If you've already had one child naturally, surely you should be able to have another, right?
Unfortunately, this is not always the case.
Increasing numbers of women are suffering from secondary infertility. Head of Clinical Services with My Fertility Check, Mary McAuliffe, explains what it is and has some helpful advice.
The desire to have children is a powerful, all-consuming urge and it can be even stronger following the birth of your first child. But sometimes, becoming pregnant a second time can prove very difficult – even if your first pregnancy was natural and happened easily.
Secondary Infertility is defined as the inability to become pregnant following the birth of one or more children... and it’s on the rise – mostly because of the corresponding increase in age of first time mothers. It’s estimated that secondary infertility now accounts for six out of every ten cases of infertility.
So how do you know when it’s time to seek help? You should see a fertility specialist if you are over 35 and you have been trying for a baby without success for six months. If you are younger, you should seek help after a year of trying.
Many of the causes of secondary infertility are similar to those seen in couples who have never had a pregnancy previously. Below are some examples of the more frequent causes:
Reduced Ovarian Reserve
You might have had your first baby in your late twenties or early thirties and it could be that you are now struggling to conceive in your late thirties or early forties. This is because the number and quality of eggs a woman has declines as she ages, so if a couple are struggling to conceive for a second or third time, it can commonly be a result of diminished ovarian reserve.
What to do:
Simple basic fertility investigations, including a hormone profile to check FSH and AMH levels, in conjunction with an ultrasound of the ovaries, can help to asses a woman’s ovarian reserve. This assessment should be arranged with a fertility specialist, who can advise the best course of action depending on your results.
Pelvic problems
Pelvic adhesions can be caused by pelvic infection, previous abdominal surgery or endometriosis (when tissue from the womb is found outside of it – most commonly on the pelvic lining, the ovaries or fallopian tubes) and can lead to blockages in the fallopian tube, meaning the fertilised egg cannot travel to the womb as normal. If there is a history of a previously complicated delivery, i.e. an emergency Caesarean section or a delivery complicated by infection, then there is an increased likelihood that there may be a problem with the fallopian tubes.
What to do:
A simple pelvic scan carried out by a fertility specialist can identify tubal problems or ovarian endometriosis. An X-ray of the fallopian tubes can determine if they are open, while surgical treatment of endometriosis can improve the chances of conception naturally. IVF might be recommended if there are significant problems.
Thyroid problems
The ovaries are very sensitive to changes in thyroid levels and an underactive or overactive thyroid can trigger imbalances in the body that will directly affect your fertility. Your thyroid function can change after a pregnancy, which can have a knock-on effect on your reproductive functions.
What to do:
The first step is to get the problem diagnosed – a simple blood test can diagnose an under- or over-active thyroid and treatment can be initiated to correct the thyroid hormone imbalance. It is important to have healthy thyroid hormone levels prior to and during pregnancy.
Male factor
The quality and quantity of a man’s sperm can also change over time just like a woman’s fertility and, this can be down to changes in health or medication.
What to do:
A simple semen analysis carried out by a fertility specialist can determine if there are any issues with the sperm production and a number of treatment options are available depending on the specific problem.
Lifestyle issues
A variety of lifestyle choices can also have a major effect, the two most important being smoking and weight. Smoking is directly responsible for up to 13 per cent of infertility and is also implicated in complications in pregnancy. Obesity has a negative effect on both male and female fertility; those who are overweight are less likely to conceive naturally or with fertility treatment. Likewise, being significantly underweight can cause irregular ovulation for the woman, which has a knock-on effect on her ability to conceive.
What to do:
It is strongly advised that couples quit smoking immediately and maintain a healthy weight. Find an exercise you enjoy and partake in it at least once a week, eat a varied and healthy diet avoiding processed foods, fizzy drinks and reduce your caffeine and alcohol intake.
Mary McAuliffe is Head of Clinical Services at Cork Fertility Centre.
Check out their simple fertility assessment at myfertilitycheck.ie or on Twitter. 
