Understanding the Causes of Secondary Infertility and Treatment Options
Some couples may experience challenges conceiving or giving birth despite previous successful pregnancies. These obstacles typically hinder partners from reaching their family size easily and early. Secondary infertility is the inability to conceive or to deliver a baby where there has been previous successful delivery of at least one child after trying for 12 months before age 35 years and after six months after age 35 years.
Secondary infertility affects at least 11% of couples in the United States. Male and or female causative factors are responsible for secondary infertility. Medical conditions or diseases that impair ovulation and fertilization or damage the male or female reproductive tracts can cause secondary infertility.
In this article, you will learn more about the male and female causes of secondary infertility and the available treatment options.
Causes of Secondary Infertility in Females
Medical disorders and diseases that affect the female reproductive system and hormones are causes of secondary infertility in females. Here are common causes of female secondary infertility.
Ovulation disorders include anovulation, which is the inability of the ovaries to release a matured egg during the menstrual cycle. Females with anovulation may not get pregnant because fertilization cannot occur without a matured egg. Oligo-ovulation is ovulation at irregular intervals, often unpredictable, resulting in irregular menses.
Ovulatory disorders account for approximately 25% of female infertility cases. Polycystic ovarian syndrome (PCOS) is the most common ovulation disorder and causes 80% of anovulation infertility. PCOS inhibits the normal cyclical hormone regulatory processes that control ovulation, affecting a female’s ability to get pregnant.
Fallopian Tube Blockage
The sperm fertilizes the egg in the ampulla region of the fallopian tubes. Hence, damage or blockage of the tube hinders the sperm from reaching the egg for fertilization. Infections of the fallopian tubes trigger inflammatory reactions that can damage and block the fallopian tube, especially in chronic pelvic inflammatory diseases. Another risk factor for tubal infertility is a history of pelvic surgery, potentially leading to scar tissue.
Chronic infections and procedures such as dilation and curettage predispose the uterine wall to form scars and adhesions that impair the implantation of the fertilized egg. Also, uterine fibroids, especially the submucous types, may impair implantation and lead to secondary infertility.
Genital Tract Infections
The Centers for Disease Control (CDC) reports that approximately 1 out of 8 women with a history of pelvic inflammatory diseases experience difficulties getting pregnant. Chronic or poorly treated Chlamydia or Gonococcal infections of the genital tract are major causes of female secondary infertility.
Endometriosis is a medical disorder in which the cells lining the uterus, called the endometrium, are found outside the uterine cavity. These external endometrial cells may trigger inflammation that affects the reproductive process in the uterus and fallopian tubes necessary for fertilization and successful implantation.
Causes of Secondary Infertility in Males
Male factors account for approximately 20-30% of infertility cases. Here are common male factor causes of secondary infertility.
Some medical conditions may alter the blood level of testosterone, the reproductive hormone responsible for sperm production. Also, brain injury or trauma could damage the pituitary gland or hypothalamus in the brain, which may affect the release of regulatory hormones that control testosterone production.
Genital Tract Infections
Chronic genital infections, such as sexually transmitted diseases, cause inflammatory changes that form scars blocking the sperm transport tubules in the male reproductive tract. This blockage halts the transport of sperm from the testis to the vas deferens for storage.
Damage to Sperm Transport Tubules
After sperm production in the testicles, special transport tubules move matured sperm cells to the vas deferens (the tube that connects the testicle to the penis). However, these transport tubules are at risk of damage in males with previous testicular trauma or pelvic surgeries.
Some medical disorders interrupt the blood supply to the testis, affecting the quality and quantity of sperm cells the testes produce. Examples of medical conditions that could affect the testicular blood supply include :
• testicular torsion
Medications, such as chemotherapy drugs or steroids, affect sperm production and increase the risk of male secondary infertility.
Exposure to Toxic Environmental chemicals
Prolonged exposure to toxic environmental chemicals and radiation damages the testes and affects sperm formation. Examples include some pesticides and heavy metals like lead.
Lifestyle and Unhealthy Habits
An unhealthy lifestyle typically affects the formation and quality of sperm produced in the testes. Hence, males who engage in unhealthy habits such as alcohol and tobacco intake are more prone to secondary infertility than those who avoid these habits.
When to Seek Treatment for Secondary Infertility
If you suspect you or your partner may have secondary infertility, consult a fertility doctor for evaluation.
During your visit to the fertility clinic, the doctor will take your clinical history, conduct a clinical examination, and order tests for diagnostic purposes.
For females, the doctor will take the following clinical history:
• duration of infertility
• your last menstrual period
• menstrual cycle length and frequency
• past pregnancies and their outcomes
• history of medical disorders, including STDs and past pelvic surgeries
• intake of medications such as birth control pills, etc
• sexual history
Subsequently, your doctor may conduct a pelvic examination and ultrasound to evaluate your reproductive organs.
While for males, your doctor may take the following clinical history:
• testicular trauma
• history of infections such as orchitis or mumps
• use of medications or previous testicular surgeries
• exposure to toxic chemicals
• use of tobacco, alcohol, and illicit drugs
Thereafter, your doctor may perform a pelvic exam to examine your male reproductive organs.
Tests for Secondary Infertility
Your doctor will typically order some tests to identify the underlying cause of secondary infertility and to select the most appropriate therapeutic intervention.
For females, here are some of the common fertility tests:
• hormone profile test
• pelvic ultrasound
• specialized X-ray called Hysterosalpingography to outline the uterus and to check for blocked fallopian tubes
For males, semen analysis is the primary fertility test your doctor will order to assess the following:
• sperm count
• sperm volume
• sperm viability
• sperm morphology to assess any defects in shape
• chemical properties such as pH, etc
Also, your doctor may request other tests based on the clinical history and examination findings. For example, your doctor may request a scrotal ultrasound scan if the examination reveals a varicocele. Also, serum testosterone level is crucial for suspected cases of hormone imbalance as the cause of secondary infertility.
Treatment and Fertility Options for Secondary Infertility
There are various treatment modalities for secondary infertility, and your fertility doctor has the medical expertise to decide the most suitable intervention. Generally, identifying the underlying cause and administering the specific treatment may help resolve secondary infertility. Here are the major treatment options for secondary infertility.
Your doctor will use fertility drugs to optimize the sexual hormones and other specific medications depending on the cause. In females, fertility experts use drugs to induce the ovulation of 1 or more eggs.
Clomiphene citrate is common medication doctors use in fertility clinics. It inhibits the negative feedback effect of serum estrogen in the hypothalamus and pituitary gland. This inhibition enables the pituitary gland to continue secreting gonadotropin hormones that aid the ovulation process and eventually release 1 or more matured eggs.
For males, doctors can prescribe hormone replacement medications in cases of low testosterone blood levels.
Also, your doctor may prescribe antibiotics in clinical cases of chronic genital tract infections.
Surgical procedures may be the most suitable therapy for specific causes of secondary infertility in males and females. For instance, in females with uterine fibroids or severe endometriosis, surgery may be an effective remedy for these medical disorders.
In some clinical cases, your doctor may perform a minimally invasive surgical procedure using laparoscopic techniques— surgeries are done using a laparoscope which is a special tube with an attached camera.
For males with varicocele, a doctor may recommend surgical intervention to repair the dilated testicular veins.
Assisted Reproductive Technology
Assisted reproduction technology (ART) is a fertility-based treatment that involves the manipulation of eggs or embryos to aid conception. The two most common types of ART are in-vitro fertilization and intracytoplasmic sperm injection (ICSI).
After stimulation of the ovaries with injectable medications, ART involves obtaining eggs from the ovaries through a small outpatient procedure.
In vitro fertilization involves the exposure of each egg to several sperm in the laboratory, eventually resulting in a fertilized egg, now called an embryo. Intracytoplasmic sperm injection (ICSI) is an alternative method of aiding fertilization, involving the injection of a single sperm directly into each egg in the laboratory resulting in an embryo. After the creation of the embryo through either IVF or ICSI, the embryo grows in the laboratory, and then eventually, the embryo may be transferred to the uterus to achieve pregnancy.
Do you Need Help with Secondary Infertility?
Secondary infertility in males and females is due to various causative factors. Hence, it is essential to seek help from qualified fertility experts to help you identify the specific cause and proffer the appropriate solution.
Our team of experts at Reproductive Gynecology & Infertility are qualified fertility specialists with a track record of helping couples with infertility cases. To expand and reach your family size early, seek help from Reproductive Gynecology & Infertility today.