Since you've given birth before, it may not occur to you that you are suffering from infertility unless you become pregnant again. Those who have experienced secondary infertility learn that this can happen only when they consult a doctor.
There is a misconception that infertility is congenital and will not happen to women giving birth, but infertility is usually an afterthought. As you know, infertility is a very broad topic. However, today I will talk about a more subtle topic, secondary infertility.
What is Secondary Infertility?
Secondary infertility is the inability to get pregnant even if you have had a child before, even though you try to get pregnant again.
Just like primary infertility, secondary infertility can occur due to a problem at any point in the natural process necessary to get pregnant. Any problems with ovulation, fertilization, entry of the fertilized egg into the uterus, or the development of the fertilized egg may result in inability to become pregnant or the pregnancy terminated in miscarriage.
What Are the Causes of Secondary Infertility?
Primary and secondary infertility often share the same causes. I will explain them one by one for you.
Ovulation Disorders
In fact, 40 percent of women with infertility problems do not ovulate consistently. Therefore, the chance of getting pregnant decreases. Ovulation disorders can be caused by a variety of conditions and factors, such as:
- Polycystic Ovary Syndrome (PCOS)
- Primary Ovarian Insufficiency (POI)
- Decreased egg production due to aging
- Thyroid or other endocrine disorders that affect hormone production
- Certain lifestyle factors, such as weight, diet, and alcohol or drug use
One of the most common causes of infertility in women is PCOS, which causes the ovaries or adrenal glands to produce too many hormones that prevent the ovaries from releasing eggs. It can also cause cysts to develop in the ovaries, which can further inhibit ovulation.
But do not despair at this point. I have good news for you. 70 percent of women with PCOS do not have any problems getting pregnant after the necessary treatments.
Problems with the Uterus and Fallopian Tubes
Structural issues can affect your ability to get pregnant. For example, if there is a blockage in the fallopian tubes, the sperm and egg may not be able to come together. The uterus may also have a structural or tissue defect that prevents implantation. Some special conditions that affect the fallopian tubes or uterus include:
- Endometriosis
- uterine fibroids or polyps
- uterine wound
- Uterine-shaped abnormality, such as a unicornuate uterus
Secondary infertility due to endometriosis can occur after cesarean section or uterine surgery, when uterine cells are misplaced and symptoms begin or increase.
Scar in the Womb
If you had a cesarean delivery with a previous pregnancy, it's possible to have a scar on the uterus called an isthmocele. An isthmocele can lead to inflammation in the uterus that affects implantation. This causes problems in conceiving.
Infections
Infections, including sexually transmitted infections, can cause pelvic inflammatory disease. This can cause injury and blockage of the fallopian tubes. A human papillomavirus (HPV) infection (and its treatments) can also affect cervical mucus and reduce fertility.
I have to give important information about this. The sooner the infections are treated, the less impact it will have on fertility. This is an important example for you to see again the importance of regular gynecological examination.
Age
Age plays an important role in fertility. Biologically, fertility peaks around age 20 in women and begins to decline at age 30. Of course, this does not mean that a successful pregnancy cannot occur at a later maternal age. Just getting pregnant may take longer or be more challenging.
Other Causes
Causes such as stress, smoking and weight gain are also factors affecting fertility. Just like primary infertility, secondary infertility can also occur due to such conditions.
When Is Secondary Infertility Suspected?
If you can't get pregnant despite trying for the last year or if your pregnancies end in miscarriage, we start to suspect secondary infertility. For women over the age of 35, this period decreases to 6 months.
How Is Secondary Infertility Diagnosed?
When we suspect secondary infertility, we want to do an examination and some tests for diagnosis. These:
- blood tests to look at your hormone levels
- Ovulation tests
- pelvic exam
- X-rays to view your fallopian tubes
- Transvaginal ultrasound
- Other tests to view your uterus and cervix
If your tests show no problems, we may recommend testing for male infertility.
How Is Secondary Infertility Treated?
Once we know the cause, we develop a treatment plan to increase the likelihood of conception. I have listed the most common ones for you below.
Medicines
Medications are often used to normalize hormones, or fertility-enhancing drugs are recommended to help stimulate ovulation.
Operation
In some cases, you may need to have surgery. There are several effective surgical procedures that can treat problems such as uterine fibroids, uterine scarring or advanced endometriosis. Most of these procedures are performed minimally invasively.
Hysteroscopy is used to diagnose and treat uterine abnormalities such as polyps and endometriosis.
Laparoscopy is a method to help diagnose infertility when other measures have failed and can be used in conjunction with hysteroscopy as an effective treatment.
Vaccination and IVF treatment are among the most preferred methods in the treatment of infertility.