When another baby fails to come

By Dr. Abayomi Ajayi 
Phone: 01-4667360, 07026277855 
Email: info@nordicalagos.org
~Punch Nigeria. SUNDAY, OCTOBER 14, 2018

 Dr. Abayomi Ajayi 

There is always a feeling of joy when years of struggle with pregnancy are followed by conception, pregnancy and birth of a baby with ease. A woman that has never conceived and has difficulty conceiving has primary infertility. However, there are several women that have trouble conceiving again after their first or subsequent pregnancy. This is known as secondary infertility. Many people think primary infertility is more common than secondary infertility.

Whether or not they are right is debatable. However, one thing that is certain is that primary and secondary infertility, though common, can be adequately diagnosed and treated.

Primary infertility is when a woman has never been pregnant and is having difficulty to conceive. Secondary infertility, on the other hand, is the inability of a woman that has had at least one pregnancy, but is unable to become pregnant or carry another baby to term after at least one year of trying. Both primary and secondary infertility share a number of similar causes.

Why am I unable to conceive this time round? This is one of the biggest questions in the minds of men and women that experience secondary infertility. People may wonder why these women are trying so hard and why they cannot just relax. This, again, is not easy to answer.

I have interacted with several women diagnosed with secondary infertility and one thing I can confirm is that secondary infertility is as big a problem as primary infertility. Secondary infertility can be unexpected and stressful as much as it can be confusing and shocking. It is logical to ask why a couple that had no trouble getting pregnant the first time is now struggling.

About one in 10 couples that already have a child experiences secondary infertility. Worse still, for one reason or the other, couples experiencing secondary infertility may be more likely to delay seeking help. They may also find that friends, family, and even doctors downplay their fertility struggles. But whether you're struggling for child number one, or number two, or a higher number, there is often anxiety and grief to confront at every point.



Every couple has an image of the kind of family they want and your first or second child may be asking for a sibling. And the medical causes of secondary infertility aren't any less difficult to treat and diagnose than primary infertility. If you are younger than 35 years and you are unable to get pregnant after a year of frequent, unprotected sex, you should seek help. Also, if you are 35 years old or older and you are unable to get pregnant after six months of frequent, unprotected sex, you should also seek help. This is the rule of thumb.

The best place to start the investigation is to consult a fertility specialist. This could require going to a fertility clinic. In fact, most clinics prefer that you have a referral from a primary gynaecologist or physician. You should go with your partner.

To prepare for your appointment, it would be useful to have certain detailed information. These include: the dates of your last six periods, even if you menstruate like clockwork. Get a list of all the medications you and your partner take on a regular basis, including certain antidepressants and even over-the-counter allergy treatments. Also note all (if any) infertility symptoms or risk factors you have. When you discuss your symptoms, make sure that you mention even the embarrassing ones as well, such as painful sex, unwanted hair growth or low libido. These can all be symptoms of a fertility problem. Include any symptoms your male partner may be experiencing as well.

Whether you are thinking of starting a family or adding to the one you have, it is necessary to get pregnant. Getting pregnant requires regular sex each month when the woman is most fertile. It also helps to have sex even when the woman is not ovulating. The most fertile days for a woman are from the day of her ovulation and two days after.

Every woman's ovulation period can be accurately calculated utilising ovulation predictor kits and charting the basal body temperature. Having sex throughout the month makes for healthier sperm and helps to increase the odds of getting pregnant as well, and having sex after ovulation may improve your chances of getting pregnant on the theory that semen may play a role in embryo development and implantation.

Irrespective of your age, if you experience two consecutive miscarriages, you should seek help. Some causes of infertility worsen over time. Delaying to get help may reduce your odds of pregnancy success. The fact that you got pregnant in the past doesn't guarantee you'll conceive again on your own. Having had children doesn't mean you can't experience infertility. Depending on the circumstances, a couple might need medical evaluation and specialist treatment at a fertility clinic.

Secondary infertility is caused by the same problems that lead to primary infertility. Factors that cannot be ruled out include challenges for the male and female partners such as age, weight and use of certain medications.

Primary among the causes of secondary infertility includes male infertility that may be due to low or absent sperm count, problems with sperm shape (also known as sperm morphology), or problems with sperm movement (also known as sperm motility). The possible causes include impaired sperm production in men and fallopian tube damage, ovulation disorders, endometriosis and uterine conditions in women. Complications related to prior pregnancy or surgery may also be the cause of secondary infertility.

About one-third of infertility cases are related to male infertility, another third are related to female infertility and another third are related to problems in both the man and woman or remain unexplained.

Age is a major cause of secondary infertility which may strike when a woman is older, had her first child at 35, and is trying for a second at 38; her fertility has naturally declined significantly. A woman's new partner could also have an undiagnosed fertility problem. But it's also possible for one with children from a prior relationship to have developed a fertility problem.

It could also be that an underlying fertility problem has worsened, for instance, endometriosis or Polycystic Ovary Syndrome (PCOS). Being overweight or underweight can cause ovulation problems in women, and possible impact sperm health in men.

Testing for secondary infertility is the same as testing for primary infertility. Both the man and woman need to be checked.

The need for treatment for secondary infertility is the same as for someone with primary infertility. In fact, in many instances, treatments for secondary infertility are the same as for primary infertility. Treatments may include using fertility drugs, having surgery and interventions, such as Intrauterine Insemination (IUI) and In vitro fertilisation (IVF).

One procedure that is of importance in diagnosis and treatment of primary and secondary infertility is Laparoscopy. It is a surgical procedure that involves making one, two, or three very small cuts in the abdomen, through which a laparoscope and specialised surgical instruments can be inserted. A laparoscope is a thin, fibre-optic tube, fitted with a light and camera.

Laparoscopy allows the physician to see the abdominal organs and sometimes make repairs, without making a larger incision that can require a longer recovery time and hospital stay. More about this procedure will be treated in details as a stand-alone topic in the near future.