By Guest Blogger Erika B. Johnston-MacAnanny, MD, FACOG, Board-Certified Reproductive Endocrinologist, Center for Reproductive Medicine, Wake Forest Baptist Health

Many couples struggle to conceive from the get-go, but not you. You got pregnant naturally—perhaps even quickly. And now that you have a beautiful child, you would like to add another little one to the family. Except this time, things don’t seem to be going as smoothly. You’ve been trying for a while to get pregnant again, and it’s just not happening.

If this is the situation you’re facing, you probably have secondary infertility.You’re not alone; many women experience secondary infertility. In fact, around 20 to 30 percent of the patients I see in my practice come to me with this problem.

Secondary infertility is diagnosed when a woman who has conceived before is unable to conceive again after trying for a year (if she is under age 35) or six months (if she is age 35 or older). Fortunately, an understanding of the causes of secondary infertility can help us move forward with appropriate tests and treatments. Causes can include:

1. Ovulation issues. Being a mom (I have 2 kids myself) can be stressful. Stress, weight gain or weight loss can affect one’s menstrual cycle to the point where as woman who was previously ovulatory can have absence of ovulation. By taking a good gynecologic history and tracking cycles, I can typically tell if a woman is ovulating. Simple blood tests can also confirm this.

2. Low egg reserve. It may be that getting pregnant the first time was easier just because you were younger. To see if this is the issue you’re facing, I’ll check your egg reserve. This is done two ways: first with a blood draw that shows your anti-mullerian hormone level (a snapshot of your egg reserve) and then with a transvaginal ultrasound that lets me see your antral follicles and evaluate your egg pool.

3. Low sperm count. Don’t forget your husband’s part in all this! Sperm counts can change. I have a hard time convincing patients of this fact, but it’s true. I recommend a semen analysis from your husband so we can rule out or address his role in secondary fertility. It’s non-invasive, and if the levels are normal, it usually isn’t a test that needs to be repeated. Plus, results just take a day to be returned.

4. Possible tubal/uterine factor. Many of my patients experienced complicated first-time deliveries that required a C-section or created factors that put them at risk for pelvic scar tissue formation. Such damage can potentially affect the function of their fallopian tubes. A simple transvaginal ultrasound can evaluate the uterine cavity, and an X-ray dye study (hysterosalpingogram) of the tubes can show any blockages. This is done on an outpatient basis and takes about 15 minutes.

Regardless of the cause of your secondary infertility, there are numerous treatments available to increase your chances of getting pregnant again. And most treatment options don’t involve in vitro fertilization (IVF).

Ovulation problems and low egg reserve: While you can’t gain more eggs, there are strategies – like clomiphene citrate & letrozole tablets and follicle-stimulating hormone injections – for boosting the number of eggs you ovulate each cycle. You shouldn’t worry too much about multiple births with this method; only 5 to 8 percent of patients who undergo egg-boosting fertility treatments with tablets conceive twins. Triplets are very unlikely with careful monitoring.

Low sperm count: I will refer your husband to a urologist to help him determine the cause of his low sperm count, which can include varicocele, a dilated vein near the testicles. Ultimately, we can try intrauterine insemination (IUI) with your husband’s sperm, if necessary.

Tubal/uterine factor: If this is the source of your secondary infertility, treatment can be a bit more challenging. The damage may be difficult to repair, and IVF may be your only option.

The most important thing to take away from all this is to not delay evaluation. Most diagnostic procedures are covered by the majority of insurance companies, so see a board-certified fertility specialist as soon as possible.

Have you experienced secondary infertility or have you received fertility treatments for a second or third pregnancy? If so, feel free to share your experience with other moms in the comments section.

For more information or to make an appointment with the experts at Wake Forest Baptist Health, or call 336-716-WAKE.

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