Secondary Infertility

In the US, secondary infertility accounts for approximately 60% of the existing cases of infertility. While in 1995 the number of people suffering from secondary infertility was estimated at 1.8 million, the 2006 statistics claim that there are 3.3 million people suffering from secondary infertility. It is estimated that approximately 20% of women experience secondary infertility at some point in their lifetime.

What is secondary infertility?

While primary infertility means that a woman is unable to become pregnant at all, secondary infertility occurs in women who have already had a child but is unable to do so a second time. Frequent miscarriages also could be due to secondary infertility. Unfortunately couples suffering from secondary infertility do not get the much needed help and support from doctors, friends and family as they are not perceived as truly infertile since they already have had children.

Causes for secondary infertility

Age is one of the primary causes for secondary infertility. Statistics reveal that by the age of 45 only 6% of women with carefully timed, unprotected intercourse, can conceive each cycle. While fertility in women peaks from the mid-20s, it is markedly decreased by mid 30s and much lower by age 35. to 40. To quote from Dr.Stephen Corson, Director of Women's Institute for Fertility, Endocrinology and Menopause in Philadelphia, USA, there are two reasons for the rise of secondary infertility.

"People are waiting longer to have babies and more couples in their second marriage are trying to have children."

In fact 52% of men with secondary infertility were married before, according to a survey of 578 infertility patients conducted for the American Society for Reproductive Medicine.

About one third of infertility cases can be due to blockage of the fallopian tubes in women. These are ‘abdominal adhesions' that can interfere with conception. Such irregularities can be caused by ovulation, lack of ovulation or premature ovarian failure that can cause secondary infertility. Approximately 25% of infertility cases occur due to this reason. Other medical causes for secondary infertility are:

• Abnormal uterine/pelvic area
  
• Endometriosis (which accounts for an additional 30% of infertility causes).
  
• Hostile Cervical Mucus
  
• Medications/Contraceptives and infertility
  
• Polycystic Ovarian syndrome
  
• Premature Ovarian failure
  
• Uterine Fibroids
  
  

Secondary Infertility after miscarriage: This form of female factor infertility can be caused by hormonal, environmental, immunological and physiological problems. Some common causes of secondary infertility are:

• Body trauma
  
• Surgery
  
• Complications with the previous delivery
  
• Asherman's syndrome
  
• Factors such as a new partner, weight gain, aging and stress can also cause secondary infertility.
  
• In some women the gap between the first and the second proves to be too long and the ability to reproduce declines.
  

Diagnosis of secondary infertility

A complete history and physical examination of both partners is essential to determine the causes of secondary infertility. Tests include:

• Semen analysis to determine the volume and viscosity of semen and sperm count. motility and swimming speed and shape.
  
• Measuring basal body temperature
  
• Monitoring cervical mucus changes throughout the menstrual cycle to note the wet, stretchy and slippery mucus associated with the ovulatory phase.
  
• Postcoital testing to evaluate sperm cervical mucus interactions through analysis of cervical mucus (normally collected 2 to 8 hours after couple has had intercourse).
  
• Measurement of serum
  
• Biopsy of woman's endometrium
  
• Biopsy of the man's testicles (very rarely done)
  
• Measurement of Luteninizing hormone in urine
  
• Progestin challenge when the women has sporadic ovulation
  
• Serum hormone blood tests
  
• Hysterosalpingography which is an x ray procedure what is done with a contrast dye
  
• Laparoscopy procedure that helps direct visualization of the pelvic cavity.
  
• Pelvic examination of the woman to determine the presence of cysts if any.
  

Treatment for secondary infertility

Treatment depends upon the cause for secondary infertility. These include:

• Simple counseling
  
• Medicines in case of infections
  
• Medicines to promote ovulation
  
• In-vitro fertilization and other such highly sophisticated medical procedures.
  

Above all it is important for couples to recognize the emotional impact that infertility has on them. They should seek medical advice together from their health care provider. However, it is essential to understand that secondary infertility whether in male or female is not the same thing as sterility. Conception and successful pregnancy are possible in many cases.