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Infertility can sometimes come as an unexpected problem for couples who managed to get pregnant easily the first time. This is called secondary infertility. About one in seven couples have problems conceiving second child. Secondary infertility is actually a fairly common problem which accounts for about half of the women of reproductive age seeking fertility treatment. Dr Kelly Loi, Obstetrician & Gynaecologist at Mount Elizabeth Hospital tells you why.
The causes of secondary infertility are similar to those of primary infertility. Fertility problems may arise due to problems in the female or male reproductive system, or both.
"Female infertility reasons can broadly be divided into ovulation disorders (that is caused by for example, polycystic ovaries), endometriosis, and tubal disease," says Dr Kelly Loi. In secondary infertility, it is possible that a woman had an underlying health problem when she conceived before, but was fortunately not affected then. However, tubal disease does seem to be a more frequent factor in secondary infertility, accounting for up to 40 percent of cases of secondary infertility. This is more than twice the frequency in primary infertility. Tubal disease can occur as a result of infections or previous surgery, resulting in adhesions and damage to the fallopian tubes. Treatments for cancer - such as chemotherapy and radiotherapy - may also damage fertility. In such cases, sperm and eggs can be frozen before treatment starts (known as "fertility preservation") in order to prolong fertility.
Age is another important contributing factor in secondary infertility. Although the evidence is less strong compared to women, Dr Loi says that men may also become less fertile as they get older. In men, quantity and quality of sperm may deteriorate with time, making it difficult for them to reach and fertilise an egg. This can occur as a result of poor diet or lifestyle habits as well as chronic illnesses such as diabetes and raised blood pressure. The likelihood of conceiving falls from 20 percent a month in a woman's late 20s to eight percent in the late 30s. The likelihood of conceiving in one year falls from 86 percent to 65 percent respectively. Even the success rate of artificial reproductive treatment is not spared and pregnancy rates fall with increasing age from over 40 percent in women less than 35 years to just 10 percent in women over 40 years.
Women are born with a fixed number of eggs. With increasing age, there is a fall in ovarian reserve - this is the number of functioning follicles or eggs left in the ovaries. In cases of early menopause, the eggs run out much sooner than usual. In addition, there is also a decline in quality of eggs with an increased risk of genetic abnormalities. This in turn results in an increased risk of miscarriage. Women under the age of 35 years have about a 15 percent chance of miscarriage while those 35 to 45 years old have a 20 to 35 percent chance of miscarriage.
"With increasing age, our general health also tends to decline. Existing conditions may worsen or new illnesses may develop, which can have an impact on fertility too," adds Dr Loi.
Early diagnosis and treatment of secondary infertility is especially important in older couple. This is particularly true in the case of women over the age of 35, who should make an appointment after six months of trying to get pregnant.
If she has a history of amenorrhoea (lack of menstrual periods), oligomenorrhoea (infrequent menstruation), pelvic inflammatory disease (PID), or previous surgery, she should also seek specialist advice sooner rather than later
There may also be unique psychological struggles that face those struggling with secondary infertility. Although there is a substantial body of literature pertaining to the psychosocial impact of infertility, it is largely focused on primary infertility. However the impact of secondary infertility can be every bit as devastating as primary infertility, and in some cases even more so.
One unique aspect of secondary infertility would be how it impacts on the family and the couple as parents. Children of parents trying to conceive through reproductive technology may be affected by some of the changes in their parents' emotional and physical state. Discussing the topic of infertility with a child can be a daunting task due to the pain the diagnosis has caused the parents and the uncertainty around what to convey to a child.
For couples who are actively trying to conceive, there are certain lifestyle, sexual and health tips that are easily observed. In general, anything that increases the health of either partner may increase the likelihood of pregnancy.
For more information or an appointment, please call our 24-Hour Helpline at 6735 5000.
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