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Infertility comes back to haunt many couples that can’t get pregnant again when they want to. They already have a child or children and see friends and acquaintances becoming pregnant again and again and yet again. For one reason or the other, they are unable to join “the club”.
After having the first baby, getting pregnant again may not happen easily. You and your spouse want to have another baby, but pregnancy is stubbornly elusive this time around. This is a surprisingly common problem.

Questions like – “When are you going to have another baby?”… “Do you want an only child?”… “Don’t you think it’s kind of selfish to have only one?” … “When are we celebrating another birth?”… so on and so forth.  Each question hurts. They hurt, physical pain, like being punched in the stomach. And then a brave smile that makes us feel isolated and alone. Again.
I’m being left behind again. I’m less than again. This hurts, again.
Or even the child’s question– “When will I be a big brother or sister?” Seeing your child holding someone else’s’ new born brother or sister might be a glaring reminder of your family’s incompleteness.

Many couples have no problem conceiving the second time around, but millions of couples struggle to conceive again. It is not uncommon in the fertility industry that 1 in 4 couples seeking treatment are already parents.

Some may have had trouble conceiving the first time, so they know what they’re up against when they try again. But many others have been stunned to learn that infertility, past success is no guarantee of future success. A new mother may develop an infection without realizing it. A woman who’s never had a baby before can be completely unaware of how much postpartum pain or bleeding is normal, and many women have symptoms of infection they never report. Their diminished fertility won’t be discovered until they try to conceive again. While it isn’t uncommon occurrence, the good news is that you’re more likely to have a successful second pregnancy if you already have a child.
As discussed last week, secondary infertility is the inability to conceive or carry a pregnancy after the delivery of a child previously. When a couple is unable to attain a pregnancy after one or more previously successful outcomes, so many factors could be responsible.
One of the lessons in human biology is that fertility is not always within human control. Many couples who easily conceived and carried their first child, often face an unexpected diagnosis of secondary infertility. Parents who, after 12 months of unprotected intercourse, fail to conceive another child or suffer recurrent miscarriage also fall into the equation.
Secondary-infertility patients are in a kind of no-man’s land. As parents, they’re not wholly accepted by the infertility world because they already have a child. Yet they feel alienated from the fertile world because they cannot conceive. Many couples are told that they should be grateful for the child they have. They are grateful, but that doesn’t take away the longing for another child. The desire is just as urgent and as desperate and as it was the first time around.

People with secondary infertility may be only half as likely to seek treatment as those facing primary infertility. This reluctance stems from emotional denial. It is often assumed there’s no medical reason when couples who have previously demonstrated their fertility take an unusually long time to conceive. Unfortunately, such a wait-and-see approach tends to allow an untreated problem to become an untreatable one.

Also last week we identified the age factor. A woman’s most fertile years are between ages 15 and 30, with a drop-off occurring at 30 and a quite precipitous plunge at 35. Many women are unaware of this reality and delay first-time pregnancy until 30 or beyond. That means they are even older when seeking a second. A woman’s eggs suffer chromosomal damage with age; the older the eggs, the more damaged they are, and the less likely they are to become fertilized or becomes babies
Passing time also means that other conditions, not specifically age-related, can develop where they didn’t previously exist. Hormonal shifts or other endocrine problems can crop up, altering the body’s delicate balance. More often, though, the reason for the change can’t be pinpointed, making the diagnosis especially bewildering.

It’s no surprise that one of the most important factors that influence a couple’s chance of getting pregnant is age. Women in their mid- to late-30s and older are more likely to experience secondary infertility since their eggs quality have been lost with age. Changes in hormones and risk for certain diseases also increase as with age, and both can impact fertility. But if you are in your mid-30s and are still waiting for a second child, don’t despair: Just because it might take you longer to get pregnant doesn’t mean you won’t get pregnant again.

As both men and women delay childbearing, an emerging disorder is being recognized, that of the aging gamete. As women enter the last decade of their reproductive capacity, anovulation, spontaneous abortions, and decreased fertilization are much more common. The overall quality of the egg is diminished and genetic errors are more common. Men too have their issues with bad and abnormal sperms.

Infertility is regarded as a two-patient disorder, couples are evaluated, counseled, and included in the therapeutic decision-making processes. Exclusion of the male partner may lead to feelings of isolation in the female and to disinterest and lack of cooperation of the male partner.
Infertility evaluation and treatment is not cheap, but not having the fulfilment of completing your family is far more expensive. Infertile couples spend their money in pursuit of infertility treatment because it is a need. The financial burden is often left with the infertile couple. Evaluation of fertility issues may be extremely stressful to some married couples. Loss of privacy, disruption of spontaneous sexual habits, and a feeling of reproductive failure or inadequacy are frequent causes of depression, anxiety, and grief in these patients. As practitioners we are aware of the psychological impact of infertility, we are therefore sensitive and understanding to the patient’s needs. Referral for counselling or to local infertility support groups help.
The infertility evaluation serves to determine the etiology(ies) of infertility as expediently as possible; provide the couple with recommended treatment protocols;  determine expected success rates and approximate costs for recommended therapy, and educate the couple about their specific disorder and available alternatives.

Certain percentage of patients are merely seeking diagnosis and do not intend to pursue therapy or cannot afford recommended diagnostic tests or treatment. Some couples proceed with adoption, while others comply with specific medical and/or surgical therapy

Practically, the amount of time to be allowed before consulting a fertility expert operates on a sliding scale according to age. Even at the peak of fertility, a woman’s chances of conceiving during any given cycle are about 30 percent. Rule of the thumb is this: If you are under 35, give it 12 months; if you are over 35, you should try for 6 months. If you’ve had no success after six to nine months of treatment, see a fertility specialist.

If you’re struggling to conceive but still hoping for another child, don’t lose hope. Patience is good, but don’t wait too long to get help. Secondary infertility is more likely to be treatable than primary infertility. If you act promptly, consult with a specialist, and faithfully follow the prescribed treatment plan, you have every reason to feel confident that eventually, you’ll have another baby.

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