What is Secondary Infertility?
Secondary infertility is generally defined as patients who have already had at least one past pregnancy, but who have been trying for greater than one year to conceive again. Others who qualify for secondary infertility include patients less than 35 years of age or patients greater than 35 years of age who have been trying to conceive for six months. The first pregnancy does not need to necessarily be a live birth, but rather could have been an ectopic pregnancy or miscarriage. Secondary infertility affects approximately 20% of all the patients we see at Coastal Fertility Specialists.
Secondary infertility is clearly very frustrating in that things have worked in the past, but are no longer working. During your new patient consultation your physicians at Coastal Fertility Specialists will help determine what may have changed resulting in the new diagnosis of infertility and ways that we can help to improve the outcome.
The evaluation of secondary infertility typically includes a hysterosalpingogram to look for any new changes in the functioning of the fallopian tubes. Sperm counts can also change over time with the new diagnosis of male factor infertility coming from the new use of male hormones, new medications, recent surgery, illness and stress.
Decreased ovarian reserve (decreased egg number and quality) is one of the most common causes of secondary infertility and is measured through a Day 3 measurement of estradiol, FSH and LH and typically through a newer hormone measurement called anti-mullerian hormone (AMH). A baseline ultrasound is performed during a new patient visit to look for any changes in the uterus over time such as uterine fibroids. That same baseline ultrasound can help count the number of antral follicles in the ovary which is also a very sensitive measurement of ovarian reserve.
Secondary infertility has one of the highest success rates of all forms of infertility as there is generally something new causing the infertility that hopefully can be overcome to help you conceive again. If the hysterosalpingogram is normal, sperm count is normal and ovarian reserve testing appears reasonable, we typically would recommend proceeding with simpler forms of treatment such as ovulation induction and intrauterine insemination.
At Coastal Fertility Specialists, the ovulation induction and intrauterine insemination process generally starts with a combination of Letrozole and gonadotropins which in combination helps to lower overall treatment costs and improve pregnancy rates. Pregnancy rates ultimately depend on the cause of secondary infertility and the female age, but range from 15% to 20% per treatment cycle.