My husband and I have been trying to have another baby for almost a year now. Our first will be three years old this year. However, it is not happening.

The first pregnancy kind of took us by surprise but now, I can’t seem to get pregnant. I went for a checkup and was told that nothing is wrong but I’m really starting to get worried. Why is it taking this long?

Nadia

Dear Nadia,

It seems you are suffering from secondary sterility, that is, failure to conceive while trying for a year after having one child. Almost 50 per cent cases of infertility are those of secondary sterility. Problem is after having one child, the couple delays seeking treatment thinking all is well. 

Usually, conception occurs after the union of a sperm with the ovum. This occurs on the day of ovulation, which falls from the 14th day to the 21st day of menstruation (counted from the first day when menstrual bleeding occurs). The fertilised ovum is carried by the fallopian tube and implanted in the uterus, where it takes shape, grows and a baby is delivered at end of nine months. Any disruption in this entire process will lead to sterility.

A good balance of hormones is needed for fertilisation and nurturing of the fetus. Any hormonal imbalance can lead to failure of conception. This can be due to disorders of pituitary, thyroid gland or even ovaries, which may have developed recently. Hormonal contraceptives taken after the delivery of the first child can delay or disrupt fertility. High prolactin levels persisting after the birth of the first child can delay conception of a second child.

Pelvic infections, sexually transmitted diseases, interventions done during the first child birth causing pelvic infection, use of intrauterine device causing infection, etcetera, can block the fallopian tubes, thus preventing the fertilised ovum to travel up to the uterus, preventing pregnancy. 

Infection of the inner lining of the uterus or uterine fibroids can also disrupt fertility. As the age of a woman advances, fertility usually declines after 35 years or so. Use of alcohol and or tobacco disrupts the normal hormonal balance of the body leading to secondary sterility. 

The underlying cause for secondary sterility may lie with the male partner. Use of alcohol and tobacco disrupts hormonal balance in men as well, causing infertility. Very tight underpants or use of nylon underpants can increase scrotal temperature thus reducing the sperm production. Putting a laptop on the lap for long hours continuously is also associated with reduced sperm count. Viral infections like mumps in childhood or recent infections of testes impair normal sperm production.

It is also very important for both partners to be relaxed and stress free, when together. Stress can cause spasm of the reproductive tubes, thus impeding conception. Coitus when planned as per the days of ovulation is more effective, when a baby is desired. This can be known by recording basal body temperature in the morning (which may be elevated) or serial ultrasound studies.

Dr Rachna is a specialist in internal medicine at Ruhengeri Hospital