Monday, April 23, 2012

Don't Ignore the Pain of Secondary Infertility

This week is National Infertility Awareness Week, a week dedicated to talking openly about infertility and the impact it has on millions of men and women worldwide. For my first post of the week I have decided to write about Secondary Infertility, a taxing emotional and physical reality for millions of couples.

Secondary Infertility is a tricky subject in the infertility community. There are so many women suffering from primary infertility, women who are doing all they can to have one child, pining for and lamenting about the desire to have a second child can seem greedy and unappreciative to some. I can remember seeing women with young children in my fertility specialist’s office. I remember thinking, “Seriously? I would just be happy with one baby. Is that too much to ask, just one baby? Please just give me a baby. I will never ask for anything else again.”

Fast forward the time it took me to finally conceive my daughter and give birth to her. When I took her from the hospital I was asking, “Please let me just get two hours of sleep in a row? I promise, I won’t ask for anything else again.”

Fast forward 6 more months after that and there I was “THAT” greedy patient in my fertility specialist's office with an infant (whom I was lucky enough to be able to leave with my husband during my doctor’s visits as not to antagonize other patients). That is right. I wanted another baby. I was pleading with the universe, “Please just let me have one more baby? My daughter needs a sibling. I don’t want her to be alone in the world.”

There is nothing like the pain of not being able to have a baby when that is all you want with all your heart. I know that pain all too well and carried the weight of it for many years before we had our daughter. Not being able to have another baby is also difficult for some of the same reasons, but also there is the pain of not being able to easily provide your child with a sibling, if that is what you have always wanted for your family.

I recently sat down again with Dr. Michael Blotner, Medical Director of Westchester Fertility, who covered the basics for me regarding Secondary Infertility.

What is Secondary Infertility?
The inability of a couple to conceive after having a child is termed secondary infertility. The time interval that this becomes as issue is dependent on the age of the woman. Just as in primary infertility, for a woman under this age of 35, the time interval is one year. If the woman is 35 years or older, the definition applies after 6 months, as time is of the essence!

What are the most common causes of secondary infertility?
Secondary infertility can arise from either the male or the female. Environmental toxins, as well as cigarette smoking, excessive alcohol intake, and certain medications can have a progressive negative impact on sperm quantity and quality. Physical conditions, such as chronic illness, or varicocele (a varicose vein in the scrotum) can similarly cause a progressive decline in the sperm over time, to the point that the male fertility potential is affected. In the female, the most common cause is a decline in egg quality and/or quantity. These phenomenon often occur simultaneously, and are a natural result of aging. Each woman has her own endowment of eggs at birth, and this is highly individual. Unfortunately, we are seeing several younger women with a decline in their egg reserve, based on hormonal and ultrasound evaluation. On a more positive note, if the problem is discovered early, and fertility treatment instituted, the chances of a successful pregnancy improves.

Physical factors can also include tubal damage from prior undiagnosed infection (which is often without symptoms) and endometriosis, a non-infectious inflammatory condition of the pelvis, both of which can progressively worsen over time. Uterine fibroids, while not directly impacting fertility, can affect the blood flow to the uterine lining, which may lead to early or late pregnancy loss.

What treatments are available to help couples with secondary infertility?
The most important step a couple can take is to seek the help of a reproductive endocrinologist. Of course, the treatment will depend on the factors involved in the couple’s infertility. Evaluation of the egg reserve, semen, and fallopian tubes are critical. If the woman is suspected to have tubal disease or endometriosis, a laparoscopy with CO2 laser may be indicated. For the more common sperm and egg factors, the simplest approach is to stimulate the ovaries to produce more than one egg per cycle and perform a well timed intrauterine insemination. This approach can affect a 40-50% pregnancy rate by the third treatment cycle. For more severely compromised sperm and egg issues, or if insemination fails, an in vitro fertilization may be required. IVF allows for direct fertilization of the eggs in the laboratory with the partners’ sperm, and development of embryos that can be transferred to the uterus. The pregnancy rate per transfer is approximately three times higher than intrauterine insemination, and the number of embryos transferred can be limited to avoid high order multiples.

Experiencing Secondary Fertility is painful, stressful and often shocking to some couples who never experienced any issues getting pregnant with their first child. If you are experiencing Secondary Fertility just know that you are not alone and that there are resources out there to help you through this journey.

For more information regarding infertility and National Infertility Awareness Week check out:

Michael Blotner, MD, is board certified in obstetrics and gynecology and reproductive endocrinology. For over 15 years, he has been helping patients in his care achieve their goal of having a child through state-of-the-art infertility treatment. Dr. Blotner has dedicated himself to providing personalized professional care in a relaxed environment.