Getting Pregnant For Dummies. Sharon Perkins

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      Dealing with disbelief: But it worked before …

      Perhaps one of the most confusing physiological and psychological dilemmas occurs when something worked before and suddenly, apparently without reason, ceases to be effective.

Those struggling with secondary infertility commonly lament:

       “We conceived the first month we tried.”

       “All my husband had to do was look at me and we got pregnant with our first two.”

       “Conceiving a child was never a problem with us.”

      Sometimes secondary infertility seems to defy proper or satisfying explanations; other than being a year or two older than you were the last time you had a baby, nothing seems to have changed. Other times, getting to baby number one may have been a challenge, and the fact that it’s not going to be easier the second time around is disappointing, but not unexpected.

      Begin with a careful review of your first successful go-round. Ask yourself the following:

       Was it as easy as it seemed the first time or is that merely in comparison to the current struggle of secondary infertility?

       Did you miscarry two or more times on the way to a healthy baby? Were these miscarriages investigated and found to be due to chromosomal abnormalities, which increase with age?

       Was it ever suggested, prior to conception, that there might be issues that could cause a problem in conceiving or carrying a child (for example, abnormal hormonal levels; structural issues in the uterus, ovaries, or fallopian tubes; a family history of infertility; and so on)?

      It’s not uncommon to disregard a previous observation, even if it was made by a medical professional, particularly if their diagnosis proved to be wrong, and the proof — the child — is now pulling all the pots and pans out of your cabinet and trying to flush them down the toilet. It’s even more common to ignore a family member’s recollection of history (for example, every woman on your mother’s side went into menopause at the age of 35) if you seem to be the exception.

      Conduct your own investigation if you feel that you may have overlooked a comment or a speculation the first time around. Ask your partner if you can’t remember correctly or check with the physician whose care you were under prior to the conception of your first child. You may also see this as an opportunity to open or reopen discussion with family members to get an accurate picture of your genetic history when it comes to reproduction. You may well end up finding out that you do indeed have a clean bill of health, but you may also uncover information that can help you get to the bottom of secondary infertility.

Looking for What’s Different This Time Around

      So, the reproductive system isn’t working like it used to — what could be the problem? Similar to primary infertility, finding the answer to secondary infertility can take a while and fill up at least an entire book such as this one. But, for the sake of getting to the point, we list some quick and perhaps not-so-obvious possibilities.

      Changes in age

      Unless (or even if) your last child was born six weeks ago, time does march on! And from an infertility point of view, that’s never a good thing. One of the primary reasons for secondary infertility is the age of the mother. But put this into perspective. If you had your first baby at 27 and now are trying for number 2 at 30, age is not the issue. However, if you had your previous child at age 38 and now you are 41, age becomes a major issue.

      Age-related male infertility can also be a consideration, although Father Time does seem to be a bit more forgiving when it comes to the dads. Regardless of whose age we’re discussing, by definition, both you and your partner (should both parties remain the same!) will be older when you try to conceive your next child. As we have seen in preceding chapters, fertility declines throughout the years, so the baby that popped up so easily in your 20s may not be as forthcoming in your 30s or 40s. The longer the interval between children, the more likely that time is not on your side. The fact that you have conceived, carried, and delivered a baby are certainly positive predictors of your ability to do so, but realize that many cite the age of the mother as the primary reason for reproductive success. Is this true? Only time will tell.

      

One interesting way to look at the effect on age is to look at the IVF data that the Society for Assisted Reproductive Technologies (SART) publishes. SART divides people using IVF into age-based categories. If you take the average delivery rates for each age category and graph them, they are almost a straight declining line. For the under-35 crowd, the average is about 45 percent per try. For the 45-and-over crowd, the average is 0. So for the ten years that this represents (35–45), there is a 45 percent drop, which because it is linear means that each year represents a 4.5 percent loss in fertility potential when using IVF. Based upon this logic, at age 38 your chance of a live birth using IVF is close to 20 percent per try, but by age 40 this has declined to 10 percent. So, in just two years your chance of success has been cut in half.

Remember, your age isn’t an admonishment. Family planning is all about the spacing of children to fit with your lifestyle, finances, and capabilities. Having children back-to-back is not necessarily the best thing to do, for your health and well-being and that of your family. Most physicians recommend a minimum of one year in between pregnancies in order to allow your body to heal. Considering that sex is a no-no for the first six weeks after delivering, those who have a ten-month difference in the age of their children are ignoring someone’s advice. While age is certainly a large factor in planning your family, it can’t be the only thing.

      So what now? You’re older and having problems. As with primary infertility, if you are over the age of 35 and have not conceived after trying naturally for six months, it may be time to visit your primary care physician, OB/GYN, or reproductive endocrinologist. They will likely run the same battery of tests on you that they would on a patient who presented with primary infertility. Be patient. You want a thorough report, not a speedy one. Two weeks won’t make a difference!

      Changes in health

      As with primary infertility, your overall health does make a difference. While you may still be living the clean life, it doesn’t mean that your body hasn’t undergone changes all its own. Have you had an increase or decrease in your weight? As we discuss in detail in Chapter 9, BMI (body mass index) can certainly play a part in your fertility or lack thereof. Have you suddenly become a marathon or long-distance runner? This too can affect your metabolism and your body’s responses, including the reproductive ones. While these can be positive health changes, they can also upset the delicate balance to which your body may be clinging. Take a look at any lifestyle changes, good or bad, and discuss them with your physician to see if therein lies the culprit.

      Occult, or not yet uncovered, chronic or acute illness can also play a role in reversing your fertility. Diabetes, autoimmune disease such as lupus, thyroid problems, and a host of other issues, large and small, can also affect your ability to conceive and may be brewing without your knowledge. If you haven’t had a complete physical workup, as well as a gynecological one, now would be the time.

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