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
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
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