Secondary Infertility: A Silent Struggle
Some people have never even heard of it. I hadn't, until I was diagnosed with it last year. How is it possible to be infertile once you have already had a child? It turns out there are lots of reasons...obvious ones if you actually think about it. Anything that might cause damage to either partner's reproductive system can cause infertility. Some medicines required for other diseases that are necessary can cause infertility. Early menopause and complications from the first child's birth can cause it. In our case, two weeks before my son was born, my husband had inguinal hernia surgery. When my son was two, we decided to have another child. Two and half years went by. Two and half years of purchasing ovulation kits, monitoring my basal body temperature, trying every imaginable way to help conception, of negative pregnancy tests, tears and heartache. When we finally went to the doctor, she ordered some tests done, and found that my husband not only had low sperm count and low mobility, but the liquid around his sperm was too acidic for the sperm to even get out of the liquid. "How did we get pregnant before so easily?" I asked her. I had gotten pregnant on the first try. As it turns out, scar tissue from my husband's surgery was pushing on the vas deferens, the tube that carries the sperm from the testicle to the urethra. Apparently, according to my OBGYN, men usually have a dominate testicle and my husbands had been compromised, causing the issues they found in his testing. Our diagnosis: secondary infertility.
Our Treatment Plan
My doctor scheduled a meeting with us to discuss our situation. She recommended we try intra-uterine insemination (IUI). IUI is a procedure in which the sperm is washed, concentrated and placed inside a woman's uterus using a small catheter inserted through the uterus. She recommended we try six IUI's to try and get pregnant. I would take Clomid, a fertility drug that aides ovulation. During ovulation, which I monitored through expensive kits, the IUI was performed. A week after I ovulated, I would receive a blood test to check my progesterone levels to make sure I ovulated. We had to pay out of pocket for the IUI's, which cost about $500 each since infertility was not covered under our insurance plan. At the time, we could only afford two procedures. The first one, my progesterone levels were very high, I had ovulated and our sperm sample was very good. Our hopes were high then crashed with another negative pregnancy test. Next month, the second IUI was performed. A week later the blood test showed I had not ovulated that month. Five hundred bucks down the drain. Frustrating.
We could not afford any more IUIs for quite a while. My periods were beginning to become irregular. First they were 30 days apart. Then they were 35, 38, 40...41, 44. I went to the doctor and she told me I was not ovulating every month. My cramps got more painful and would occur sporadically throughout the month with little relief. I began to have intestinal cramps along with my menstrual cramps and at one point was taking 16 ibuprofen a day for pain. My doctor said I needed to go back on birth control until we could do more IUIs. We have yet to save up enough money to be able to perform the remaining four IUIs. In the meantime, I have had to switch anixety medications and the one I am currently on I will have to wean off of before performing the IUIs. This is our current situation.
Treatment of secondary infertility depends entirely on the cause of it. Below you will find some of the more common causes.
Common Causes of Secondary Infertility
Some of the more common reasons fertility doctors see with secondary infertility include:
- Polycystic Ovarian Syndrome. This disease occurs when the ovaries produces too much androgen, which is a male hormone. Excess androgen leads to irregular ovulation or no ovulation at all, which makes getting pregnant difficult or impossible.
- Endometriosis. Endometriosis occurs when tissue similar to uterine tissue grows outside of the uterus, on the ovaries, tubes, bladder and intestines. The tissue irrates the structures it touches and causes scar tissue. The inflammation of the pelvic structures can affect ovulation. Studies show that 30-50% of infertile women have endometriosis.
- Pelvic Inflammatory Disease. Pelvic Inflammatory Disease is caused by a bacteria that infects the pelvic organs including the ovaries and the uterus. It is treated with an antibiotic but can reoccur enough times that scar tissue starts to develop. The scar tissue, just like in endometriosis, can affect ovulation and cause infertility.
- Advanced Reproductive Age. As a woman ages, the number of eggs her body decreases as well as the quality of the eggs. As a man ages, the sperm count and quality also decrease, making pregnancy more difficult and risky at older ages.
- Low Progesterone Levels. Progesterone plays a key role in pregnancy by preparing the lining of the uterus for implantation of a fertilized egg. If progesterone levels are too low, the uterus is not thick enough to support a fertilized egg causing infertility and repeated miscarriages in some cases.
- Thryoid Problems. The thyroid controls hormones that play a part in growth and development. Recent studies have shown that 2.3% of infertile women have an over or underactive thyroid, compared to the 1.5% of those in the general population. The cause and effect of the thyroid on pregnancy has yet to be discovered.
Commonly Given Respones
The two most common responses to our situation are:
- You can just adopt. To that I say: expense. The cheapest private adoption I've found is $10,000. We could adopt through foster care free of charge, but this is no easy task either. In the state of Illinois, where we live, the goal of the foster care system is to reunite with the birth family. Therefore, they do not terminate parental rights of younger children. We would want a child younger than our son, so he would still be the firstborn. Then there are the issues of physical and emotional problems commonly dealt with in the foster care system. My husband also feels that it would be hard on the adopted child if we had one biological child and one adopted child. He has pretty much ruled it out for us.
- At least you have one. Just be satisfied with that. While I am extremely grateful for my one precious boy and am so thankful we had him before becoming infertile, that does not change the grief I feel over our infertility. Anyone who has experienced infertility knows what I am talking about. You grieve as if you have lost a child. No one would tell someone who lost a child, "Well at least you have one left!" It feels almost like that when someone says this to me.
Helpful responses might actually be:
- I am so sorry.
- What can i do?
- Your child must be very special.
- Let's get our kids together to play more often.
Whether you are struggling with secondary infertility or someone you know is, it is important to understand the facts and treatment options available. For those who know someone with secondary infertility, please do not underestimate the turmoil and heartache this issue can cause and especially be sensitive not to downplay it to the person.