Dr. Abayomi Ajayi
There are hundreds of thousands of couples who conceived
easily when they started a family, but find it more difficult when they want
number two kids. Such couples suffer from what’s called Secondary Infertility.
Admittedly, it is a condition that is hard to accept and
initially a lot of people ask “Why?” or “What have we done wrong?”
There are no straightforward answers, just numerous
possibilities, and in order to get a second pregnancy going, quite complex investigations
and treatment may be involved. Most people believe that once a woman has had
one child, she has proven herself to be fertile and therefore will have no
problems conceiving again in the future. Unfortunately, this is not always the
case. Secondary Infertility is a very common problem. In fact, it is
so common that it accounts for as much as 60% of infertility cases. Yet, there
are women who often fail to see this type of infertility as a major problem.
Though secondary infertility is usually defined as the inability to conceive
after one or more prior pregnancy(ies) irrespective of outcome, it commonly
affects women who have successfully and naturally conceived one or more
children. Millions of Nigerian couples are experiencing Secondary Infertility.
Unlike
those experiencing Primary Infertility (when a childless couple is unable to
conceive), couples that are affected by Secondary Infertility are much less
likely to get treatment for their infertility. This is usually due to the
misconception that “once you’re fertile, you’ll always be fertile”. While this
false belief is often perpetuated, it is not uncommon for a couple to be told
to just keep trying and that eventually it will happen.
While this may be true in some cases, in many others, advice
like this only adds to the frustration and heartache experienced by a couple
having fertility problems.
Reasons for Secondary Infertility tend to be the
same as reasons for Primary Infertility. For instance, if since a woman was last
pregnant, she or her partner has had an infection, gained some weight, or
started eating fewer healthy foods. These seemingly small variances in their
lives can have large repercussions on their reproductive health.
Additionally, if it has been a few years since they last had
a child, the woman’s egg quality may have begun decreasing or the man’s sperm
may not be what it once was. Abnormalities with sperm and ejaculation are
frequently cited as causes of Secondary Infertility.
Generally, factors, which cause Secondary Infertility, are
numerous. Age is primal. For women in their late 30s and early 40s, the chance
of conceiving is actually quite low.
As for Fallopian tube damage, complications during a
previous pregnancy or delivery, or a recent pelvic infection can harm or block
the fallopian tubes and reduce the chances of the eggs being fertilized. Polycystic
ovaries may also be a common condition affecting women who have put on a
significant amount of weight during their first pregnancy, increasing their
body mass index above the normal range. This can interfere with regular
ovulation, cause an imbalance of hormones and significantly reduce fertility.
Unless women diet back down to the weight they were when
they first conceived, they will not regain their previous fertility. Research shows that even a little weight loss
will help improve your chances of conceiving.
Sperm Count
Most healthy men retain their fertility well into middle
age. But any chronic illness (like diabetes or high blood pressure) can have a
detrimental effect not only on the sperm count but also on the motility and
structure of the sperm, both of which have a role to play in the fertility
process. But there are occasions when, despite all the tests and
investigations, no apparent cause can be found for Secondary Infertility. This
is frustrating and upsetting, so after a year of trying (sooner if you’re mid
to late 30s) you should consider active fertility treatment.
Ideally, it is always a good idea to seek out a fertility
expert if you have troubles conceiving. If you are under 35, have been a having
regular unprotected sex for a year and have not been able to conceive, make an
appointment with your doctor or a fertility specialist. If you are over 35, then
start investigating the issue after six months of regular unprotected sex.
However, there are times when you should make that
appointment with the specialist sooner. If you experience two or more
miscarriages, have irregular periods, have painful periods, an unusual increase
or a burning vaginal discharge, or if your partner experiencing a decrease in
his sex drive, painful ejaculations or impotence, then make an appointment
sooner. These are all indications of medical problems that need attention
before a successful conception can occur. But because Secondary Infertility is
often unrecognized as a problem, many couples find it hard to receive the
proper support from their family and friends. Some couples may even find that people
criticize them as seeming ungrateful for the child or children they already
have. You may find it necessary to sit down and discuss the issue with those
closest to you, so that they can understand why you need their support so much
right now. Treatment depends on diagnosis. If the woman has irregular
ovulation, ovulation can be induced with fertility tablets such as Chlomiphene
Citrate or injections with Gonadotrophins (fertility drugs) to
restore regular, predictable ovulation. For damage to the fallopian tubes,
surgery may be needed or In-Vitro Fertilization (IVF). The woman
is given hormones to stimulate the ovaries to produce a large number of
follicles. The follicles are emptied and the eggs collected with ultrasound
guidance. The eggs can then be fertilized with the partner’s sperm and the
resulting embryos are transferred into the uterus two to three days later,
where, with luck, they will implant. A maximum of two to three embryos are transferred
during a ‘fresh’ embryo transfer cycle, but any surplus embryos of good quality
may be frozen for a subsequent attempt.
For minor sperm problems, the procedure of Intra-uterine
Insemination (IUI) helps conception. A sperm sample is taken and
prepared so that good quality sperm are retrieved. The insemination is carried
out at the optimum time in the partner’s ovulation cycle. This treatment can be
made more effective by gently stimulating the ovaries with hormones to ensure
the woman releases two or three eggs with each ovulation. If he sperm count is
very low or if only a few eggs can be retrieved at IVF, then the technique of Intra
Cytoplasmic Sperm Injection (ICSI) can be used. With this treatment,
the woman will undergo a conventional IVF cycle, but once the eggs have been collected,
one sperm is injected directly into each egg to fertilize it. Even after a Vasectomy
or failed reversal, when a man will obviously not be able to ejaculate
sperm because the Vas Deferens has been blocked, it is still possible to
collect the sperm.
This can be done surgically, either by taking them from the
epididymis, or directly from the testes. The sperm can then be used with ICSI in
an IVF
cycle. Overall, the chances of conceiving for a couple with secondary
infertility are quite good. The key thing is to consider assisted conception
techniques sooner, rather than later. Don’t hang around hooping and waiting. While
fertility problems can always put a strain on a relationship, Secondary
Infertility can be especially stressful. The ways in which people deal
with the situation can vary.
Communication can break down when one partner does not want
to discuss the issue at all, causing the other to feel shut out. Whether or not
treatment for the infertility should be pursued, and how much to spend can become
other areas of contention for couples.
It may be beneficial to seek out therapy to help you and
your partner deal with the emotions that secondary infertility brings. Joining
a support group for people experiencing secondary infertility can help you realize
that you’re not the only ones going through this difficult time. Support groups
have been shown to be very effective in helping people cope during a difficult
time. In addition to dealing with your own problems of infertility and your
relationship, you will also need to address the issue with your child in an
age-appropriate manner. Children are very receptive to the world around them,
so it is unrealistic to think that your child will not notice the tense
atmosphere at home.
Talk about your feelings and encourage your child to express
herself on the issue. With proper support and guidance, you and your partner
will be able to make the right choices for your family.
City People
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