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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 infertility?

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 factor. 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 conceive.
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 Unless you are using a technique to identify your most fertile days, to optimize fertility, you should have intercourse every other day starting a few days before ovulation. 

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