Infertility After Having a Child: Explanations, Data, Therapeutic Methods, and Beyond
In the United States, secondary infertility affects approximately 11% of couples, making it a common reproductive issue[1][4]. This condition, characterized by the inability to conceive after previously giving birth, is often complex and multifaceted.
The most common causes of female secondary infertility include ovulation disorders, Polycystic Ovary Syndrome (PCOS), endometriosis, and various structural anomalies or hormonal imbalances[2][5].
Ovulation disorders disrupt regular or effective ovulation, accounting for approximately 25% of female infertility cases globally[2][5]. PCOS, the leading cause of ovulation-related infertility, involves hormonal imbalances linked to symptoms like acne, obesity, insulin resistance, and excessive facial or body hair[2][5].
Endometriosis, a condition where uterine tissue grows outside the uterus, affects about 15% of infertile women[5]. It can lead to pelvic adhesions (12%) and tubal obstruction (11%), which impair fertility[5]. Other factors include tubal or uterine abnormalities (about 11%) and hormonal issues such as hyperprolactinemia (7%)[5].
Male infertility can also contribute to secondary infertility, with conditions such as Y-chromosome microdeletion, Klinefelter syndrome, and myotonic dystrophy leading to a low sperm count or no sperm[6]. Varicocele, a condition involving large veins within the testicle, may affect sperm shape and number[6].
Lifestyle habits like excess alcohol consumption and smoking can also contribute to male infertility[3]. Prostate enlargement, reduced hormone production, complications of advanced diabetes, and irritable male syndrome are examples of effects of aging that can result in male infertility[6].
Chlamydia and gonorrhea, sexually transmitted infections, can lead to pelvic inflammatory disease (PID), which can cause difficulty getting pregnant[7].
Diagnosis of secondary infertility may involve a medical history, pelvic exam, semen analysis, blood tests, and ultrasound[3]. Treatment for secondary infertility may include medications to improve fertility, surgery to manage an underlying condition, and assisted reproductive technology methods such as intrauterine insemination (IUI) or in vitro fertilization (IVF)[1].
Assisted reproductive technology options for secondary infertility include inserting collected sperm into the uterus, injecting a single sperm into an egg, mixing sperm with an egg outside of the body and later placing it in the uterus, freezing eggs, and other methods[1].
Uterine conditions such as fibroids, adhesions, adenomyosis, and congenital anomalies can increase the risk of infertility[3]. Early diagnosis and treatment increase the chances of conception with medical assistance such as fertility medications or in vitro fertilization (IVF)[1].
[1] Mayo Clinic. (2021). Secondary infertility. https://www.mayoclinic.org/diseases-conditions/secondary-infertility/symptoms-causes/syc-20350686 [2] American College of Obstetricians and Gynecologists. (2018). Infertility. https://www.acog.org/womens-health/faqs/infertility [3] American Society for Reproductive Medicine. (2021). Male infertility. https://www.asrm.org/resources-and-publications/patient-resources/infertility-101/male-infertility [4] Centers for Disease Control and Prevention. (2020). National Survey of Family Growth 2017-2019. https://www.cdc.gov/nchs/nsfg/keystats/nsfg_2017-2019_inf_t_fertility_rate.htm [5] World Health Organization. (2018). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility [6] National Health Service. (2021). Male infertility. https://www.nhs.uk/conditions/infertility/male/ [7] Centers for Disease Control and Prevention. (2021). Sexually Transmitted Diseases. https://www.cdc.gov/std/default.htm
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