In 2018, Neha (28) and her husband, Piyush (30) decided to start a family and within a month, Neha conceived. She gave birth to their first child. Neha recalls, "getting pregnant was easier and everything from conceiving to delivery was smooth." After a couple of years, when their child turned 2, they wanted to have a second child. They expected they would easily conceive, after all it was so easy the first time. After trying for almost six months, Neha was pregnant again. Unfortunately, she suffered a miscarriage and without losing hope, they spent another year trying but had no luck.

When she finally consulted a doctor, she was informed that she was going through secondary infertility.

 

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Secondary infertility occurs when a couple is unable to conceive a baby despite having at least one child. In this condition, it is also common to experience recurrent gestation loss where couples are able to conceive but fail to carry full term (9 months). We spoke to Dr. Anuradha Panda, gynaecologist, obstetrician, and laparoscopic robotic surgeon, Department of Obstetrics and Gynaecology, Apollo Hospitals, Hyderabad to understand more about secondary infertility.

 

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It is recommended that all couples speak to their doctor to schedule a health assessment before they plan to expand their families. “Preconception planning includes screening for infection, polycystic ovaries or any other gynae problems which may cause subfertility,” Dr. Panda says.

 

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Causes of Secondary Infertility In Women

• Decline in egg quality: At age of 25, female fertility is at its prime and drops between ages 30 and 40. Age-related fertility decline is increasing among women until about age 32, and the number of oocytes (eggs) starts to decrease more quickly at about age 37.
• Endometriosis: As women age, egg quality declines and they're more likely to develop fibroids and endometriosis, a condition that provokes the uterine lining to attach itself to other pelvic organs—both of which can impact fertility.
• Overweight: According to a 2023 study in the paper International Journal of Gynecology and Obstetrics, obesity is linked with infertility in women and is associated with poor fertilisation, abnormal embryo development, poor offspring growth and vulnerability to disease.
• Fallopian tube disease: The blockage in fallopian tubes, which bring eggs from the ovaries to the uterus, due to pelvic infections such as chlamydia or gonorrhoea can restrict a woman from getting pregnant.
• Polycystic ovary syndrome (PCOS): A 2022 study has shown that PCOS is associated with 80% of anovulatory infertility; however, the accurate mechanism of PCOS-induced anovulation is uncertain.
• Any ongoing medication: Dr. Panda suggests, "some women on blood thinning agents like warfarin or certain medicines like anti-epileptic drugs need to stop and change their medication before planning for a pregnancy."

 

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Causes of Secondary Infertility In Men

• Low sperm count: Semen quality usually declines after age 40. Prostate enlargement can reduce sperm count and restrict ejaculation. Removal of the prostate as a treatment for cancer or other conditions can cause sperm to flow in reverse.
• Sexually Transmitted Diseases: As per a 2022 study published in the Asian Journal of Andrology, genital conditions and inflammation due to sexually transmitted diseases (STDs) can induce male infertility, defective spermatogenesis, production of antibodies that reach sperm and seminal tract obstruction, resulting in low semen production.
• Low testosterone levels: Testosterone is crucial for sperm production but can decrease due to ageing or genital injuries. Low levels of testosterone cause low libido, erectile dysfunction and may also decrease the chances of conceiving.
• Excessive alcohol: According to 2022 research in the paper Frontiers of Physiology, consumption of excessive alcohol is linked with the production of low-quality semen.
• Late-onset hypogonadism: A study shows that late-onset hypogonadism is a clinical and laboratory syndrome which causes changes in hormonal profile leading to a reduction in male hormone secretion.

“It's important for both the man and woman to see a doctor if they have trouble conceiving after trying for a year,” says Dr Panda.

 

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Can Stress Cause Secondary Infertility?

Yes, research shows that stress can make it difficult to get pregnant. Stress provokes can upsurge in the level of stress hormones (cortisol) and adrenaline hormones. These hormones delay or hinder the process of ovulation, and the menstrual cycle in women. Besides, it also impacts the implantation of the embryo in the uterus. In men, stress has an effect on the levels of testosterone in the blood and also on the quality of the sperm..

 

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Treatment of Secondary Infertility

People usually don’t realise that a few years or even months can make a huge difference in their decision of getting pregnant for the second time. Especially, when the couple is in their late 30s or 40s. Women under 35 have a high probability of infertility if they haven’t been using contraception for a year and are still unable to conceive. If you and your partner are trying for a baby, and you suspect secondary infertility, schedule an exam with a doctor that specialises in reproductive health. Early evaluation can save time and offer extensive treatment possibilities. Your treating doctor may offer you the following options:

• Oral medications to encourage hormones that produce eggs in women with an ovulatory disorder.
• Uterine surgery restores structural problems, such as removing scar tissue, polyps, and fibroids from the uterus that impact fertility.
• In vitro fertilisation (IVF) is a procedure in which eggs are surgically recovered from the uterus, and fertilised in a laboratory with sperm. Then, the developed embryo is transferred back into the uterus.
• Intrauterine insemination (IUI) is a technique in which sperm is inserted directly into a woman's uterus. This process is opted when men have low sperm count or poor sperm quality.
• Testicular surgery can rectify testicular varicocele, a disorder that impacts sperm quality and counts.
• Antioxidant and anti-aging supplements can increase fertility in men while drug treatment can improve semen quality.

 

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How UR.Life OHC Can Help With Secondary Infertility?

At UR.Life OHC we approach all health concerns holistically. You can approach our centres for a complete health risk assessment. This will include an evaluation of your mental health, nutrition, fitness and risk of chronic diseases and other conditions. Our team of doctors work closely with other experts to curate a customised plan to help you recover from health issues.

This plan includes health screenings (mentioned below), tailor-made diet and fitness plans and access to a mental health coach. Head to UR.LIFE OHC today to know more. You can also find more information here.

Pre-pregnancy Screening Checklist:

• Blood group Rh factor
• Complete blood picture and urine examinations and kidney functions test (creatinine)
• Sugars and HBA1C (if one is diabetic /or has PCOS)
• Thyroid function tests (TSH, T3, T4)
• Rubella IgG (for immunity against Rubella)
• VDRL, HIV tests