality of semen tends to decline.
This can lower sperm count and hinder a normal ejaculation (the discharge of semen from the body).
The prostate may be removed due to cancer or other conditions. Removal of the prostate can cause semen to flow backward.
Late onset hypogonadism.
This is a condition where there is a reduction of hormone secretion.
Certain drugs that affect sperm count and quality.
These drugs include some antibiotics and medication that treat high blood pressure. Sperm quality can also be affected by treatments for the following conditions:
- Prostate cancer.
- Enlarged prostate.
- Fungal infections.
- Stomach acid.
- Urinary tract infections.
- Ulcerative colitis.
Use of certain commercial sexual lubricants that are toxic to sperm.
Nontoxic, natural lubricants include peanut, safflower and vegetable oils; raw egg white; and petroleum jelly.
Exposure to certain chemicals.
Being exposed to pesticides, lead, industrial chemicals and excessive heat can all impact a man’s fertility.
Excessive weight gain.
This can decrease testosterone levels and increase estrogen levels.
What are possible signs of secondary infertility?
If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.
Diagnosis and Tests
What should a couple do if they suspect secondary infertility?
If you suspect secondary infertility, schedule an exam with a women’s health provider, reproductive endocrinologist or urologist. Don’t delay. Early evaluation is critical to ensure the widest variety of treatment options.
Your doctor will review your medical history to determine if anything has changed since your previous pregnancy. The doctor will ask if you’ve experienced irregular menstrual cycles and will want to find out if you’re ovulating and producing eggs normally. For men, a medical history will show if thyroid disease, cancer or age-related conditions might have affected sperm count or quality.
The doctor and couple will discuss possible tests. For example, an X-ray of the uterus (called a hysterosalpingogram, or HSG) would reveal scarring or abnormalities. The doctor might also order a semen analysis.
Management and Treatment
What are treatment options for secondary infertility?
Regardless of whether infertility is primary or secondary, treatments are similar and include:
- Medications, including clomiphene (Clomid®) and letrozole, to induce ovulation in women with an ovulatory disorder.
- Intrauterine insemination (IUI), which involves surgically placing sperm inside a woman’s uterus, to increase the chance of fertilization. Sperm donors can be used in IUI.
- In vitro fertilization (IVF), which involves daily injections to stimulate the ovaries, a surgical procedure to retrieve eggs, egg fertilization in a lab to make embryos, growth of embryos in the lab, and transfer of an embryo into the uterus. Egg or sperm donors can be used in IVF. While not legal in all states or countries, a gestational surrogate (a woman unrelated to the child) may be involved in IVF to carry the pregnancy to term. For women without a partner or who desire future fertility, egg freezing can be done before fertilization so that the eggs can be stored for future use.
- Surgery to repair uterine-related problems in women. Doctors can repair structural problems, such as removing scar tissue, poylps, and fibroids from the uterus. Surgery to repair testicular varicocele. This condition is the most surgically correctible cause of male infertility.
- Antioxidants and anti-aging supplements, which can increase fertility in men. Drug treatment can also improve semen quality.
What is the emotional impact of secondary infertility?
Infertility can be a devastating disease with a high emotional toll on individuals and couples. If treatments for secondary infertility fail, couples might suffer from a range of emotions, including anger, sadness, grief, guilt and loneliness. They might experience a lack of empathy from family members and friends, who may tell them they should be thankful to have one child. Unfortunately, even healthcare providers can lack sympathy, which adds to a feeling of isolation.
Couples and individuals with secondary infertility may need emotional support and may benefit from support groups or a mental health professional.
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