Trying for Baby No.2, but it’s just not Happening?

1. Maternal Age: Maternal age is a significant factor and often the most important indicator of a woman’s chance of conceiving as egg quantity and quality begins to decline as we age. Conception rates for healthy couples are, at best, 20-25 per cent per menstrual cycle. Once a woman reaches the age of 35, her fertility begins to decline. By age 40, it is estimated that her conception rate is in the range of 8-10 per cent per month and at age 43, the pregnancy rate is thought to be as low as 1-3 per cent per month.
2. Female Factor: 
   – Irregular menstrual cycles may suggest a problem with ovulation and result in difficulty conceiving. The average length of the menstrual cycle is 28 days, but can range between 25-35 days. The female menstrual cycle is determined by a complex interaction of hormones, so any hormone imbalance can make your period irregular. While in most cases, irregular cycles are not dangerous, it is important to determine what is causing the irregularity. Pinpointing your precise ovulation dates is crucial too.
   
   – Blocked fallopian tubes are more common in secondary than primary infertility. If the egg can’t meet the sperm, normally due to a blockage, conception will be very difficult.
   
3. Male Factor: Poor sperm function resulting in not having enough moving sperm per ejaculate can impact conception. Unfortunately, having a previous pregnancy is not proof that this is the case. Developing and transporting mature, healthy, functional sperm depends on a specific sequence of events occurring in the male reproductive tract. Many disturbances can occur along that path, preventing cells from maturing into sperm or reaching the woman’s fallopian tube where fertilisation occurs.
4. Lifestyle: Weight is a common factor affecting fertility success. For women, ovulation can be impacted by being either underweight or overweight, and studies have shown that bringing BMI within the normal range can assist ovulation to occur normally, thus increasing the chances of pregnancy. It’s also very important for men to ensure a healthy BMI, and studies have consistently linked obesity to a lower sperm count because testosterone levels drop while oestrogen levels rise in men who are overweight.
5. Unknown: Unfortunately, it is estimated that roughly ten per cent of infertility remains unexplained even after complete medical evaluation.

As always, you should seek the advice of a fertility specialist after 12 months if you are under 35, or after six months if you are over 35, and have not fallen pregnant.

Following a thorough investigation to try and determine the cause of secondary infertility, these are some of the more common treatment options I often recommend on a case-by-case basis:

• Ovulation Induction: This involves the use of medication (Clomid or follicle stimulating hormone) to stimulate the ovaries and encourage or regulate ovulation. Ovulation induction is often combined with Intra-Uterine Insemination – a procedure in which sperm is directly inserted into a woman’s uterus in order to improve the likelihood of fertilisation.

• Surgery: For women, surgery can often improve their chances of conception when the cause of infertility can be traced to past inflammation or infections which have created scarring, or conditions such as fibroids, endometriosis and other tubal or uterine issues.

• Intracytoplasmic Sperm Injection (ICSI): This method is used for more severe forms of male infertility. It involves the selection and direct injection of a single sperm into the substance (called cytoplasm) of the egg.

• In Vitro Fertilisation (IVF): IVF is used to treat infertility that has failed to respond to other medical or surgical interventions. IVF involves the fertilisation of the egg by the sperm in an incubator outside the body, and transfer of the embryo back into the uterus.

• Healthy lifestyle Encouraging the adoption of a balanced lifestyle where patients maintain a healthy weight, eat well, exercise, minimise stress, limiting caffeine and alcohol intake, stop smoking and drug use.