Secondary Infertility: Most Common Causes

Like primary infertility (no pregnancy achieved), secondary infertility affects both men (30% of cases) and women (30% of cases). The desire to have a child later and later, a decrease in ovarian reserve, a decrease in the quality of oocytes, hormonal imbalance, abnormal spermograms: what are the most frequent causes of secondary infertility? What treatments can help to make a parental project a reality?

First, what is secondary infertility?

Secondary infertility is by definition the inability to conceive naturally again after one or more previous pregnancies have resulted in the birth of a child. This inability to conceive can result from many factors, including both members of the couple. If no pregnancy occurs after twelve months of regular unprotected intercourse with the same partner, it is advisable to seek the advice of a fertility specialist and in vitro fertilization procedure might be something to consider. This period is reduced to six months for women over 35.

The different causes of secondary male infertility

Among the most common causes of secondary male infertility are cases of :

• varicocele (dilation of the veins of the spermatic cord that can affect men at any time);
• genital infection; 
• testicular trauma; 
• anejaculation (inability to ejaculate) or retrograde ejaculation (evacuation of semen to the bladder in cases of diabetes, spinal cord injury, prostate or abdominal surgery); 
• erectile dysfunction; 
• low sperm production (due to pituitary and hypothalamus dysfunction); 
• Sperm abnormalities (problems with motility, shape or vitality); 
• obesity;
• excessive consumption of alcohol, tobacco or drugs.

The different causes of secondary female infertility

Among the most frequent causes of secondary female infertility, we find cases of :

• abnormal hormonal profile;
• anovulation or lack of ovulation (due to stress, excessive weight loss or weight gain);
• hyperprolactinemia (excessive increase in prolactin caused by a benign tumor of the pituitary gland or the use of drugs such as psychotropic or antiulcer drugs) leading to ovulatory disorders;
• damage to the fallopian tubes (following a sexually transmitted disease or an ectopic pregnancy);
• Uterine anomaly (synechia, endometrial infection, after-effects of surgery);
• cervical abnormality (cervical conization, change in cervical mucus, etc.);
• endometriosis (leading to ovulatory disorders, alterations of the uterine tubes with adhesions or failure of nidation);
• polycystic ovary syndrome (PCOS);
• obesity;
• excessive consumption of alcohol, tobacco or drugs.

Late motherhood and secondary infertility

As a social phenomenon, the age of childbearing is decreasing in Western countries. In Western Europe, women are on average 31 years old at the time of their first pregnancy. The figure even climbs to 34 in large cities, such as Paris, for example. Mechanically, the age of the second pregnancy is also decreasing. It is now known that female fertility decreases with age. This is accompanied by a decrease in the quality of oocytes and an increase in the risk of miscarriage.

In practice, the probability of conception per cycle is :

• 25% for women aged 25 years;
• 12% for women aged 35 years;
• 6% for women aged 42.

Cumulatively over two years, the numbers reach:

• 90% of 25-year-old women;
• 45% of women aged 35;
• 12% of women aged 42.

The age of the patient also affects the likelihood of conception. At age 25, the chances of conceiving a child are 78% for men. The result is only 58% after the age of 35. We can therefore conclude without hesitation that late age of conception is one of the major causes of secondary infertility.

Secondary infertility: what assisted reproduction offers

To determine the cause of secondary infertility, the specialist will conduct an interview with both patients (if it is a couple). In the first instance, he will also prescribe a clinical examination. Depending on the case, other examinations may be considered. Hormonal exploration, ovarian ultrasound, hysterography, spermograms are among the examinations used to draw up a complete fertility assessment.

In addition to all these techniques that allow intervention after a diagnosis of secondary infertility, assisted reproduction is also able to help its patients in a preventive perspective of techniques thanks to the fertility preservation technique. This time, it is the patient herself who decides to save her still young oocytes for later use. Thanks to this technique of oocyte cryopreservation, the patient can keep the hope of conceiving a child with her own gametes, in spite of secondary infertility linked to chemotherapy or radiotherapy treatment, or even in case of a desire for late motherhood.

Source: IVI-Fertilite.fr

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