Many couples turn to their doctor feeling discouraged and confused about why they were able to become parents the first time, but can't seem to be able to do so the second time.
Secondary infertility, as it is called, is not uncommon. As many as 1.4 million couples suffer from it, and it can be just as heart-breaking as not being able to conceive the first time around.
The prognosis tends to be better for couples who have already had a child than for those who have not, although a number of factors come into play. An obstetrician-gynecologist who specializes in infertility and reproductive medicine can determine, through a fertility work up, why the couple is experiencing problems having a second child and can discuss infertility treatments.
Getting pregnant for the second time can become an all-consuming process, especially if the woman is older and feels the pressure of the biological clock ticking. Secondary infertility can cause a great deal of distress for both partners and it can affect jobs and marriages. Couples who decide to consult a fertility specialist might also want to consider seeking psychological counseling to help them through this stressful process.
Statistics show that 80 percent of women who try to get pregnant are able to conceive after at least a year. So, a year is generally considered a magical number in terms of infertility, though that doesn't mean that a couple shouldn't consider having an infertility work up done earlier. If a woman is 38 years old and it took her two years to get pregnant with her first child, then there is no reason to wait.
Nearly half of those couples who have trouble having a second child had trouble conceiving the first child. The causes of secondary infertility are basically the same as those for primary infertility. About 40 percent are attributed to women's reproductive problems, 40 percent to men's problems, 10 percent to combined factors and another 10 are unexplained.
A woman may have trouble conceiving because of problems ovulating, perhaps because of scarring on the fallopian tubes or ovaries or hormonal imbalances. Or the problem could be her partner's; he may be producing only a small number of sperm. The diagnostic testing for secondary infertility is similar to that done for primary infertility. It is not a cookbook situation; much depends on the history couples provide. Taking a gynecological history is a first step. If nothing signals a problem, then a typical work up would be done. In most cases, a cause of infertility can be identified.
The man may be the first to be checked, because a simple semen analysis can provide information about the number, movement and shape of the sperm. As men get older, their sperm count can drop. They may be exercising less, consuming more alcoholic beverages, sitting in a Jacuzzi at a local health club, or they may have more stress in their lives. All of those factors can effect a man's sperm count.
The treatment for male factor infertility depends on the severity of the problem, and whether it is caused by a structural condition or a hormonal deficiency. Treatments include fertility drug therapy, and technologies to assist reproduction, such as intrauterine insemination and in vitro fertilization.
For a woman, one of the first tests is to determine whether she is ovulating normally. A woman's age, of course, is a very strong fertility factor. Generally, once a woman 42 years of age, it becomes extremely difficult to conceive. However, that does not mean that it is impossible for a mom that age to have another child. It is not just the chronological age that matters; the ovarian age is important. Some 42-year-olds can be extremely fertile and some women in their early 30s can even be menopausal.
A woman can determine if she's ovulating normally by keeping a temperature chart or by using an ovulation kit that can be purchased over the counter. A woman's temperature depends, in part, on her progesterone level. At the beginning of her cycle, her progesterone level is normally low. Once she begins to ovulate, her progesterone level starts to rise. Temperature charting is often unreliable because various factors can affect a woman's temperature, such as stress, health and the time the temperature is taken.
Ovulation predictor kits, as they are called, aren't always reliable either because their effectiveness depends on whether a woman uses the test properly. The best time to get pregnant is before ovulation, not at the time of ovulation, because that is the time the cervical mucus is the best and sperm have a better chance of reaching the fallopian tubes. If a woman uses the ovulation predictor kit once ovulation occurs, it might be too late.
A blood test to determine a woman's baseline FSH (follicle stimulating hormone) level is the best predictor of whether she is fertile. FSH is what stimulates the production of an egg. The FSH test, which must be done on the second and third day of a woman's menstrual cycle, determines her estrogen and FSH levels. If the estrogen level is low and the FSH is high, then chances of pregnancy are slim.
After making sure a woman is ovulating, a woman may also undergo a hysterosalpingogram, which can tell if there is a problem with the uterine cavity or fallopian tubes. The hysterosalpingogram, which is an X-ray dye test, is a little uncomfortable and patients are usually given something for their discomfort. The test has to be done at the beginning of a woman's cycle, after finishing her menses, or period.
Another common part of any work up is a post-coital check. Couples are asked to have sexual relations the night before they see their physician. At the exam the following day, a woman is given a regular pelvic examination. The physician extracts cervical mucus with a syringe, examines it under a microscope, and looks to see if sperm is there and if it is alive. This test should be done just prior to ovulation.
If a woman has reproductive problems, it is important to try to treat the problem. If a woman's work up is normal, and it is still unclear why she cannot get pregnant, her doctor may do a laparoscopy (the examination of the abdominal cavity with a scope) to make sure she doesn't have endometriosis, which can cause infertility and cannot be determined by the other basic tests. Endometriosis is a condition where the endometrial tissue normally found inside the uterus is found outside the uterus.
Fertility drug therapy is often recommended for women who are ovulating and have normal cycles, with unexplained infertility. Gonadotropin therapy, which basically mimics the body's own natural hormones, is most commonly prescribed. Gonadotropins basically override a woman's own FSH level, stimulating the production of more eggs - more targets for sperm to hit. The drug is usually combined with intrauterine insemination. The sperm is separated from the semen, put in a sterile solution and injected directly into the uterus.
Another fertility drug, clomiphene citrate, is given primarily to patients who are not ovulating normally. Women who do not respond to this treatment usually proceed to gonadatropin therapy. Clomiphene citrate is not given to women who have normal cycles because it can actually make things worse. Clomiphene citrate is an anti-estrogen, and it can have several side effects, including drying up cervical mucus and affecting the lining of the uterus. However, it is a wonderful drug for women who have an ovulatory dysfunction.
One caution about fertility drugs: A woman who does not want to have more than one child at a time should never go on them. The odds of having twins, triplets or even more babies from taking fertility drugs range anywhere from 10 to 15 percent. Some women may be hyper-responsive to the drugs and at an even greater risk for multiple births. A woman's doctor can tell whether she is responding too well to the medications and may want to cancel a cycle, to start again with lower amounts of the fertility drug to make it safer for the patient.
The average time a woman is on fertility drugs is four cycles. If it doesn't work at that time, in vitro fertilization may be recommended, or the couple may want to consider other options, such as adoption.
A great deal of planning should be involved in trying to resolve secondary infertility problems. Infertility tests, fertility drugs, and in vitro fertilization can all be quite expensive. A couple should explore their insurance coverage before they embark upon this journey. They don't want to leap in and find out they have all these bills that are not covered.
Couples not only should plan for the cost, but mentally prepare themselves, too, for the medical work up and for the possibility that - despite the best that medicine can provide - it might not work. They need to ask themselves: What will we do if it doesn't work? How far do we want to go?
They may not have control over the infertility - but they can have control over what they are willing to do about it.
Dr. O'Shaughnessy is a infertility specialist on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton.
2006-07-19 07:08:51
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answer #1
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answered by Anonymous
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As we know, Dr's can be wrong ALOT! & they can be expensive to go see, so I suggest you go online & research your diagnosis, check websites that have chats about concieving problems to get advice from other woman, word of mouth can help you find out what to do. I know several people who were told they could NEVER concieve, & years later...oops, they did. so don't give up hope, but do your own research, & if you have the money, go to a fratility expert.Good luck!
2006-07-19 07:13:40
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answer #3
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answered by silverfox 1
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