What is Secondary Infertility?

It is defined as the inability to conceive or carry a pregnancy to term for up to 1 year of trying after a previous birth. The previous pregnancy must have occurred spontaneously. Repeated miscarriages can also fall into the category of secondary Infertility.

30%- 40% of the cases of Infertility are secondary Infertility cases so it is quite common.

What are the causes of Secondary Infertility?

Just as the pattern for primary Infertility, 30% of cases are from male factor, 30% of cases are from female factor, 30% of cases are from combined factors(male and female), and 10% are undiagnosed or from unknown( or what I call social) factors.

The commonest causes generally includes;

▪️Increase in age

▪️ Past pregnancy complications

▪️ Increase in weight

▪️ Sexually Transmitted Infections

▪️ Drugs

▪️ Alcohol abuse

▪️ Smoking.

 Let’s look specifically now:

 CAUSES OF SECONDARY INFERTILITY FOR WOMEN

▪️Reduced quality and quantity of eggs: if the first pregnancy occurred at an advanced age, following the entire pregnancy and weaning process, the age advances further. The quality of the eggs as a woman’s age increases naturally reduces especially if she is not doing anything extra to boost this quality. Quantity can only continue to reduce. Remember from past lectures, a woman is born with all her eggs and they keep reducing as she grows in age until they finish at menopause.

▪️ Fallopian tube problems: if the delivery of previous pregnancy or post partum period(specifically 6weeks after delivery) is not properly managed, infection may occur and one of the places easily affected is the fallopian tubes.

▪️ Uterine problems (womb) following pregnancy: this can occur following a c/s or a poorly conducted normal delivery. If a woman delivers at a center with poor midwifery skills, the handling of the womb may lead to problems after delivery, leading to secondary Infertility.

▪️ Endometriosis: can follow a previous birth or D&C (abortion). This is when tissues of the womb are found at other sites outside the womb. Its important to note however that not all cases of endometriosis will lead to Secondary Infertility.

▪️Incresed weight: it is a common thing for women to add weight after childbirth. If this weight is excessive however, it can cause some hormonal imbalances leading to a disruption of the cycle.

▪️ Lifestyle: certain lifestyle like alcohol and tobacco abuse eventually takes its toll on the body. It can present as secondary Infertility because quality of eggs become compromised.

▪️Breastfeeding: breastfeeding a child is a natural contraceptive. The effects take a little longer to wear out in some women even after weaning off the child. Its important to avoid stimulation of the breasts after breastfeeding is stopped. Some children still “play” with their mothers breasts after they have been stopped from feeding. This should be discouraged.

CAUSES OF SECONDARY INFERTILITY IN MEN

▪️Reduced testosterone production following increase in age: once a man is above 40, testosterone production naturally reduces and hence sperm quality also can reduce especially if there are other factors to encourage this reduction as we will discuss below.

▪️Infections: urinary and sexually transmitted infections damages the reproductive systems and can lead to Secondary Infertility in men.

▪️ Prostrate problems: which can occur with increasing age or by genetic inheritance, can cause secondary Infertility.

▪️Drugs: being on certain drugs can cause temporary secondary Infertility in men. Drugs like some antihypertensives, some antibiotics, arthritis drugs, anti cancer drugs, even some analgesics can reduce quality of sperm produced.

▪️Exposure to chemicals: we have discussed in previous lectures how this can happen. Chemicals, excess heat at work place, can impair sperm production and quality and quantity produced.

▪️Weight: increased weight also can affect men. So neglecting one’s self years into marriage and gaining excess weight has a negative impact on Fertility and Reproductive health. This is as extra fat cells increases estrogen levels(both in men and women) thereby causing some hormonal imbalances leading to secondary Infertility.

WHAT IS THE TREATMENT FOR SECONDARY INFERTILITY?

As  you might have guessed, treatment is determined by cause of the condition. Early evaluation is therefore *critical*. Once you are ready for another baby, and you try for one year without success, get evaluated by a doctor(obs/gynaecologist for women,  urologist for men, endocrinologist where indicated).

Certain investigations will be carried out;

▪️ Ultrasound to check the womb.

▪️Hysterosalpingogram(HSG) to check the tubes.

▪️ Blood screening

▪️ Infection screening

▪️ Hormonal assay to look out for imbalances like increased prolactin from breastfeeding, ovarian function, estrogen, etc. Also for men.

All these will point to the actual problems. If no actual problems are identified, lifestyle changes may be advised like weight loss, reducing exposure to chemicals, stopping alcohol, encouraging supplements intake, advise on detoxification, etc.

MEDICAL TREATMENTS MAY INCLUDE:

▪️Ovulation induction

▪️Surgery where indicated

▪️Assisted Reproductive Technology (like IUI, IVF, surrogacy) depending on underlying conditions.