Secondary infertility is more common than you think, but there’s also plenty of help available, says Sarah Breen.
For many Irish couples, conceiving a baby doesn’t require much thought. For others, it involves careful planning, meticulous timing and sometimes even medical help.
While primary infertility is the subject of countless books, TV storylines (like Charlotte’s case in Sex and the City) and movie plots, secondary infertility, which occurs after a woman has successfully conceived once, rarely gets a look in. But the reality is that secondary infertility is on the rise. And it doesn’t take into consideration whether that first pregnancy actually ended with a baby. A miscarriage still counts as a pregnancy.
“About six out of every 10 couples we see are suffering from secondary infertility,” says Dr Ahmed Omar, Medical Director at Beacon CARE Fertility Clinic (www.beaconcarefertility.ie). “One of the main reasons why it’s on the increase is that women are trying for their first child a little bit later in their reproductive life. That makes it even more difficult to have a second child. Another factor is that couples are leaving longer gaps between children for reasons like schooling and careers.”
“When you have primary infertility, there’s a whole host of different potential reasons for it,” explains Dr John Kennedy, a consultant at Sims IVF (www.sims.ie). “If you’ve gotten pregnant before, we can rule out a lot of them. The most common thing that has changed since then is the passage of time. Maternal age is a huge factor.”
It’s no secret that a woman’s fertility peaks in her 20s and declines with age. From 31 it drops by about three per cent every year. After 35 that decline accelerates even faster. According to the CSO, in 2013 the average age of a first-time mum in Ireland was 32.
While the vast majority of women in their early 30s will have little trouble conceiving, the reality is that the older you are, the harder it can be. And a year or two later it can be harder still. Medically speaking, a pregnancy where the mother is 35 is known as geriatric. Slightly unbelievable in this day and age, but true nonetheless.
Other common causes of secondary infertility include an ovulation disorder, endometriosis, damage to the fallopian tubes and pelvic inflammatory disease as a result of contracting a sexually-transmitted infection.
“Pelvic inflammatory disease is largely asymptomatic,” says Dr Kennedy. “People don’t realise they have it. When I worked in a large maternity hospital, we screened a cross section of 20 to 35-year-old women who were attending the public gynaecology clinic for various different reasons. We found a rate of chlamydia of 25%. A lot of women who have chlamydia won’t have any problems getting pregnant, but it can block the tubes and cause infertility.”
The clock is ticking for men too
And although they have been known to father children well into their 70s – and beyond, men have ticking biological clocks too. The quality of their sperm starts to deteriorate as they get older and it can also be affected by changes in weight, which increases oestrogen.
“Sperm are very, very sensitive to change,” says Dr Kennedy. “And as we get older, we tend to gain weight. That’s not good for fertility.”
Help is out there
The good news about secondary infertility is if you’ve gotten pregnant once, there’s the assumption that you can do it again. Maintaining a healthy weight, eating a nutritious, balanced diet, controlling stress, not smoking and drinking conservatively can all help. However, some medical intervention may also be required to seal the deal.
“If you’re under 35, and you’ve been actively trying to get pregnant unsuccessfully for over a year, I would suggest going to see your GP or a fertility specialist,” advises Dr Omar. “If you’re 36 or older, you can reduce that time frame to six months.” For couples that are having difficulty conceiving the second time around, an investigation can shed some light on what might have changed.
“We would check the fallopian tubes, look at ovulation and do a semen analysis,” says Dr Omar. “Treatment would be based on the results of those tests. If the infertility is unexplained, maybe artificial insemination might be something to consider, or if there’s damage to the tubes or a problem with the sperm, IVF could be the way forward.”
Embarking on certain fertility treatments can be costly, however for many couples having another child is more than worth the expense and effort. And the good news is that techniques are evolving and improving all the time so, with a little help, the success rate for treating secondary infertility in many cases is excellent.
“The best indicator of future success is previous success,” says Dr Kennedy. “I’m always especially reassured to see people who have had children already, because I know they can do it. It’s just a question of getting them to do it again.”
It’s mentally draining
Dealing with secondary infertility can be very emotional, stressful and hard to accept for couples who feel their family is incomplete. After months of trying with no success, they’re exhausted and a bit shocked. As they watch their friends’ families grow, they can be confronted with regular reminders of their inability to conceive. If they already have a child, they can also feel guilty for not being able to provide a sibling.
Family members who jokingly tell them to hurry up and try for another certainly don’t help, nor do the people who say, “Just relax and it will happen when the time is right.” On the other hand, if they choose to reveal their struggle with infertility, there can be a perception that they should be satisfied just having one child. Couples feel that they’re not allowed to grieve the loss and it can be very painful to endure.
“The couples I meet often feel frustrated and irritated more than being upset or disappointed,” says Dr Kennedy. “Other people tend to demonstrate a lack of understanding, saying things like “oh, aren’t you happy with your lot?” and that’s a difficult thing to deal with.”
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