After having her first born in 2012, Anita (not real name) has been trying to conceive for the second time but all has been in vain. Her efforts in seeking medical attention have also yielded nothing because even with all the treatment she has been getting, nothing has seemed to work.
She says she didn’t have a problem conceiving her firstborn and that up to now, the doctors still insist that the couple has no medical issue preventing them from getting pregnant.
This has left the 37-year-old devastated and anxious. Nonetheless, she still hopes that one day she will get another chance to conceive and carry her second child.
Though primary infertility normally receives attention, it is not the case with secondary infertility. Yet just like Anita, gynaecologists say many women struggle to conceive their second baby after previously giving birth to their firstborn without difficulties.
This condition is termed as secondary infertility.
Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby.
What causes the condition?
According to Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital (CHUK), secondary infertility shares many of the same causes of primary infertility.
For instance, he says causes such as impaired sperm production, function or delivery in men, fallopian tube damage, ovulation disorders, endometriosis and uterine conditions in women among others can lead to one developing the condition.
Complications related to prior pregnancy or surgery can also contribute to secondary infertility, according to him.
Experts say the risk factors vary with couples and these include age, weight and use of certain medications among other factors.
Iba Mayale, a gynaecologist at Clinic Galien says most of the time, secondary infertility strikes when one is older for example when a woman is 35 years and above.
If one had their first child at the age of 35, and they want to try out for a second child at 36 and above, it can be a bit challenging because this is a time where their fertility has naturally declined significantly, he explains.
Complications related to prior pregnancy can cause secondary infertility. Net photos.
This, he says, is one of the main reasons women find it hard to conceive when it comes to their second or third baby stressing age as a major cause of secondary infertility.
He also notes that such a situation can happen when one meets another partner after previously having a child with a different partner citing a possibility of the new partner having an undiagnosed infertility problem, and that this can apply to either partners.
The gynaecologist says that another factor that could lead to secondary infertility is an underlying fertility problem, which could only worsen after the birth of the first child. For instance, one could be having endometriosis.
Endometriosis is when the tissue that normally lines the inside of the uterus, grows outside the uterus.
“Women with endometriosis often have lower abdominal pain, pain with periods, or pain during sexual intercourse, and may report having a hard time getting pregnant,” he says.
John Muganda, an obstetrician and gynaecologist at Harmony Clinic in Kigali says another factor that could bring about secondary infertility is to do with one’s weight.
He says that if one is over or underweight, it can cause ovulation problems in women, and has a possible impact on sperm health in men as well, thus affecting their infertility in general.
“It’ s common for the new parents to gain weight after giving birth to their first born due to different reasons including stress and lack of sleep. This can only be a reason to put one at risk of becoming infertile,” he says.
Muganda hence cautions that one’s weight matters when it comes to addressing fertility issues because obesity is one of the most common causes of preventable infertility in women, adding that weight can also impact men’s fertility.
According to the American Society of Reproductive Medicine (ASRM), more than 70 percent of women who have weight-related infertility could get pregnant without fertility treatments if they bring their weight to a healthier level.
Muganda however notes that it’s also important to monitor hormonal imbalances because these can lead to weight gain.
“Weight gain at times is not just a matter of having a healthy diet and exercising. The issue can be more complicated than that and seeking help is vital as it helps one understand what the underlying issue could be,” he says.
Sebazungu on the other hand says, when it comes to addressing secondary infertility, couples need to watch out for new health ailments that they could have developed.
“It’s also possible that one of the partners has developed a new health problem, one that they didn’t have in the first place. One could have developed diabetes, or high blood pressure.”
All these, he says could be factors hindering one to have a baby again.
“Any of these illnesses may impact the fertility rate and most of the time it requires them to seek medical attention which can improve their fertility rate once again,” he adds.
Sebazungu also points out a possibility of side effects from the previous pregnancy or birth that could have led to infertility problems; these include pelvic infections and multiple dilation and curettage (D&C) procedures which can lead to blocked fallopian tubes.
Dilation and curettage is a procedure done to remove tissue from inside the uterus. Medics normally perform this procedure to diagnose and treat certain uterine conditions such as heavy bleeding or to clear the uterine lining after a miscarriage or abortion.
Mayale explains that when it comes to blocked fallopian tubes, it keeps sperm from getting to the egg or blocks the passage of the fertilised egg into the uterus thus making it impossible for one to conceive.
Diagnosis and treatment
Depending on the circumstances, Muganda says it’s important for the couple to go for medical evaluations. From here, he says, it will be determined whether there’s an issue that requires a specialist or treatment at a fertility health care.
He notes that a couple experiencing secondary infertility should create a good working relationship with their obstetrician and urologist, this will create a conducive space to rule out more complicated cases and treatment as well, if any.
For a couple who seem to not have any medical conditions affecting their fertility, Muganda says it’s up to the physician to determine what may have changed and what may be required of them in order to have another baby.
Muganda says the treatments for secondary infertility ranges from infertility medications to intrauterine insemination (IUI or artificial insemination).
For instance, he says one can be given infertility medications, which are common oral medications that are used to stimulate ovarian follicles to trigger the release of more eggs.
He adds that injectable medications such as follicle stimulating hormone are also used to produce multiple eggs in a single reproductive cycle. Both are often used in conjunction with intrauterine insemination (IUI).
Although age isn’t anything but a number when it comes to getting pregnant and having a healthy pregnancy, it matters a lot. It’s advisable for married women, to have their children before the age of thirty-five, to avoid pregnancy problems that might occur due to age-related issues.
Yvan Ntwari, general practitioner
As usual, adopting a healthy lifestyle is important when it comes to living a healthy life. Being exposed to bad lifestyle can put one at risk of many diseases and complications, including infertility.
Erick Musengimana, a nutritionist at Rwanda Diabetic Association
While pregnant, it’s important that the mother adheres to all the antenatal appointments to avoid problems when it comes to giving birth. Also, maintaining a balanced diet helps ensure a healthy pregnancy.
Sandra Busingye, a medical student
If a couple is having fertility problems, most of the time it’s women that tend to be blamed. This kind of mind-set shouldn’t be encouraged and both should seek medical attention as a couple.
Claudine Uwajeneza, nurse