By Marc Kalan, M.D.
“It was pretty easy to get pregnant with our first child, so we figured the next one should be easy too.”
Unfortunately, I hear this statement all too often. It usually comes from a nice couple in their late 30’s or early 40’s who adore their first child, and after a few years, are ready for a second. Sometimes, however, being ready for your second child is simply not enough.
Secondary infertility is the inability to conceive despite a prior successful pregnancy. This type of infertility occurs in 5 to 10% of reproductive aged couples and is about half as common as primary infertility (infertility in a couple that has never been pregnant). Like primary infertility, secondary infertility can have a significant emotional impact on a couple’s life. Feelings of frustration, sadness and even anger are quite common.
Additionally, secondary infertility is often associated with guilt. Women feel badly that they are not satisfied with what they already have, or they may feel that they “owe” a sibling to their existing child. These emotions, in addition to the everyday stresses of raising a child, can be overwhelming.
Fortunately, one of the best ways to alleviate these stresses is by seeing a doctor who can determine the cause of the infertility. These causes can be divided into 4 broad categories: female factors, male factors, egg factor and unexplained infertility.
Female factors refer to problems with the fallopian tubes, uterus or cervix. These issues tend to be less common in secondary infertility except for some specific circumstances. For example, if a patient required a D and C following delivery she could be at risk for scar formation within the uterus. Other risk factors include exposure to a sexually transmitted infection since the last delivery, abdominal surgeries or history of endometriosis.
Male factors include abnormalities of sperm count, shape or movement. These are also less common in secondary infertility unless there is a new male partner. Occasionally, a surgery on the groin or a major illness like cancer can negatively affect sperm.
In my practice, egg factor is the most common cause of secondary infertility. As a women ages, the chance that any one of her eggs will become a baby decreases. This decrease becomes clinically significant after age 34 and dramatic after age 39. With this in mind, it is easy to see how a woman who had her first child in her mid to late 30s could have a difficult time conceiving a second child in her late 30s to early 40s.
Lastly, unexplained infertility applies to about 20% of infertile couples. In this circumstance, all testing for male, female and egg factors is normal. On one hand, this is good news because everything seems to be in order. On the other hand, this diagnosis can be very frustrating because there is nothing to explain the situation.
Fortunately, effective treatments exist for each cause of secondary infertility. If you have been trying to become pregnant for 6 months, or if you have any of the above risk factors, it is a good idea to talk to your OB/GYN. Your physician may decide to start some testing in his/her office or refer you to a fertility specialist.
Ultimately, there are many tools your doctor may use to help you have a second or third or even fourth child. The most important things are not to wait too long and not let the stress overwhelm you. Secondary infertility can be a huge challenge, but with the right guidance and proper treatment, it is a challenge which can certainly be overcome.
Dr. Marc Kalan lives with his wife and children in the Los Angeles area. Dr. Kalan has a private practice in Tarzana where he specializes in fertility. He can be contacted by email at drkalan@center4fertility.com or at his website http://www.center4fertility.com