Secondary Infertility Myths

Debunking the Myths, Misconceptions, and Misinformation About Secondary Infertility:

1. If you’ve been pregnant before, you’ll be able to get pregnant again- don’t worry! Past performance is not a guarantee of future performance. At least one factor has definitely changed since your last pregnancy- your age! Other factors may have changed as well- in you, your partner, or both of you. Some factors you may be aware of, others that you may not.

2. If you haven’t gotten pregnant in a year of "trying" and you’ve already had a child, you have secondary infertility. Yes and no. You may have secondary infertility if this is the case, but you also may have had bad timing. Discuss this situation with your physician and try one of the techniques to identify your most fertile days.

3. If you are over 35, you automatically need an infertility work-up right away. Fertility does decrease over time, but if you and your partner are healthy, don’t have any of the risks, and if you are still having regular periods, you don’t need an infertility evaluation just because you are 35. Discuss any concerns you have with your gynecologist at a preconception visit.

4. Everyone else seems to get pregnant at the drop of a hat. More than six million women of childbearing age in the United States are experiencing infertility right now and many of them have secondary infertility. It’s not something that couples generally talk about, however. Support groups such as RESOLVE or on-line communities focused on infertility can help you feel less isolated and may offer useful information sources for you.

5. Infertility is a women’s problem. This is untrue. It surprises most people to learn that infertility is an equally a female and male problem- and often a combined problem. It is essential that both the man and the woman be evaluated during a thorough infertility evaluation.

6. It’s all stress! Infertility is a disease or condition of the reproductive system. While relaxation techniques may help you and your partner with your overall quality of life, the stress you feel is often the result of infertility, not the cause of it.

7. If you adopt a baby you’ll get pregnant. While there are many anecdotes of this happening, there is no data to support it. For many couples with secondary infertility-as well as for their children–adoption is a terrific option. Many couples with secondary infertility have chosen other options, however, such as exploring medical treatments and interventions (from artificial insemination to in vitro fertilization or surrogacy) or electing not to have other children.

8. Maybe you two are doing something wrong! Infertility is a medical condition, not a sexual disorder, although certainly sexual disorders can contribute to infertility. In many cases, the issue is one of timing, not technique.

9. Viagra can help women with infertility conceive. While this is an area that is currently being researched and has gotten some media attention, it’s an area that is still experimental. WOMEN: DO NOT SELF MEDICATE WITH VIAGRA IN ORDER TO ENHANCE YOUR FERTILITY! (Or for any other reason). And men should only use Viagra for its approved indication under the supervision of a prescribing physician.

What Is Secondary Infertility?

Secondary infertility is defined as the inability to conceive after one year of unprotected, "well-timed" intercourse for couples in which one or both partners have previously conceived a child. Having the label of "infertile" is often a traumatic one, whether or not a couple already has other living, healthy children.

It seems as though infertility has been steadily increasing over time, and it is: according to the National Center for Health Statistics, apr. 6.1 million women in the United States are now infertile, compared with 4.9 million in 1988. No statistics are available for the number of couples with secondary infertility, however. The most common reason for either form of infertility is the trend for women to delay childbearing. The ability to become pregnant peaks in a woman’s mid-twenties and decreases steadily as she ages. By age 35, this becomes a fertility factor; by age 40, 7 out of 10 married women who wanted to conceive were infertile. In addition, the incidence of miscarriages increases with increasing age, especially over age 35.

The fear of infertility has led many couples entering the infertility evaluation process sooner than clinically necessary, before confirming that they are having intercourse at the optimal time of the woman’s cycle. While I do recommend that all women consult their physicians for a preconception visit prior to pregnancy, this does not mean that women need to start taking fertility drugs a month or two after going off birth control pills just because they want to accelerate their pregnancy! We recommend folic acid and prenatal vitamins for all women trying to conceive; f ertility drugs, however, are not prenatal vitamins!

What causes secondary infertility?

The causes of secondary infertility include any change in fertility status in either partner; a change in partner; or sometimes, simply aging.One out of four couples with infertility have more than one contributing factor. In approximately 2 out of 5 couples with infertility, the male partner is either the sole cause or a contributing cause of infertility; in another 2 out of 5 infertile couples, the female partner is either the sole cause or a contributing cause of infertility. In the other 20%, the cause of infertility is unknown. This means that in many couples with infertility, both partners have contributing factors.

In a woman, any factor that affects her ability to ovulate, conceive, or carry a pregnancy to term may cause or exacerbate secondary infertility. Tubal blockage and/or peritoneal (intraabdominal) factors account for approximately a third of all infertility problems. Irregular or abnormal ovulation (release of eggs from the ovaries) accounts for approximately one out of four female infertility factors; this increases with aging as well as with certain medical problems. Endometriosis is found in about a third of infertile women who have laparoscopy (an operation which uses a thin scope inserted near the belly-button to look inside the abdominal and pelvic areas) as part of their infertility evaluation. Endometriosis is a disease in which uterine tissue is found outside of the uterus; on the ovaries, fallopian tube, and often on the bladder and bowel. It can occur in menstruating women of all ages, including teens, but is most common in women in their 30’s. While the connection between endometriosis and infertility is not clearly understood, early detection may result in successful control and preservation of fertility.

Many patients with specific medical diagnoses will need medical intervention in order to conceive.

Other possibilities that may cause secondary infertility in women:

# Your Age: Fertility decreases with age. If you had your first child at 20 and are now trying to get pregnant again at 35, your risk of infertility went from 4.5% to 32%, an increase of 8-fold just from aging 15 years.

# Your Weight: Excessively high or low, body fat can affect ovulation and fertility

# Your Diet: Starvation diets, binging and purging, and even yo-yo dieting affect ovulation. If you have difficulty eating regularly or normally, you should consult a dietician, a nutritionist, or a psychologist to get your diet under control.

# General Health: Numerous chronic diseases, such as diabetes, lupus, arthritis, hypertension, or asthma can affect fertility, as can the medications used to treat them.

# Your Cervix: Cervical treatments for abnormal pap smears such as cryosurgery or cone biopsy

# Your Hormones: Hormonal imbalances may cause menstrual irregularties, especially if associated with periods exceeding six days, cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles; heavy periods; heavy cramping; excessive hair or acne on face, chest, abdomen or back. One extreme hormonal problem that may cause secondary infertility is Premature Ovarian Failure (POF) or premature menopause, which is menopause for any reason under age 40. For women in their 40’s, menopause itself may become a factor; the average age of menopause is 51, but it can start much earlier. Polycystic Ovary Syndrome (PCOS), hypothyroidism, or elevated prolactin levels (often from benign pituitary tumors) are other relatively common hormonal causes of secondary infertility.

# Surgeries: Complications of a D & C (dilation and curetage) after an abortion or a miscarriage can cause secondary infertility. Complications of other abdominal or pelvic surgeries (or the problems which necessitated those surgeries) may cause scarring which can block your fallopian tubes and prevent pregnancy.

# Your Uterus: Uterine fibroid growth may obstruct a pregnancy and cause a miscarriage.

# IUD use can increase the risk of STD’s in women; this could be a fertility factor.

# Douching or using certain genital lubricants may also impair fertility.
Other possibilities that may cause secondary infertility in men or women:

# Sexually Transmitted Diseases (STDs): Twelve million cases of newly diagnosed STDs occur in the USA annually Some STDs can be asymptomatic, such as chlamydia, one of the most likely culprits in infectious infertility. They can cause pelvic inflammatory disease (PID) in women and epididymitis in men. Complications are more common in women, including subsequent scarring, miscarriage, adhesions, blocked tubes, and tubal pregnancy. All of these factors can contribute to infertility. Sometimes infertility can lead to a diagnosis of an STD that was previously undiagnosed, even one as serious as HIV/AIDS.

# Environmental Factors: Factors such as cigarette smoking, excessive alcohol consumption, drug abuse (including marijuana), or exposure to other environmental hazards from pesticides or xrays may contribute to secondary infertility in men and women.

# Frequency of Intercourse: Having intercourse once during your fertile period-or missing your fertile period altogether-can decrease your chances of conceiving. Unless you are using a technique to identify your most fertile days, to optimize fertility, you should have intercourse every other day starting a few days before ovulation.

# Stress: This can affect ovulation. . .as well as a couple’s relationship. Especially after having one child, a couple’s stress burden increases enormously. Factor in the additional pressures (internal and external) of "trying" to become pregnant, and this can become a fertility factor in itself.
Other Causes of Secondary Infertility in Men:

# Environmental factors: In addition to the above, this includes and wearing tight undergarments and excessive genital heat exposure (e.g. in steam rooms, or hot baths).

# Complications of Surgery (or the conditions that necessitated it): Hernia repair, testicular torsion, varicocele repair, etc. can all increase the risk of secondary infertility.

# Infections: Infections of the testicles, prostate, or reproductive tract such as prostatitis, urethritis, etc. from any cause. A now rare cause of infertility is mumps, thanks to the vaccine.

# Testicular Cancer: Testicular cancer or its treatment may cause infertility.

# Medications: Many medications from chemotherapy to cholesterol lowering agents may decrease your fertility.

# Masturbation Habits: Most doctors recommend having intercourse every other day to maximize sperm counts, but the purpose is defeated if the male partner is masturbating on the "off" days!
What Is Secondary Infertility?
(continued)

Dr. Donnica’s Top Tips for Enhancing Fertility:

In addition to trying these various methods, additional factors to increase fertility center around being in good health. In general, anything that increases the health of either partner may increase the likelihood of pregnancy. Specific recommendations include:

1. Try one or more of the methods to identify your most fertile days and have intercourse at that time.

2. Consult your physician for a preconception visit and specific advice. Address any concerns you have.

3. Practice stress management. As easy as it sounds, the process of making a baby can be frustrating and stressful for many couples, especially those who have been trying for some time. While stress itself does not cause infertility, the process of "trying" to become pregnant can be stressful, especially on your relationship. Various sources recommend massage, yoga, exercise, and others.

4. If you or your partner smoke, stop. Women smokers are more than 3 times as likely as non-smokers to take more than a year to get pregnant.

5. Women trying to conceive should not drink alcohol; men should limit alcohol to less than 2 drinks per day.

6. Women trying to conceive a child should take folic acid, 400 mg per day, to prevent certain birth defects.

7. Women trying to conceive should be sure that they are getting an adequate calcium intake.

8. Women trying to conceive should limit their caffeine intake: drinking even one cup of regular coffee per day can decrease your chance of conceiving by up to 50%.

9. Men trying to father a child should wear loose fitting undergarments and avoid extremely hot temperatures, especially soaking in hot tubs (for women this is generally OK until second trimester of pregnancy).

10. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.

11. Normalize your weight and practice a moderate exercise routine.

12. Have realistic expectations: all good things are worth waiting for! But don’t wait too long. If you and your partner are both healthy and under 35, yet haven’t been able to conceive after 12 months of well-timed, unprotected intercourse, consult your gynecologist. If you or your partner have risk factors for infertility (see below), consult your gynecologist sooner rather than later.
Debunking the Myths, Misconceptions, and Misinformation About Secondary Infertility:

1. If you got pregnant before, you’ll be able to get pregnant again; don’t worry! Past performance is not a guarantee of future performance. At least one factor has definitely changed since your last pregnancy: your age! Other factors may have changed as well, in you, your partner or both. Some factors you may be aware of, others that you may not.

2. If you haven’t gotten pregnant in a year of "trying" and you’ve already had a child, you have secondary infertility. Yes and no. You may have secondary infertility if this is the case; you also may have had bad timing. Discuss this situation with your physician and try one of the techniques to identify your most fertile days.

3. If you are over 35, you automatically need an infertility work-up right away. Fertility does decrease over time, but if you and your partner are healthy, don’t have any of the risks below, and if you are still having regular periods, you don’t need an infertility evaluation just because you are 35. Discuss any concerns you have with your gynecologist at a preconception visit.

4. Everyone else seems to get pregnant at the drop of a hat. More than six million women of childbearing age in the United States are experiencing infertility right now; many of them have secondary infertility. It’s not something that couples generally talk about, however. Support groups such as RESOLVE or on-line communities focused on infertility can help you feel less isolated and may offer useful information sources for you.

5. Infertility is a women’s problem. This is untrue. It surprises most people to learn that infertility is a equally a female and male problem. . .and often a combined problem. It is essential that both the man and the woman be evaluated during a thorough infertility evaluation.

8. Maybe you two are doing something wrong! Infertility is a medical condition, not a sexual disorder. . .although certainly sexual disorders can contribute to infertility. However, in many cases, the issue is one of timing, not technique.

9. Viagra can help women with infertility conceive. While this is an area that is currently being researched and has gotten some media attention, it’s an area that is still experimental. WOMEN: DO NOT SELF MEDICATE WITH VIAGRA IN ORDER TO ENHANCE YOUR FERTILITY! (or for any other reason). And men should only use Viagra for its approved indication under the supervision of a prescribing physician.

Diagnosis:

How do you know if you have secondary infertility? If you think you do, see your physician sooner rather than later. Your chance of a successful pregnancy may be much more successful if begun early.
Take Dr. Donnica’s Decisionnaire ‚Ñ¢. Check off all the risk factors that apply to you and take this list with you when you consult your physician.

Dr. Donnica’s Decisionnaire‚Ñ¢

Check off all the risk factors that apply to you and take this list with you when you consult your physician.

# You have had a child, but you have been unable to conceive again despite unprotected, regular intercourse for a year after you were no longer nursing.

# You or your partner has had a sexually transmitted disease since having your previous child.

# You have irregular menstrual cycles with periods further apart than every 35 days.

# You have had two or more miscarriages.

# You have a systemic illness, such as diabetes or thyroid disease.

# You are taking certain chronic medications, such as ACE inhibitors to lower cholesterol, or medications to treat ovarian cysts or endometriosis.

# You are over 35 years old.

# You have had pelvic inflammatory disease.

# Your partner has had an inguinal hernia or a varicocele.

# You or your partner has had chemotherapy or radiation therapy.

# You have had any pelvic or abdominal surgeries.

# Your mother or your partner’s mother was given DES during her pregnancy.

# You have a history of very painful periods.

# A doctor once told you that you might have trouble getting pregnant.
Important Questions to Ask Your Physician if You Are Trying to Conceive:

1. Should I be taking any dietary supplements?

2. Should I also be tested for hypothyroidism?

3. Do I need my prolactin levels measured?

4. Are there any changes I should make in my current medications?

5. Do my partner and I need an infertility evaluation?

Can secondary infertility be prevented?

All of the strategies for enhancing your fertility can be useful in preventing secondary infertility-or reducing your chances of having it be a problem. For many couples, age is an important non-modifiable risk factor.

Behavioral choices are important factors: preventing sexually transmitted infections, maintaining general good health habits (don’t smoke, eat a healthy diet, exercise, control stress) are a good start. Most couples with secondary infertility-or concerns about it-should see their physician for a preconception visit to discuss their individual risks. Remember too, that secondary infertility means you already have a child: this can interfere with having intercourse at the optimal time of the month to conceive. And in this area more than most others, timing can mean everything.
Is secondary infertility treatable?

Most causes of secondary infertility are treatable in some way; this is no different than with primary infertility. This does not mean they will result in a happy, healthy baby, however. In most cases, the odds of improvement are greatly improved by consulting your physician sooner rather than later. Certain causes of secondary infertility are not treatable and result in sterility (e.g. premature menopause, certain infections).