Secondary Infertility: What It Is and Its Causes

When you have been pregnant or given start earlier than, you may assume your expertise attempting to conceive a subsequent time will likely be much like the primary. For some girls, that is the case. Nevertheless, many {couples} expertise problem turning into pregnant when they’re able to attempt once more. That is known as secondary infertility.

Secondary infertility could be a complicated and irritating expertise, particularly in case you anticipate being pregnant to occur naturally or simply. You could have envisioned a selected age hole between your final child and your future child. Or maybe you deliberate a hopeful being pregnant round sure life occasions which have now lengthy handed. Possibly you might be getting questions on rising your loved ones, including strain to an already tense state of affairs. Or maybe simply the alternative: you might be receiving a scarcity of empathy from household and pals telling you that it’s best to simply be glad about the kid or youngsters you have already got. Many don’t notice you could be glad about your youngsters and nonetheless have the eager for one other child.

Irrespective of the situation, there may be loads of emotion surrounding secondary infertility for these going by way of it. There may be additionally a lot to find out about secondary infertility: its definition, frequency, causes, and coverings. This data can provide the confidence to succeed in out to your physician about what you could be experiencing and search assist.

What’s secondary infertility?

Infertility refers back to the incapacity to conceive or carry a being pregnant to time period. Most suppliers diagnose infertility after one yr of unprotected, frequent, and random acts of intercourse.^{1, 3, 28} Nevertheless, some skilled reproductive organizations is not going to diagnose infertility till it has been two years of attempting.^{2, 28} Different suppliers might diagnose infertility after solely six months, particularly if the girl is over 35 years previous or she has a identified bodily complication or medical historical past.¹⁴

Secondary infertility is restricted to the shortcoming to conceive or carry a being pregnant to time period after already having given start no less than as soon as. This differs from major infertility as a result of these with major infertility have by no means been pregnant or carried a being pregnant to time period. The variety of youngsters a lady or couple already has is irrelevant to the analysis of secondary infertility.^{5, 28} For example, you possibly can even have three or extra youngsters and battle to conceive once more, which might be thought of secondary infertility.

How widespread is secondary infertility?

Roughly 8-12% of reproductive-aged {couples} worldwide expertise infertility, and secondary infertility is the most typical type of feminine infertility.³ Secondary infertility accounts for about half of all infertility circumstances, and it’s the most typical type of feminine infertility worldwide.³

Whereas it might really feel like your friends are coming out second, third, and extra infants left and proper, it will be important and reassuring to notice that you’re not alone. In spite of everything, one examine confirmed over 10% of ladies with one child have hassle getting pregnant once more⁶, and the CDC reviews that 11% of American {couples} who’ve already had no less than one little one go on to expertise secondary infertility.²⁶ The excellent news is that you probably have already had a toddler, you usually tend to have a profitable second being pregnant.⁹

Though a excessive price of infertility will not be the very best information for society, it does imply that loads of analysis is being achieved on the subject. Analysis has been capable of establish causes and create interventions that forestall and deal with infertility and secondary infertility.

Causes of Secondary Infertility

The causes of secondary infertility are sometimes the identical because the causes of major infertility. They will current even after the start of any little one. Secondary infertility may be attributable to the male companion, the feminine companion, or each.¹² Under are a few of the causes of female and male issue infertility.

Feminine Issue Infertility

One of many main causes of feminine infertility is a failure to ovulate (anovulation). This contributes to just about one-third of all infertility circumstances.¹² Signs of ovulatory dysfunction embrace amenorrhea (lack of a menstrual interval) or oligomenorrhea (fewer than six to eight menstrual durations in a yr).¹⁵ There are additionally bodily or anatomical causes of feminine infertility that may normally be identified and handled through imaging and generally surgical procedure.² A number of the particular feminine infertility causes are defined right here.

1. Hypothalamic Amenorrhea

Hypothalamic anovulation or amenorrhea may be attributable to restrictive diets, consuming issues, low physique weight, and intense and frequent train. When you burn extra energy than you eat day by day, amenorrhea can develop. Current weight reduction is usually seen in girls with hypothalamic amenorrhea. Usually, this situation may be reversed by rising calorie consumption and reducing the frequency and depth of train. Intense emotional stress also can trigger hypothalamic amenorrhea.¹⁵

2. Weight problems

Though the connection between weight problems and infertility continues to be being investigated, excessive physique mass index is related to menstrual dysfunction and anovulation. Weight reduction in obese and overweight girls attempting to conceive has demonstrated improved reproductive outcomes.¹⁶

3. Hypothyroidism

Low ranges of sure thyroid hormones can intervene along with your ovaries’ potential to launch an egg. Hypothyroidism also can trigger hyperprolactinemia, intercourse hormone imbalance, and luteal section defects. There are drugs that may usually simply deal with hypothyroidism.¹⁷

4. Hyperprolactinemia

Prolactin is a hormone launched from the pituitary gland that aids in breastfeeding. Throughout being pregnant, prolactin prepares the breasts for breastfeeding. After giving start, prolactin stimulates milk manufacturing. Prolactin ranges can stay elevated so long as a lady breastfeeds, generally over a yr or extra. One impact of prolactin is that it suppresses ovulation, which is why many ladies don’t get their durations whereas breastfeeding. That is known as “lactational amenorrhea” and is regular.¹³ Some individuals name prolactin “pure contraception.”¹¹ Prolactin’s suppression of ovulation can contribute to secondary infertility you probably have been attempting to conceive with no luck whereas nonetheless breastfeeding. This could normally be handled.¹³

In case you are not breastfeeding however have excessive prolactin, this will sign an issue equivalent to a pituitary tumor. You may be suspicious of this in case you are experiencing milk leakage out of your nipples while you’re not breastfeeding, low libido, and painful intercourse, along with infertility.¹³

5. Polycystic Ovary Syndrome (PCOS)

In PCOS, excessive ranges of circulating testosterone and estrogen can inhibit ovulation.¹⁰ In case you are not ovulating, there is not going to be an egg to fertilize. You might assume that as a result of you might have already had a toddler, you do not need PCOS. Nevertheless, PCOS may be identified at any age after puberty, together with after being pregnant. You may request a workup out of your supplier for PCOS in case you are experiencing signs equivalent to lengthy cycles, irregular or very mild durations, extreme physique hair, weight acquire, zits, or cysts in your ovaries. There are remedies out there for PCOS that may assist your physique ovulate and show you how to conceive.¹⁸

6. Age

A girl is born with all of the eggs she’s going to ever have, and egg quantity and high quality lower over time. Feminine fertility peaks between a lady’s late teenage years by way of her late twenties. By 30, a lady’s potential to get pregnant begins to say no. This decline accelerates round age 35.^7,8 Whereas you will have conceived earlier pregnancies simply, you had been youthful then. The pure decline in fertility could also be contributing to secondary infertility.

7. Luteal Part Defect

The luteal section refers back to the time period between ovulation and your subsequent interval and may final between 12 and 14 days. Throughout this time, the uterine lining is sustained by a hormone known as progesterone secreted by the corpus luteum within the ovaries after ovulation. If progesterone is inadequate, the endometrium can’t maintain itself or assist embryo implantation. Signs of luteal section defect embrace recognizing and a brief luteal section/early interval.¹⁹ Monitoring your cycle with pure household planning or fertility consciousness strategies can assist to establish whether or not your luteal section is of adequate size to maintain a being pregnant. Progesterone supplementation and different drugs can assist lengthen the luteal section for ladies attempting to conceive. Luteal section defect accounts for 3-4% of infertility circumstances.¹

8. Pelvic inflammatory illness (PID)

Pelvic inflammatory illness, which might end result from sexually transmitted infections like gonorrhea or chlamydia, may cause scarring to the feminine reproductive tract, stopping or blocking the egg from with the ability to be launched, fertilized, or carried to the uterus.²⁰

9. Scarring

Earlier stomach or pelvic surgical procedure may cause scarring within the uterine cavity or reproductive tract. Surgical procedures, together with cesarean part, dilation and curettage, and even appendectomy, may cause scarring and adhesions within the stomach and uterus. If the adhesions are intensive, they’ll trigger a skinny uterine lining that will not assist the implantation of an embryo.^{12, 21} These surgical procedures also can improve the chance of ectopic being pregnant.²¹ A symptom of this situation to look out for is diminished or absent menstrual blood circulation. Adhesions or fibroids also can bodily occlude the fallopian tubes or forestall implantation.¹⁵

10. Endometriosis

Endometriosis is a situation by which the liner of the uterus grows on the skin of the uterus or the floor of different stomach organs.¹² It will possibly trigger painful durations, painful intercourse, power ache, and infertility. Endometriosis also can trigger uterine scarring that contributes to infertility. It’s thought that endometriosis contributes to five% of infertility circumstances. It may be handled with surgical procedure, and many ladies who’ve endometriosis can get pregnant.¹

Male Issue Infertility

Male issue infertility accounts for about one-third of secondary infertility circumstances.¹² There’s a false impression that infertility is a girls’s problem, however male or mixed issue infertility is simply as probably. A number of the causes of male secondary infertility are described under.

1. Age

Girls aren’t the one ones whose fertility is impacted by age. Male companions also can see a decline in fertility with age, however this normally doesn’t occur till a person’s mid- to late-forties. Adjustments in a person’s sperm might trigger points with fertility and chromosomal situations. In case your companion is nearing this age, his sperm high quality could possibly be contributing to secondary infertility, even in case you didn’t have problem conceiving prior to now with the identical companion.⁸

2. Varicocele

A varicocele is a cluster of enlarged veins within the testes that adversely have an effect on sperm manufacturing. 15% of males have varicoceles, and they’re considered the most typical explanation for male infertility. About 35% of infertile males and almost 70% of males with secondary infertility had been discovered to have varicoceles.²² Varicocele prevalence will increase over time, which can clarify why extra males with secondary infertility have them—as a result of they’re older than they had been after they conceived their first infants.²³ There are a number of totally different strategies of surgical varicocele restore, and plenty of are profitable in restoring ample sperm high quality for fertility.²²

3. Elevated Scrotal Temperature

One concept on how varicocele impacts male fertility is {that a} varicocele raises scrotal temperature, making the testes too heat to provide sperm.²⁴ Exterior components also can have an effect on scrotal temperature, equivalent to carrying briefs as an alternative of boxers, utilizing a laptop computer in your lap, or sitting for lengthy durations, particularly in a automotive. Fortunately in case your male issue infertility is attributable to elevated scrotal temperature, there are simple fixes to decrease that temperature and make a distinction in semen high quality and amount inside just a few months.²⁵

4. Unexplained Infertility

Whereas one-third of secondary infertility is attributable to the male companion and one other third is attributable to the feminine companion, the remaining third is attributable to mixed or unknown causes. Secondary infertility may be identified as unexplained in about 20% of secondary infertility circumstances.⁵ Unexplained secondary infertility can convey with it its personal frustrations if you find yourself in search of solutions and a possible remedy or path ahead.

The excellent news is that because you had been capable of carry a primary being pregnant, your odds of conceiving one other little one are 1.8 instances better than a pair experiencing major infertility.²⁷ That is true even with out with the ability to establish the reason for your secondary infertility. Many {couples} experiencing secondary infertility are profitable in conceiving once more in the event that they hold attempting. In actual fact, 95% of {couples} efficiently conceive by the two-year mark of attempting.²⁷ Regardless of the time period “infertility,” this isn’t essentially a everlasting situation and doesn’t at all times imply that you’ll by no means get pregnant once more. Some medical literature refers to it as “secondary subfertility,” reflecting that though conception is taking longer than you want to, it’s definitely not unattainable.²⁷

Managing Your Feelings

Whatever the statistics and the hope that exists for {couples} experiencing secondary infertility, your feelings, fears, frustrations, and nervousness are legitimate—simply as legitimate as a pair with major infertility. These feelings may cause a pressure in your relationship and even trigger sexual difficulties. Some discover it embarrassing or tense to reveal this example, which prevents them from in search of medical or therapeutic assist.⁴ Nevertheless, there may be nothing to be ashamed of in case you are going through secondary infertility, and there are promising treatments to handle most of the underlying causes.

In case you are experiencing emotional misery associated to secondary infertility, there are alternatives to assist. You may attempt assist teams, particular person and group remedy, confiding in an in depth, trusted member of the family or pal, or having candid conversations along with your companion. There may be hope in diagnosing and resolving the causes of your secondary infertility, however it is very important deal with your self and your loved ones within the meantime. Give your self grace and empathy throughout this time. Secondary infertility is taken into account a medical illness that may be simply as distressing as a most cancers analysis. Don’t be afraid to hunt assist in case you really feel defeated or really feel that one thing is improper.

References

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