2 May 2019

Why Can’t I Get Pregnant Again? It May be Secondary Infertility

Why Can’t I Get Pregnant Again? It May be Secondary Infertility

Because a woman’s fertility declines with age, sometimes it can be harder to get pregnant with a second child than it was with the first. Fertility doctors refer to this as secondary infertility: when a woman has trouble getting pregnant on her own after a previously successful natural conception and birth.

Does that sound familiar? Reproductive Medicine Associates of Northern California (RMANorCal), with offices in San Francisco and Palo Alto, can help. Our reproductive endocrinologists, Dr. Scott Morin and Dr. Jonathan Kort, have experience diagnosing and treating a range of infertility causes, including secondary infertility.

They answer the most common questions about secondary infertility below:

Why would a woman experience secondary infertility?

Dr. Morin: A woman is born with all the eggs she’ll ever have, and that supply slowly decreases as she releases eggs every month during her menstrual cycle. So as a woman ages, she has fewer eggs, and fewer good quality eggs – both factors that reduce her chances of getting pregnant naturally. Generally, a woman is most fertile in her mid- to late-20s, after which point her fertility begins to decline slowly until age 35 when the decline accelerates. That said, every woman is different, and that decline can begin earlier or later. Because fertility declines with age, it’s possible – and even common – for women who had no trouble getting pregnant with their first child to struggle to conceive the second time around, when they are older and less fertile.

But if I still have eggs left, why am I not getting pregnant?

Dr. Kort: While women over the age of 35 still have eggs left, it becomes more difficult to get pregnant because the eggs are of lower quality. Research done by doctors in the IVIRMA Global fertility network – to which RMA of Northern California belongs – showed that a woman’s age impacts the viability of the embryos created from her eggs. Namely, the older a woman, the more likely it is that her eggs have a chromosomal error which will, in turn, result in embryos being aneuploid, or chromosomally abnormal. For example, in her mid-to-late 20s, the rate of aneuploidy in a woman’s eggs is a little more than 20 percent, rises to the mid-30s by age 35, is about 50 percent by age 40 and is nearly 90 percent by age 42 and 43. This means that while about 20 percent of the embryos a woman creates may be abnormal in her late 20s, almost 90 percent could be abnormal by her early 40s. That is a significant change in a little over a decade.

What does aneuploidy have to do with a successful pregnancy?

Dr. Morin: A lot. The opposite of aneuploid is euploid, which means an embryo is chromosomally normal, or that it has the normal amount of chromosomes and has a good chance of implanting inside the uterus and leading to a successful pregnancy. Aneuploid embryos, on the other hand, have too few or too many chromosomes, and often fail to implant inside the uterus. In the chance they do implant, they often lead to miscarriage or an affected child. So the older the woman, the higher her chances of producing aneuploid embryos which fail to implant, leading to infertility.

How can I tell if I have secondary infertility?

Dr. Kort: If you were able to get pregnant naturally and gave birth without issue in the past but are having trouble conceiving on your own for the second or third time, you may have secondary infertility. However, it is also possible that there is another cause for your infertility, and doing the necessary testing will help you determine the cause so you can move forward with the appropriate treatment. All patients at Reproductive Medicine Associates of Northern California undergo diagnostic testing to get a complete picture of their fertility before moving onto treatment; this includes blood work to learn more about a patient’s egg count, which can help determine whether or not she is experiencing secondary infertility.

What type of help is available for women who do have secondary infertility?

Dr. Morin: Secondary infertility is treatable, and many women diagnosed with it go on to have successful subsequent pregnancies. There are various treatment options based on the woman’s specific fertility profile, including Intrauterine Insemination (IUI), where sperm is inserted into a woman’s uterus at the time of ovulation, and In Vitro Fertilization (IVF), where sperm and egg are fertilized outside the woman’s body and a resulting embryo is transferred back into the woman’s uterus in hopes of implantation. No matter which treatment path you pursue, you should have hope that we are here for you and you can overcome secondary infertility with just a little bit of help.

If you are struggling to get pregnant and want to know more about treatment options, book a consultation with Dr. Kort or Dr. Morin. Call the San Francisco office at (415) 603-6999 to speak to one of our patient liaisons and get started today.

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