Secondary infertility – when baby #2 (or 3 or 4 …) doesn’t come easily

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Secondary infertility, defined as the inability to conceive despite having conceived in the past, affects approximately 10% of women.1 It is different from primary infertility, which is when a woman who has never conceived before struggles to fall pregnant.

Secondary infertility can produce similar heartache to primary infertility, especially if you feel your family is not yet complete, you want to provide your children with a sibling, or you long for the son or daughter you don’t yet have. It’s important to recognise that your feelings and concerns are valid, and shouldn’t be brushed aside simply because you already have one or more children – you are equally deserving of seeking help to achieve a second or subsequent child, as are a woman or couple yet to have any children.

What causes secondary infertility?

There are a number of factors that are commonly associated with secondary infertility. These include:

Age

It’s common knowledge that women have a ‘biological clock’ – that is, the age-related decline in a woman’s fertility, due to a decrease in the number and quality of her eggs. This decline accelerates once a woman hits 35. Given that a woman is usually older when planning subsequent pregnancies, her increasing age can be a significant contributing factor to any difficulty she is experiencing second (or third or fourth …) time round. This is particularly true nowadays due to the societal trend towards older age at first pregnancy, meaning women can be well over 35 when they are ready to start trying for another child. For men, there is also a gradual age-related fertility decline from the age of 40, even if their sperm count is reported as normal.

Lifestyle

Successful conception requires unprotected sexual intercourse to occur at the right time – around the time of ovulation, when an egg is released from the ovaries. Consequently, unprotected sex every one to two days during this ‘fertile window’ each month provides the best chance of falling pregnant. However, with one or more young children to take care of, maintaining regular sexual intercourse, let alone doing it at the ‘right’ time, can be difficult. Further, you may not be taking care of yourself as well as you usually would, as you put the needs of your little one/s first. A good diet and regular exercise can fall by the wayside for mums of busy toddlers. This, combined with potential weight gain, can also contribute to sub-optimal fertility at this time of life.

Complication from a prior pregnancy or delivery

Scar tissue can sometimes form inside the uterus (womb) or cervix. This may be an issue if you have ever had a procedure called a dilatation and curettage (D&C) to remove tissue from the uterus due to a miscarriage or retained placenta after a previous birth. Although uncommon, the presence of scar tissue can prevent a pregnancy. However, it can usually be removed via a simple procedure called a hysteroscopy.

Secondary infertility can also be caused by many of the same factors that cause primary infertility. For women, this includes ‘structural’ disorders that may be affecting the health of your reproductive organs (e.g. endometriosis, fibroids, polyps), as well as hormonal disorders like polycystic ovarian syndrome (PCOS) and thyroid disease. Thus, a full check-up with your gynaecologist is a good first step if your next pregnancy isn’t coming as quickly as you would like or expect.

What should I do if I’m experiencing secondary infertility?

The advice for those experiencing secondary infertility is the same as for those experiencing primary infertility. If you are under 35, seek help after 12 months of trying. If you are over 35, seek help after 6 months of trying. Depending on your circumstances, fertility treatment may be as simple as ovulation tracking and fertility optimisation through lifestyle changes. For advice specific to you, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933 or by booking online via our appointments page.

Exercise

Further reading

 

Reference
  1.  Mascarenhas et al. PLoS Med. 2012;9(12):e1001356. ↩

The ART of falling pregnant later in life

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So, why is age so important?

Put simply, as you get older, the number and quality of your eggs decreases. Unlike men, who continue to produce new sperm throughout their lives, a woman is born with all the eggs she will ever have. While sperm quality (shape and speed) falls as a man ages, there is little effect on fertility or the child until men enter their mid 50s.

Thus, if you are over 35 and haven’t fallen pregnant within six months of trying, we may begin our assessment by checking your ‘ovarian reserve’. There are two tests we commonly use. The first involves measuring the level of anti-mullerian hormone (AMH) in your blood. This hormone is secreted by the cells that surround and protect the eggs, so it gives us an idea of how many eggs you have left (the higher the hormone, the higher the number of eggs you are likely to have left). We can then assess if your egg reserve is about what we would expect given your age. The second test we can use is called an ‘antral follicle count’. An ultrasound is performed (usually in the first week after a period) to look at your ovaries and count the number of follicles (small ovarian cysts containing the eggs that will grow that month). Both tests will help inform our approach to fertility treatment. Unfortunately, neither test tells us anything about the quality of your remaining eggs.

What are my options for falling pregnant later in life?

While it may be hard to hear that you are statistically less likely to conceive after the age of 35 than you were in your 20s, the good news is that there are now a number of fertility treatments available to assist couples who start trying for a baby later in life but then find that they’re unable to conceive naturally.

Some of the options that may be presented to you include:

1. Ovulation tracking

­This is a relatively simple approach where we track your menstrual cycle using blood and ultrasound tests. By doing so, we can tell you when you are most fertile (i.e. most likely to release an egg from your ovary), so you can align the timing of sexual intercourse accordingly. Basically, we want egg and sperm to both be in the same place at the same time, thereby improving your chances of fertilisation (i.e. egg meeting sperm and joining to form an embryo). This is a bit like the old TV show ‘Perfect Match’, where one girl (i.e. one egg) has her choice of a few different men (i.e. the millions of sperm present in a man’s semen), but it doesn’t necessarily mean she’ll hit it off with any of them. We are more likely to try this approach first if your AMH test shows that you have a good egg reserve. Note: if you have tried an over-the-counter home ovulation kit, be aware that ovulation tracking in the clinic is more accurate.

2. Ovulation induction

If your egg reserve is good, we may use medication to encourage your ovaries to release a small army of mature eggs. Again, sex is then timed accordingly, so a team of eggs and a team of sperm are both ‘hanging out’ in your reproductive tract at the same time – the equivalent of a group date where you just have to wait and see if anyone hits it off! Occasionally, we will also use medication to ‘trigger’ the release of eggs at the optimum time.

3. Intrauterine insemination (IUI)

If we think there is an issue with sperm getting to where it needs to be in your reproductive tract (i.e. having sex at the right time is not the problem), we may suggest pre-collecting your partner’s semen, so that we can ‘flush’ a large amount of highly concentrated sperm directly into your womb (with a syringe) around the time of ovulation. We may use this approach in combination with ovulation tracking or induction to ensure an egg is also available to meet the sperm.

4. In vitro fertilisation (IVF) using your own eggs

IVF involves stimulating your ovaries to produce multiple mature eggs, collecting these eggs, then placing them with sperm in a laboratory dish. Ideally, the sperm will then fertilise one or more of your eggs resulting in an embryo/s. One embryo is then placed into your womb in the hope that it snugly implants in the wall of your uterus, leading to pregnancy (any other embryos remain frozen for future use). By placing egg and sperm together outside the body, we help overcome any barriers that may be preventing this process from occurring naturally. Unfortunately, the revolutionary science of IVF cannot make up for the natural decline in fertility that occurs with age, including a drop in egg quality, which means that IVF success rates do tend to drop as women get older.

5. Pre-implantation Genetic Testing (PGT) of embryos as part of the IVF process

If you are an older woman undergoing IVF, we may recommend genetically testing your embryos before placing them in your womb to help improve your chances of a successful cycle. You can read more about PGT elsewhere on our website, but essentially these tests involve checking your embryos for genetic anomalies, so that we can select the embryo with the best potential for development for transfer into your womb. These tests can be particularly helpful for older women because the incidence of genetic abnormalities increases with age, leading to higher rates of implantation failure and miscarriage with IVF. Thus, if we can identify the highest-quality embryo for transfer, we give IVF the best chance of success.

6. In vitro fertilisation (IVF) with ICSI or IMSI

ICSI or IMSI may also be used during IVF to improve your chances of success. Again, you can read about ICSI and IMSI elsewhere on our website, but in general, these techniques help overcome any sperm-related issues that may be impacting your ability to fall pregnant naturally. While sperm ‘problems’ are not necessarily a sign of older age, certain health or lifestyle issues can be more common with age, which may impact the quality and quantity of your partner’s sperm. ICSI may also be used if there are no obvious sperm problems but fertilisation failed during one or more previous IVF cycles (i.e. when eggs and sperm were placed together in a laboratory dish, no pairs came together to form an embryo).

7. In vitro fertilisation (IVF) using donor eggs

If you’re older and do not succeed with IVF using your own eggs, egg donation from a younger woman may improve your chances of having a baby via IVF. Studies show that if an older woman undergoes IVF using eggs from a younger donor, her chances of having a baby match the donor’s age group. IVF using donor eggs is also an option for women whose ovaries don’t produce any mature eggs despite hormonal stimulation or who have entered menopause prematurely (< 40 years old).<

8. ‘Going it alone’

If you are an older, single woman without a male partner but want to try for a baby on your own, donor sperm with the help of IUI or IVF now makes this very possible. However, it’s better to make this decision earlier rather than later, while you are still likely to have a good number of quality eggs. Every year after 35 reduces your chances of having a successful pregnancy, even with the help of IUI or IVF.

When to seek help

If you’re over 35, we advise seeking help from a fertility specialist if you don’t fall pregnant after 6 months of trying. If you’re a single woman over 35 and want to explore the option of donor sperm, we advise seeking professional help as soon as possible, as there can be a wait-list for donor sperm.

For advice specific to you, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933 or by booking online via our appointments page.

Further reading

Sperm donation – separating fact from fiction

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Wanted: a few good men!

As a growing number of single women make the decision to embark on solo parenting, lesbian couples embrace techniques like artificial insemination and IVF to help them have a family, and fertility issues become more common for heterosexual couples who meet and marry later in life, there’s never been a more appropriate time for Australian men to donate their sperm.

However, despite a clear need for more donor sperm, there’s still a lot of myths around sperm donation, and understandably, men are often hesitant to put themselves forward. Here, we explore the truth behind the most common misconceptions to help overcome some of the fears men may have about becoming a donor.

“Gay men can’t donate sperm.”

A gay man can donate sperm just like any other healthy male. In Australia, sexual orientation plays no part in deciding whether or not you can become a sperm donor (admittedly, this is a clear contrast to the policies of some international sperm banks). Unfortunately, because men who have sex with men are prevented from donating blood – due to a perceived increased risk of sexually transmitted diseases – some people assume that gay men can’t donate sperm either. However, that’s simply not the case and here in Australia, gay men have actually been credited for increasing the availability of donor sperm.

The fact is, all sperm donors – no matter their sexual orientation – are screened for infectious diseases before their sperm is cleared for use. This includes blood tests at the time of donation and again at 3 months. Sperm is only made available to potential recipients after both sets of blood tests have been given the all clear (this is why donor sperm is not used straightaway but quarantined for 3 months).  Simply put, sexual orientation doesn’t form part of the eligibility criteria for sperm donors and is irrelevant to your ability to donate. Whether you’re gay, bi or straight, your intent is exactly the same – to give in order to help others in need.

“My sperm could be used to make hundreds of children.”

You may have come across news stories about men abroad who have fathered many, many children through sperm donation (some well into the double figures!). However, Australian law simply does not permit this. In Victoria, sperm from a single donor is only allowed to be used by a maximum of 10 different patients or ‘families’. This effectively limits the number of potential children that can be conceived by any one donor.

On the other hand, there is no limit to the number of children that can be born from the same sperm donor within each of these families. This gives families the opportunity to bear siblings who are genetically related. So if a recipient has success with your sperm, they may choose to use your sperm again in the future when trying for baby #2 or 3 in order to give their child a biologically-related brother or sister.

But it’s also important to realise that your sperm may never be used or may only be used once or twice. If it is used, there is also no guarantee that the process of assisted conception (e.g. IVF or IUI) will be successful for the recipient, i.e. a child may not result every time your sperm is used. Further, the semen we collect from you may also not ‘stretch’ to ten different families. This, along with unsuccessful IVF attempts, is why we like donors to provide a few sperm samples over time.

“If you donate sperm, you’ll have children showing up on your doorstep for years to come.”

The Victorian government was one of the first to query the ethical implications of the secrecy surrounding sperm donorship. As such, current legislation states that a donor-conceived person can request identifying information about their donor once they turn 18. This loss of guaranteed anonymity is one of the main reasons why the number of sperm donors has dropped over recent decades. However, although a donor-conceived child has the option of getting in touch with you once they are an adult, this doesn’t necessarily mean they will do so. Some children may not know they are donor-conceived while others will simply have no inclination to reach out.

If a child conceived from your sperm does choose to get in contact with you, you still have no legal, financial or parental responsibilities to that child. However, you may find that you are happy to build and maintain a relationship with them. In this case, you can discuss and agree together the extent of any future contact, in line with what you both feel comfortable with.

“If you’re a sperm donor, you’re a father of all the children who are born.”

When you donate your sperm, it provides the biological means to create a baby only. Men who donate sperm anonymously through a registered sperm bank are not legally or financially responsible for any child born from their sperm. Sperm donor recipients (i.e. the mum and dad to be) must also receive counselling to ensure mutual understanding of your rights as a donor. Put simply, you are just the sperm donor, not the Dad. And we make sure that everyone involved knows that they do not have the right to ask or expect you to be anything more than that.

“Only good-looking men’s sperm will be used”

Don’t think your sperm will be wanted? Think again! The reality is that recipients often have their own ideas of the ‘dream’ sperm donor. And this could be you! When it comes to donor selection, your physical attributes (e.g. blue eyes, brown hair, height) are listed but photos are never provided. More often than not, recipients will choose a donor based on other information provided, including your age, medical history, hobbies/interests, ethnic background, and reason for donating. For example, we know one woman who chose her donor based on the fact that he (like herself) had a penchant for trivia, a trait she hoped would be passed on to her future child!

The fact is, the most important attribute of any sperm bank is variety, thereby enabling choice. That’s why we welcome donors from a wide range of nationalities, cultures, professions, and stages and ages of life. This ensures that women and couples have the opportunity to choose a donor that aligns with their personal preferences, particularly if bearing a child with a clear physical resemblance or from a certain ethnic background (e.g. Asian, Anglosaxon) is important to them.

Donate life, change lives with Newlife IVF

Newlife IVF loves hearing from new sperm donors – single men, fathers, gay individuals or couples. Come one, come all! If you have been thinking about becoming a donor but haven’t yet taken the next step, please call us on (03) 8080 8933 or email [email protected] so we can give you all the facts and get your swimmers to those who need it sooner rather than later!

Further reading