Cause and treatment of secondary infertility

DR MAXWELL ADEYEMI

Infertility is a disease of the reproductive organ characterised by the failure to achieve a clinical pregnancy after 12 months of regular, unprotected sexual intercourse.

There are basically two types of infertility: primary and secondary.

Primary infertility simply means a woman has never been able to bear a child, either because she cannot get pregnant or because she is not able to carry pregnancy to a live birth.

Secondary infertility is when a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth.

Generally, the rule of thumb is, if the woman is 35 years old or under and has been trying to conceive for one year without successful pregnancy or over 35 years old and trying to conceive for six months, it is time to seek advice from a reproductive endocrinologist or fertility specialist.

Causes of secondary infertility in women

Problems in the quantity or quality of eggs: women are born with a limited supply of eggs and are unable to create new eggs after birth. As women approach their 40s and beyond, the numbers of eggs left in their ovaries decrease, and the remaining eggs have a higher chance of having chromosomal problems.

For women where age isn’t a concern, there are other reasons that can cause a low number of quality eggs, including autoimmune or genetic conditions and prior surgery or radiation.

Problems with the fallopian tubes: the fallopian tubes, which carry eggs from the ovaries to the uterus, can become blocked due to pelvic infections such as chlamydia or gonorrhoea.

Problems with the uterus: there are many conditions related to the uterus that can cause secondary infertility. Scarring can occur during a dilation and curettage (D&C) or Caesarean delivery that can create adhesions inside the uterus that interfere with future pregnancies Fibroids or polyps are benign (non-cancer) growths inside the uterus that can impair pregnancy. A retained placenta can cause infection and uterine scarring.

Endometriosis: endometriosis is a condition where tissue that normally grows inside the uterus grows elsewhere in the body, such as on the ovaries or bowel surfaces. While endometriosis is common, not all endometriosis causes infertility.

Polycystic ovary syndrome: this is a hormonal disorder characterized by longer-than-normal or infrequent menstrual periods. A woman with this condition has an excessive quantity of male hormones, and the ovaries fail to release eggs regularly.

Breastfeeding: if a woman feeds her baby only by breastfeeding, her body stops ovulating or releasing eggs for potential fertilization.

Weight gain or other lifestyle changes: weight gain can lead to ovary dysfunction in some patients. Certain diets may affect fertility. Medications may also affect fertility.

Causes of secondary infertility in men

Reduced testosterone level: testosterone plays a key role in sperm production. Testosterone levels can decline due to ageing, injury to urinary or genital organs, or certain medical conditions. These conditions include: genital infections, thyroid diseases, diabetes, tuberculosis, mumps, smallpox, blood diseases, benign tumours, emotional stress, myocardial infarction, coma, stroke, respiratory failure, congestive heart failure, burns, sepsis.

Testicular varicocele: this is an enlargement of veins in the scrotum, or the sack of skin encasing the testicles. This condition is a common cause of low sperm production and infertility in men. About 30 per cent of infertile men have testicular varicocele.

Poor-quality semen: after age 40, the quality of semen (the fluid that carries the sperm) tends to decline.

Prostate enlargement: this can lower sperm count and hinder a normal ejaculation (the discharge of semen from the body).

Prostate removal: the prostate may be removed due to cancer or other conditions. Removal of the prostate can cause semen to flow backward, a condition known as retrograde ejaculation.

Late onset hypogonadism: this is a condition where there is a reduction of hormone secretion.

Certain drugs that affect sperm count and quality include some antibiotics and medication that treat high blood pressure. Sperm quality can also be affected by treatments for the following conditions: prostate cancer, enlarged prostate, fungal infections, stomach acid, urinary tract infections, arthritis, gout, pain, cancers, seizures, schizophrenia.

Toxic chemicals: use of certain commercial sexual lubricants that are toxic to sperm as well as exposure to pesticides, lead, industrial chemicals and excessive heat can all impact a man’s fertility.

Excessive weight gain: this can decrease testosterone levels and increase oestrogen levels.

Regardless of whether infertility is primary or secondary, treatments are similar and may include:

• Medications, including clomiphene (clomid) and letrozole, to induce ovulation in women with an ovulatory disorder.

• Intrauterine insemination (IUI), which involves surgically placing sperm inside a woman’s uterus, to increase the chance of fertilization. Sperm donors can be used in IUI.

• In vitro fertilization (IVF), which involves daily injections to stimulate the ovaries, a surgical procedure to retrieve eggs, egg fertilization in a lab to make embryos, growth of embryos in the lab, and transfer of an embryo into the uterus. Egg or sperm donors can be used in IVF. While not legal in all states or countries, a gestational surrogate (a woman unrelated to the child) may be involved in IVF to carry the pregnancy to term. For women without a partner or who desire future fertility, egg freezing can be done before fertilization so that the eggs can be stored for future use.

• Surgery to repair uterine-related problems: Doctors can repair structural problems, such as removing scar tissue, polyps, and fibroids from the uterus. Surgery to repair testicular varicocele.

Contact Dr Maxwell at 363-1807 or 757-5411.