It’s a common theme: you get engaged, and people ask when you’ll get married. You get married and conversation centres on when you’ll have a baby. You have your first child and the pressure builds to have another. But what if it doesn’t happen quite so easily the second time around? Secondary fertility is becoming increasingly common and can be devastating for the families experiencing this private anguish.
What is it?
Secondary infertility is commonly diagnosed when a couple have successfully fallen pregnant in the past, but have been unable to conceive again after approximately one year of trying. And it’s becoming increasingly more common. According to Dr Michael Flynn, a specialist in fertility management and pregnancy care, one of the primary reasons for secondary infertility is age.
“Couples are delaying the commencement of pregnancy further,” he says. “It’s not uncommon for couples to have their first baby at 35, and then be trying for their second child at 38 or 39.” But time is not on your side in the pregnancy game. “Women’s fertility rapidly declines from the age of 35,” says Dr Flynn. “And at 39 it declines even more drastically.”
After ruling out potential concerns such as past diagnoses of appendicitis, chlamydia, pelvic inflammatory disease or endometriosis which can all affect a woman’s fertility, Dr Flynn says age is overwhelmingly the cause of secondary infertility. And as none of us can stop the clock, this can be devastating news for a couple trying for their second or third child.
And while egg quality rapidly declines with age, other factors may also influence a woman’s ability to fall pregnant.
“Polyps and fibroids increase with age,” says Dr Flynn. “These can make it more difficult for an embryo to implant, so treatment may be required before conception.”
A new relationship, and therefore a new medical history can also influence a woman’s ability to conceive.
“Perhaps the couple has split, and the woman now has a new partner and is trying for another child,” says Dr Flynn. “The new partner’s sperm quality may not be as good, his health profile may be different – there are a number of factors that affect male fertility.”
But it seems some common concerns do not contribute to secondary infertility. Repeated miscarriages or difficulties with a previous birth do not seem linked to secondary infertility.
“However, recurrent miscarriages may indicate there is something else going on,” says Dr Flynn. “This would require further specific investigation.”
For some couples, it can be shocking to discover getting pregnant is not as easy the second time around.
“There are a number of people who were perhaps on the verge of having fertility problems with their first child. Perhaps the male’s sperm quality was not optimal then, or the female’s egg count was low, but they still managed to fall pregnant. There may have been underlying issues with the first conception that were not uncovered. Add a few years, which impacts fertility and ovarian reserve even further, and couples can experience difficulties conceiving.”
Dr Flynn suggests treatment options for secondary infertility can be purely a statistics game.
“At age 30, you can afford a moderate amount of time to try to conceive naturally,” he says, recommending couples try for around 12 months (assuming the woman has normal cycles and neither partner has underlying medical conditions).
“At age 39, the numbers are against you,” he says. “IVF is really the best option if you haven’t conceived after six months, as fertility rates significantly decline for women after age 39.”
Dr Flynn’s patients first complete a full medical history and testing to explore sperm quality, thyroid function and hormone levels.
“We check to see that ovulation is occurring, and check ovarian reserve through a blood test,” he says. For men, perhaps they are overdoing the gym or taking exercise supplements, which can affect fertility. “We know that antioxidants such as co-enzyme Q10 and minerals such as zinc can improve sperm quality, “ says Dr Flynn.
“Then we work with the couple and outline their options, based on a number of scenarios including their age and preferences.”
Do complementary therapies work? “Acupuncture around the time of implantation does seem to make a difference,” says Dr Flynn. “And Chinese medicine can help with ovulation.”
But ultimately, it all comes down to time.
“Patients should come to see me as a last resort,” says Dr Flynn. “And if time is on your side, you can afford to try alternatives to improve your chances of conception naturally.”
But he recommends couples be realistic and investigate fertility management options if the clock is ticking.
“The reality is the chances of conceiving again are better for the couples who seek help sooner rather than later.”