You had no problems conceiving your 3 year old and all went to plan without a hitch, so it should be easy to fall pregnant again naturally, right?
Many couples trying to get pregnant do not have identifiable problems to explain their sub fertility and I see more and more couples come into my clinics having difficulties getting pregnant second time around and it's not without its stress and causing barriers.
Annette a business woman in her late thirties, walked into my clinic reception with an air of confidence and carried a bright smile, she worked in the city for an international banking company, married for five years and mother to a beautiful three-year-old little girl.
As she told me her story, her composure began to fray at the edges and tears began well up in her eyes as she tried to hold back the floodgates.
“I just don’t understand it,” she said. “I got pregnant first time around which wasn’t on purpose, it just happened that way, and all my friends around me are getting pregnant, and Simon and I keep trying, but every month goes by and I’m not pregnant. I’m just not understanding what’s wrong, I mean it’s not like I’m infertile.”
Annette’s words are a reflection of many women who find themselves echoing similar stories to practitioners and clinicians. Patients who are having difficulty conceiving their second child have a very difficult burden to bear. They often do not think of themselves as an infertile couple since they already have conceived in the past. As I explained to Annette, having a child once is not a magic potion that guarantees eternal fertility.
A diagnosis of secondary fertility may be given if;
A couple who have already given birth without the use of medical support or
fertility medications find themselves unable to get pregnant within 12 months or experience recurrent miscarriages (three consecutive miscarriages)
Couples in these situations usually ask themselves the same questions as Annette did when she came to see me.
“It was easy the first time. So why is it so difficult now?”
Causes of Secondary Infertility
Causes of secondary infertility vary, but there are a number of factors.
Advanced reproductive age: The woman’s age is one of the most common reasons for secondary infertility. Although a woman like Annette may have had no problem getting pregnant a few years ago, those interim years can change things. It is critical to understand that a woman is born with all of the eggs she will ever have. As a woman ages, her ovarian reserve will diminish. This means that her egg quantity and egg quality will decrease, while the chance of miscarriage increases. This is true whether or not she conceived easily in the past.
Structural complications: Some other important factors relate to the structures in the pelvis which includes the fallopian tubes. Pelvic adhesions - which may be caused by endometriosis or prior abdominal surgeries - may make it difficult for the egg to be picked up by the fallopian tube. Without a connection that functions normally, pregnancy cannot result. In addition, if there were complications that developed during a prior delivery and a uterine infection resulted, she may have developed Asherman’s syndrome (intrauterine adhesions) or adhesions that develop around the fallopian tube.
Sperm quality and quantity: The third category to consider is the sperm. Just as a woman’s fertility can change with time, so can a man’s. Changes in sperm quality and quantity may occur due to changes in health or new medications. A semen analysis is one of the basic aspects of the initial infertility evaluation.
Weight gain: Weight can have a huge impact on the ability to conceive. Excessive weight gain can contribute to ovulatory dysfunction. With increased weight, insulin resistance can increase as well which leads to elevated production of testosterone from the ovaries, a phenomenon that can further prevent normal ovulation. In men, excessive weight can also negatively affect sperm production by increasing estrogen levels.
Smoking: Cigarette smoking in both the male and female can significantly impair the ability to conceive. And, smoking can seriously impact a woman’s ability to carry a normal pregnancy.
Whatever the underlying causes for difficulty conceiving, talking with a specialist is the best way to untangle a web of confusing information and emotions.
Natural and Conventional Treatments
There are many couples looking towards natural therapies to help improve their chances of conception.
The British Medical Journal published a review in 2008 outlining the effects of acupuncture alone during fertility treatment and found that genuine acupuncture had increased women’s chances of pregnancy by 65% through assisted reproductive treatments such as IVF. According to traditional Chinese medicine, the needles unblock energy (or chi) and increase blood flow to promote a state of balance in the body. According to Western doctors, the needles stimulate the nervous system to release chemicals that help alleviate pain and promote healing. (MRIs even show that acupuncture has an effect in the brain.) Where fertility is concerned, acupuncture helps improve blood supply to reproductive organs, stimulate hormones, regulate ovulation, and decrease stress — all of which is seen to help increase your chances of getting pregnant. For this reason, acupuncture is one of the most popular researched natural fertility treatments recommended by clinicians in the field of reproductive medicine for both men and women. For men, there has seen an increase in sperm quality and count. Acupuncture can be a fertility treatment used alone or it can be part of a holistic treatment plan that may include herbs, nutrition and lifestyle changes. It is also being used in IVF clinics alongside reproductive treatment.
Eating a fertility diet in preparation for pregnancy and to boost fertility is one of the most powerful health changes you can make. Numerous studies have shown that specific changes to the diet can improve fertility, prevent recurrent miscarriage and support a healthy pregnancy.
Nutrition plays a big role when it comes to having a healthy body and reproductive system. The building blocks for hormones are found in the foods we eat. Antioxidants, which help to protect the egg and sperm from free radicals, are found in the foods that we eat. Just as nutrients in food can be helpful for fertility, there are some foods and chemicals added to foods that can be harmful for your health and fertility. Traditional Chinese medicine food energetics take a holistic approach to add and avoid certain foods to balance your body based upon your medical Chinese diagnosis that is specific to your fertile health needs.
Reflexology works on the principle that reflex points found on the feet (and hands) directly reflect certain organs and systems in the body. By stimulating specific reflex points on the feet it is possible to stimulate the corresponding parts on the body itself.
The roots of Reflexology are discovered in many ancient cultures - from Traditional Chinese Medicine to the Ancient Egyptians, but its revival in the West dates back to an American physician, Dr William Fitzgerald (1872 - 1942). Dr Fitzgerald discovered that pressure on certain points on feet and hands produced localised anaesthesia to corresponding body parts in what he called certain 'zones' of the body.
A full reflexology session will aim to balance the whole of the body's organs and systems - in particular the endocrine system for hormonal balance.
Homeopathy works on the principle that substances that can produce symptoms in a healthy person can also cure those symptoms in a sick person. Homeopathy medicines are prepared using a technique that involves two processes – dilution and succession. Succession is the method of vigorous shaking and striking against a surface. You may wonder how effective a medicine can be if it is diluted to a one-hundredth of its potency, however experts think the process of dilution and succession leave an imprint of the original substance’s energy pattern in the medicine, which in turn stimulates the body’s healing energy system to start working.
Homeopathy uses the same principle for treating infertility. It rectifies the cause of infertility by going to the root of the problem. For example, if your infertility is mainly because of problems with your hormones, your homeopath will give medicines to rectify the imbalance.
Hypnosis is now being taught at major medical schools and is officially sanctioned by the American Medical Association. It’s used to treat a range of conditions, such as anxiety, eating disorders, and increasingly being used for fertility. Hypnosis has shown to enhance fertility by promoting relaxation, which may help particular if stressed or suffering anxiety. How does stress interfere with fertility? Stress creates a fight-or-flight response that tells the body to release stress hormones such as cortisol, which in turn upsets the hormonal balance needed for ovulation, fertilization, and implantation of an egg. It follows then, that decreasing stress through hypnosis can be a major fertility booster. Studies show that when women were hypnotised during IVF procedures (to reduce stress), their rates of conception were improved.
Assisted Reproductive Technologies
Fertility treatments are constantly improving: pregnancy rates for infertile couples using Assisted Reproductive Technologies (ART) are currently higher than the average monthly fertility rates. Even if you already have a child, if you suspect secondary infertility, seek help from a fertility specialist as early as possible. Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue.
Medications that are used to enhance fertility include oral medications such as clomiphene citrate (Clomid) and is usually the initial treatment option here in the UK.
In vitro fertilisation has been useful in circumventing some of the tubal and pelvic disorders that can cause secondary infertility and is also helpful in increasing rates of fertilisation even if a woman’s fallopian tubes are already opened, as in the case of severe sperm-related abnormalities. PGD and PGS is an up and coming process used in many clinics to identify any potential causes of aneuploidy or screen for genetic disorders that may not have been detected on your previous pregnancy.
In the case of women who are diagnosed with severely diminished ovarian reserve with no remaining ovarian function, egg donation is an option.
With so many different treatment options it’s no wonder that stress has also been named as a culprit for a diagnosis of infertility as there are many considerations and options for couples.
Both natural and conventional methods of treatments have their advantages and disadvantages, but as I see it you have a better outcome if you start improving your health with natural therapies that include nutrition and if need be integrate both natural and conventional treatments to improve your pregnancy outcomes.
It is important to remember that some couples will have an identifiable reason for their infertility, and some will not. Regardless of whether or not there is a ready diagnosis, every women struggling with questions about her fertility can benefit from a consultation with a natural or conventional fertility specialist. By educating yourself about your body, your issues and your options, you can get started on your way to building the family you dream of.