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Dr. Rana

Infertility is often associated with emotional and physical stress including, anxiety, depression, weight gain or weight loss, and may lead to marital discord.  Secondary Infertility is no exception. This too can cause the same feelings and reactions.  Add to this an extra ‘level’ of emotion with another child in the picture, also being affected by Infertility.

Why Is This So Hard?

Couples who have had children in the past without medical treatment may feel even more frustrated than those who have been successful with the assistance of infertility management procedures (“It was easy the first time!”).  There are multiple causes that can lead to this inability to conceive the second time around.  While the patient is the same, the body is not.  By definition, in secondary infertility the woman’s body has not only aged (from the first pregnancy) but has also undergone pregnancy and delivery resulting in issues that may affect conception.  Some of these problems (endocrine disorders) may include changes in weight which may lead to a dysfunctional ovulation process including luteal phase defects.  Other issues may include pelvic endometriosis, both with and without ovarian involvement, post-partum infection leading to tubal disease/ tubal occlusion.  Many women develop uterine fibroids during their 30’s, which may interfere with embryo implantation, or cause miscarriages.  Similarly after Caesarean section, a patient may develop ovarian and tubal adhesions. Finally, even if a minimal amount of time has passed since the first pregnancy, the body, and specifically the egg quality and quantity may have been compromised (decreased ovarian reserve or premature ovarian failure).   For a couple looking to expand their family, these possibilities can be difficult to consider and manage emotionally.

Is the Second Time the Charm?

The good news is that couples facing secondary infertility are more successful in achieving a pregnancy than couples with primary infertility.
At Team RMI, our goal is to help an individual or a couple achieve a healthy pregnancy and child, whether it be their 1st, 2nd or 5th.  If the couple has already undergone fertility treatment, their previous diagnosis(es) may be of assistance in determining and successfully treating the issues at hand.

Nonetheless, it is crucial that, wherever our patient(s) are in the process, that we begin with an initial evaluation, or re-evaluation of the couple:

  1. Ovarian reserve assessment, usually done on days 2-3 of the menstrual cycle. The blood tests include  FSH, LH  Estradiol and AMH
  2. Hysterosalpingogram to evaluate the uterine cavity and the fallopian tubal patency
  3. In Polycystic Ovarian Disease, women may need endocrine system testing including thyroid function, Prolactin, glucose, insulin and Hb A1C, male hormones (testosterone and other androgens), especially with hirsutism.
  4. The male partner will require complete semen analysis based on Strict Criteria as a starting point. Further evaluation, may include hormonal testing or urological consultation, depending on the findings from the semen analysis.

Treatment options will depend on the reason(s) for the secondary infertility.  Treatment may consist of ‘simple’ ovarian stimulation with oral medicine such as clomid, and with or without insemination.  Patient evaluation may determine the need for more advanced treatment, such as surgical intervention for pelvic endometriosis, hydrosalpinx, uterine fibroids or intra uterine pathology (adhesions, endometrial polyps).

Invitro Fertilization (IVF), with or without ICSI, may be needed for overcoming issues that cannot be managed with the more basic infertility treatment already mentioned.  Preimplantation Genetic Diagnosis (PGD) through the Select Comprehensive Chromosome Screening (CCS) can also be used to select chromosomally normal embryos to transfer, thus increasing the odds for a healthy pregnancy and baby.

The Telltale Biological Clock

Women with secondary infertility may feel that they can wait to seek treatment.  However, in the world of Infertility, advancing age results in decreased ovarian reserve.  The passing of time may also mean that conditions, easily remedied in the first pregnancy, require additional time and treatment.

Secondary Infertility may or may not be completely different from the scenario experienced when trying to conceive for the first time.  One thing, however, remains the same…our collective commitment to providing patients with state-of-the-art services and care to best meet their individual needs.

Nasir Rana M.D., MPH, Medical Director – Reproductive Medicine Institute

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