I Have 3 Children I Don t Think I Can Get Pregnant Again
What Causes Secondary Infertility?
When the first pregnancy arrives with little effort, struggling to conceive again can come as a shock.
This story was originally published on Sept. vi, 2019 in NYT Parenting.
The doc sketched a crude outline of my reproductive organs and nearby anatomy as she talked. The black lines on white paper seemed then thin, when in reality they represented our hopes for the hereafter. My husband and I had a salubrious, smart, sassy, thriving preschooler; but we wanted another child. And with the relative ease of our start pregnancy — iii months of trying followed by a clockwork twoscore weeks (and three days) of pregnancy — we assumed the 2nd would come up easily.
Instead, information technology took u.s.a. a little more than ii years to conceive. The process hit us like a daze moving ridge, draining our savings and deflating our dreams.
The doctors chosen it secondary infertility, a sometimes nebulous term that's frequently given to women (or couples) who take successfully given birth but are struggling to get or stay pregnant once more. Every bit with regular infertility, information technology's diagnosed in women who can't seem to conceive after trying for a yr or more (if they're nether 35); or for six months or more (if they're 35 or older).
For many women, a secondary infertility diagnosis can come as a stupor — if you've had a infant one time, why shouldn't you be able to have some other?
"I had heard that secondary infertility was possible, but I never idea it would happen to u.s.a.," said Shannon Stockton, a mom of two girls who are more than than eight years apart. "I had gotten significant and then easily the offset time."
Stockton, who works as an executive banana for a medical nonprofit, had her showtime daughter at 28, and hoped to accept a second child iv or 5 years afterward. She and her husband started trying once again when she was 33, but she didn't give birth until she was 37.
"Why couldn't we figure out the timing? Why wouldn't our bodies do what they were supposed to do?" they wondered. Their diagnosis: unexplained secondary infertility.
A tricky diagnosis
More than vi million women between 15 and 44 struggle to go or stay meaning — whether they've previously had kids or not — according to the United States Department of Health and Human Services. Of those, i-third are estimated to have secondary infertility.
Dr. Jacqueline Ho, M.D., a fertility specialist and assistant professor of obstetrics and gynecology at the University of Southern California'southward Keck School of Medicine, said that information technology can be challenging to give parents advice nigh secondary infertility, in part because it often isn't researched separately from full general infertility.
Dr. Richard V. Grazi, M.D., founder of Genesis Fertility and Reproductive Medicine in Brooklyn, said he ofttimes sees Catholic and Orthodox Jewish women — who already have had five or half-dozen children — coming to him because they desperately desire more.
"The frustrating thing to me that we see quite often is somebody who is on their second life event — they've had a kid, many years have passed, and either they've awakened to the fact that they desire to have some other child together or there'southward been a breakup and they desire to have a kid with some other partner," Dr. Grazi said.
What raises the risk?
The trouble with secondary infertility diagnoses is that their causes are hard to pin down. For some couples, such as those over twoscore, information technology might simply be run-of-the-mill infertility problems because of age. But for others, information technology could be tied to previous wellness weather or surgeries, such as scarring on the fallopian tubes or a previous cesarean.
Hither are some common take chances factors for secondary infertility.
Advanced age. While American women today are more than likely to have children than they were more a decade agone, according to the Pew Research Center, they're likewise waiting longer to accept them. That ways that women trying to conceive for the 2d, 3rd or fourth times are naturally older than commencement-time moms, and therefore more than probable to bump confronting age-related issues.
But we tin can't defy nature. Salubrious couples take almost a 25 pct chance of getting significant in whatever given cycle upwards until their early 30s, according to the American College of Obstetricians and Gynecologists. By 40, that chance dips to 10 pct for women, according to ACOG; while the American Society for Reproductive Medicine puts that likelihood even lower, at fewer than 5 per centum for women.
"We think that historic period 46 is the natural stop of a woman's reproductive life span," Dr. Ho said.
Weight gain. While no studies have been washed that directly link weight gain with secondary infertility, Dr. Ho and Dr. Grazi said, information technology stands to reason that women who have given birth might be at to the lowest degree a few pounds heavier than they were earlier they gave nascence. And prove suggests that having more body fat tin can increase the risk of secondary infertility.
Contempo studies have found, for instance, that women who are classified as overweight or obese tin experience hormonal shifts, which might disrupt their menstrual cycles and ovulation patterns and increase their risk for infertility.
Scarring, adhesions and blocked tubes. Scarring or adhesions in or on the reproductive organs can make getting pregnant challenging. If such adhesions or scarring block 1 or both fallopian tubes, for example — such as from complications of an ectopic pregnancy or a subsequent surgery — that blockage might prevent sperm from entering the tubes to fertilize an egg. In the uterus, adhesions or scarring can lead to bug with menstruation, such equally calorie-free or missed periods, or tin can forestall a fertilized egg from implanting and becoming a pregnancy.
For some women, surgery to clear the adhesions might be enough to help them get pregnant. Just according to Dr. Zev Rosenwaks, M.D., director and physician-in-principal of the Middle for Reproductive Medicine at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, most women who have such internal scarring or harm might be amend served going straight to in vitro fertilization, since that technique tin implant a fertilized egg directly into the uterus, bypassing the blocked tubes. This option, notwithstanding, may exist cost prohibitive for some.
Previous infections. Pelvic inflammatory disease, or P.I.D., an infection of a woman'due south reproductive organs, can also damage the fallopian tubes and uterus enough to cause infertility. The condition tin exist caused by previous sexually transmitted infections, such equally chlamydia or gonorrhea; as well as from infection from a by surgery, such as from a cesarean.
"Anytime the belly is open, including with a C-department, there is a potential for scar tissue formation," Dr. Grazi said. (This complication is rare, according to the experts I spoke with.)
Chronic endometritis is a condition where the lining of the uterus is chronically inflamed — typically from an infection — which tin make it hard for an embryo to implant in the uterus. This condition affects as many every bit 40 per centum of women with infertility, can be difficult to diagnose and may worsen with historic period.
Other health weather. While age, weight and scarring can account for many secondary infertility cases, other medical weather condition can play a role, too.
Endometriosis — which occurs when uterine lining cells grow outside the uterus — tin cause inflammation and scar tissue on the ovaries, fallopian tubes and other internal organs, and tin can lead to issues with egg quality or embryo implantation. All of this can make getting pregnant a claiming for some, Dr. Ho said.
Polycystic ovary syndrome, a common condition in which a hormonal imbalance causes irregular periods, weight gain, cysts on the ovaries and more than, can increase the risk of infertility.
Uterine fibroids, which are noncancerous growths on or in the uterus that tin can abound larger with age, tin likewise block fallopian tubes and oversupply the uterus, making formulation difficult for some. PCOS and fibroids can worsen with age, which may at least partially explain why an earlier pregnancy wasn't every bit difficult to reach.
[Read more than nigh uterine fibroids. ]
Thyroid conditions, such every bit hypothyroidism or Hashimoto's illness, can also shift hormone levels and interfere with the ovulation procedure.
Male person infertility. While information technology'due south often the female partner who is referred to a specialist and who makes the appointments, the reason for infertility may stalk from the male partner, said Dr. Jeanne O'Brien, K.D., a urologist who specializes in male infertility at the Academy of Rochester Medical Middle.
The almost common effect is low sperm count, which tin can event from extreme temperature changes (like regular soaks in a hot tub), steroid use (including from some supplements) and being overweight.
A diagnosis is non the finish of the road
Whatever the reason for your secondary infertility, the doctors I spoke with said that all hope is typically not lost. "Even if y'all accept infertility for two years, yous all the same have a reasonable chance of getting pregnant," Dr. Rosenwaks said.
My family unit'southward happy catastrophe sits in her crib, pitching blimp animals over the side as I write. I will never know exactly why we needed more than two years to conceive her, versus the three months we needed for her big sis. Was it considering I was overweight? Or because I was 38? More likely, my md told me, blocked fallopian tubes from adhesions and scarring from my previous cesarean were to blame.
We'll never know what happened with full certainty. Because for all our science, all our medical capacities, all our goals, sometimes babies come up, or don't come up, on their timing, non ours.
[Read more on determining your risk for infertility , and how to manage if yous're diagnosed.]
Anne Miller is a freelance editor and writer who lives in Brooklyn.
Source: https://www.nytimes.com/2020/04/15/parenting/fertility/secondary-infertility-causes.html
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