Why Can’t I Have Another Baby?

Almost half of infertility occurs following an initial pregnancy that may have occurred soon after discontinuing contraception.  This problem, known as secondary infertility, is often overlooked or downplayed by physicians who see these patients as being fertile and are then reluctant to evaluate or treat.  Maternal age and the duration of secondary infertility are critical issues.

We know that women are born with a certain number of eggs – they never make any more eggs the rest of their life.  The number and quality of eggs declines as a function time, resulting in a significant decrease in pregnancy rates after age 35, and a drastic decrease after 38.  Infertility is defined as a lack of conception after one year of unprotected intercourse.  For individuals 35 years or older, most reproductive medicine specialists recommend initiation of a work-up after four to six months of trying.  Ultimately, again, remaining egg number and quality are the critical issues.

Evaluation for secondary infertility should be identical to that of primary infertility targeting those issues that are most suspect.  Almost 40% of all infertility is male related.  Even if a male has fathered a child, semen parameters can change drastically due to a variety of health changes including medical problems, surgeries, traumas, or infections.  A semen analysis will evaluate a male’s current fertility status.  If there has been a change in male partners, particularly if the new partner has not fathered children, certainly male factor may be the issue.  Almost 50% of infertility is female related, primarily ovulatory or anatomic problems.  While a female may have a history of regular ovulatory cycles prior to, her ovulatory pattern can change drastically following a pregnancy, especially if there has been a significant weight gain.  If prior pregnancy was delivered by cesarean section, adhesion scar formation certainly can occur and be associated with significant tube compromise.  Loss of weight will often bring about a return of regular ovulatory cycles.

If there has been a long time between the first pregnancy and initiation of a second pregnancy, certainly the issue of egg quality may be the problem, especially if mom is now over age 35.  Strategies to try and improve fertility due to an egg quality issue include superovulation (getting the patient to release multiple eggs) or in vitro fertilization (transferring more than one embryo back to the uterus).  If the initial pregnancy was delivered by cesarean section and especially if there was a history of infection, adhesions may be causing a tubal factor.  If there was retained placenta following delivery, uterine scarring can occur – hysteroscopy (outpatient surgery – scope is used to look into the uterine cavity) should be considered.  With a significant time delay before initiating a second pregnancy, conditions like endometriosis, the growth of endometrial tissue outside the uterine cavity, i.e. in the pelvis, may cause significant anatomic distortion.  Likewise, fibroid tumors that may have been small and clinically insignificant prior to pregnancy may now be large and compromising fallopian tubes or the uterine cavity.

In conclusion, secondary infertility is a very common problem.  Delaying evaluation and treatment is often associated with severely diminished chances for pregnancy.  Secondary infertility should be approached in an aggressive, targeted manner especially in the context of advanced maternal age.

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14 Comments

  1. Sheetal
    Posted April 8, 2012 at 7:09 am | Permalink

    I tried IUI last 2 yrs back & m/c at 9 weeks. Please let me know if I can try to get pregnant now at 35 yrs of age. What would be the best option IVF or IUI. Thank you.

  2. Posted April 19, 2012 at 7:34 am | Permalink

    Absolutely trying to conceive at 35 is reasonable. It would be important to review your case to determine the best option. Our goal is to always help you conceive as easily and most cost effectively as possible. Thanks, Dr. McCoy

  3. Amanda
    Posted May 26, 2012 at 10:23 am | Permalink

    I have a child that is 8 years old and would like to have another one. I had to take fertility pills to get pregnant with her. But before I got pregnant with her I found out that I have PCOS. I had a miscarriage at 8 weeks before getting pregnant with my daughter. I haven’t been on any birth control since the day she was born. I was over weight which I know had a lot to do with it. But this past year I made my mind up to lose weight and as of right now I have lost a total of 30 pounds and would very much like to get pregnant again. I’m 34 years old, married to the father of both pregnancies. Do you think with me losing the weight and taking the fertility pills that I would be able to get pregnant the natural way with out having to do IVF or anything to that extreme. Is there any suggestions that you can give me to ask my GYN doctor when I go for my physical next month.

    Thanks for any advise.

  4. Posted May 26, 2012 at 7:39 pm | Permalink

    There are a lot of factors that can come into play when not conceiving. If it has been that long with you trying, your best bet would be to talk to a fertility specialist, as your general Gyn may not be able to adequately discuss what issues may be affecting your fertility and may only be able to give you limited assistance.

  5. Mimi
    Posted June 25, 2012 at 4:23 pm | Permalink

    Hi I miscarried 4weeks ago but I also received and abnormal pap my dr says I have to have a Leep prodecure ASAP I asked him if it would stop me from having kids he replied that shouldn’t b a concern at this point should I see someone else because I don’t want him doing surgery and not wanting to answer my questions

  6. Posted June 27, 2012 at 9:18 pm | Permalink

    A LEEP wouldn’t usually keep you from conceiving in the future. This is a fairly simple procedure that your ob/gyn can manage. Any abnormality treated by this would not have been related to your recent miscarriage.

  7. Laurie
    Posted July 10, 2012 at 12:56 pm | Permalink

    I’m currently preparing to concieve,I have had a womens wellness check up and will be having mammogram soon.Dr. Winslow comes to the town and office of my gyno.My question would be,when i do consulate with Dr. Winslow,will he be performing his own check up? The reason for this question is to understand if i can have these check ups done by him or just keep seeing my gyno until i consultate with him.

  8. Heather
    Posted July 14, 2012 at 1:56 pm | Permalink

    I have PCOS and I have 2 children which I concieved on my own. I did go through fertlity shots before them which ended in a tubal. I have been trying to concieve # 3 for about 8 years now. I am frustrated at my doctor as he doesn’t seem to care. I have taken clomid for about 6 months off and on and now he tells me anything over 4 months can cause cancer. Are there any other tests that I should be doing? hysterosalpingography? Your thoughts?

  9. Posted July 15, 2012 at 6:15 pm | Permalink

    You should see your regular gynecologist for your routine checkups and annual exam. Dr Winslow will work to address fertility issues with you.

  10. Posted July 15, 2012 at 6:21 pm | Permalink

    With such a long time between conceptions, you should be evaluated in order to find out why a pregnancy is not occurring. Clomid does not cause cancer, but if you are not conceiving within a few months, other things should be looked at. I would recommend that you see us to help sort out your situation.

  11. Shai
    Posted August 21, 2012 at 5:19 pm | Permalink

    Hello I have a 14 year old son and I am now married to the love of my life. It has been two years and no conception. I had an etopic pregnancy about 11 years ago and I only have one tube now. Although my grandmother conceived four children from one tube I was hopeful after my surgery. Now at age 30 I want to have more children. I don’t know where to start since the natural way doesn’t seem like an option at this point.

  12. Posted August 25, 2012 at 7:42 pm | Permalink

    At 30, if not conceiving in at least 6 months, you should definitely see us to talk about trying to find out what may be going on and how to best help you. You can call our office and we would be happy to see you very soon. Thanks, Dr. McCoy

  13. Posted October 8, 2012 at 10:33 am | Permalink

    At 34 I have 2 kids and my hubby has none.We have been trying now for 3 yrs with 3 recurrent miscarriages all at 6 weeks and a tubal removal from eptopic pregnancy this march pass. They had a hard time retrieving my placenta and plus I was recently diagnosed with hashmoto thyroid disease.At this point would it be best to just do IVF.

  14. Posted October 9, 2012 at 8:08 pm | Permalink

    We would need to sit down and talk about your situation in more detail. An evaluation of the recurrent miscarriages is definitely something to look at. Now with only having one tube functioning, you could still conceive, but it can take longer. The hashimoto’s isn’t really an issue for conceiving, but that needs to just be in a stable position. We can definitely talk about IVF as an option, it is always the fastest way to a pregnancy and may be a good choice in your case.

    Thanks,
    Dr. Travis McCoy