Hoping for a second child

Secondary infertility, or the difficulty in having a second child, is a surprising problem for many couples. It is actually a very common issue, affecting 1 out of every 7 couples. It even accounts for half the number of women seeking fertility treatment in their reproductive age.

Let Dr. Kelly Loi, Obstetrician and Gynaecologist at Mount Elizabeth Hospital, tell you more about secondary infertility.

What causes secondary infertility?
The causes of secondary infertility are mostly the same as those of primary infertility. Fertility problems may arise from female or male reproductive systems, or both.

Female infertility is usually caused by one of the three broad categories of causes: ovulation disorders (caused by polycystic ovaries), endometriosis, and tubal disease. In secondary infertility, it is possible that a woman had an underlying health condition which did not surface when she first conceived.

Of the three types, tubal disease is the most common factor, accounting for up to 40% of cases of secondary infertility.  That is more than double the frequency in primary infertility. Tubal disease can be caused by infections and prior surgeries, resulting in damage to the fallopian tubes.

In addition, treatments for cancer - such as chemotherapy and radiotherapy - may also damage fertility. To prolong fertility, it is possible to freeze the sperm and eggs before the treatment starts. This is known as fertility preservation.

Is age a factor in secondary infertility?
Very much so. Although the evidence is not as strong compared to studies done on women, menfolk are likely to become less fertile as they age. In men, quality of sperm may deteriorate over 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 diseases such as diabetes and raised blood pressure.

Assuming the couple has regular intercourse, the likelihood of conceiving falls from 20% a month for a woman in her late 20s down to 8% a month for a woman in her late 30s. The likelihood of conceiving in one year falls from 86% to 65% respectively. Even the success rate of artificial reproductive treatment is affected by age: pregnancy rates falls from 40% for women less than 35 years down to 10% for women over 40.

Women are born with a fixed number of eggs. As age increase, there is a drop in the number of functioning eggs left in the ovarian reserve. In cases of early menopause, eggs run out faster than usual. In addition, there is also a decline of quality and the risk of genetic abnormality is increased. In turn, miscarriages become more likely. Women under 35 have about 15% chance of miscarriage, while the percentage jumps to 20 to 35% for women between 35 and 45.

As we age, existing medical conditions may worsen, or new illnesses may develop, all of which impacts fertility.

When should one seek treatment for secondary infertility?Early diagnosis and treatment is important, especially for women who are over 35. Couples should make an appointment if they fail to conceive after six months of active attempts.

If a woman has a history of amenorrhoea (lack of periods), oligomenorrhoea (infrequent periods), pelvic inflammation disease or previous surgery, she should seek specialist advice sooner rather than later.

Are there unique psychological aspects about secondary infertility?
Although there are substantial amounts of medical literature on the psychological aspect of infertility, most of them are focused on primary infertility. The impact of secondary infertility is every bit as devastating, and sometimes even more so.

One unique aspect of secondary infertility would be how it affects the family, and the couple as parents. Children of parents who try 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, especially with the weight of the diagnosis and uncertainty over what and how to convey to the child.

What are some tips for couples who are actively trying to conceive?
In general, anything that increases the health of either partner may increase the likelihood of pregnancy.

• Couples should aim to get fit, normalise their weight, and practice a moderate exercise routine.
  
• They should eat plenty of fruits and vegetables so that their diet is full of antioxidants.
  
• Stop smoking. Women who smoke are 1.6 times likely to be infertile. Smoking can also impair sperm quality.
  
• Couples should limit their alcohol intake to less than 2 drinks per day.
  
• Women should lower their coffee intake to not more than one cup a day. High caffeine levels have been associated with decreased fertility and can increase the risk of miscarriage.
  
• Women should take folic acid to prevent certain birth defects.
  
• Men trying to father a child should wear loose fitting undergarments and avoid extremely hot temperatures, such as soaking in hot tubs.
  
• If lubricants are used for intercourse, use a formula which is suitable for conceiving.

Where can one get more help?
Seeking medical assistance for such a condition can be extremely stressful. It is difficult to admit to oneself and others that there is a problem, and help is needed. Stress affects the libido, and it becomes a downward spiral from there on. Fertility support groups and counselling will also help couples who are trying to overcome secondary infertility.

Publication of article by courtesy of Dr Kelly Loi, Obstetrician & Gynaecologist at Mount Elizabeth Hospital