The stork hasn’t visited again, though you long for a second child. Find out what the issue could be.

After your first baby arrives, you may think that it’s only a matter of time before you get pregnant again. Yet, the stork doesn’t always cooperate, so you’re wondering why have yet to conceive baby #2. 

Celebrity couple Fann Wong and Christopher Lee had once hope to give their 5-year-old son Zed, now 5, a sibling. However, in a recent radio interview, Fann, 48, revealed that she had given up the idea of having a second child because of her advancing age.
A couple’s inability to conceive again after a previous pregnancy is known as secondary infertility.

Notes Dr Steven Teo, obstetrician and gynaecologist from STO+G Laparoscopy & Fertility Practice, Thomson Medical Centre, “Infertility among Singaporean couples exists on an endemic scale, with over 10 per cent of them suffering from some degree of infertility. See a suitable fertility specialist early if you suspect something is amiss, such as pelvic pain or irregular cycles.”

Causes of secondary infertility

These are possible reasons if you’re aiming for number two but have problems conceiving again:

1.  Age
Because couples are getting hitched later, they are also have their first child at an older age. However, shelving one’s procreation plans until a woman is in her early 30s is a key cause of secondary infertility, since a woman’s fertility declines with age, especially after their mid-30s. The man’s sperm count can also be affected by age, health or medication, or exposing the testes to heat from wearing tight clothing.

Infertility among Singaporean couples exists on an endemic scale, with over 10 per cent of them suffering from some degree of infertility. See a suitable fertility specialist early if you suspect something is amiss, such as pelvic pain or irregular cycles.”

2. Weight issues
Being obese or overweight can lead to problems with ovulation and hence, challenges with conceiving. Moreover, extra weight on women could cause insulin resistance, a precursor to developing type 2 diabetes, and greater testosterone levels. These conditions can impair the women’s ability to conceive naturally.

3. Hormonal imbalance (Polycystic ovary syndrome)
A regular menstrual cycle help couples to figure out when they should do the horizontal mambo. However, if the woman suffers from irregular menstruation or absent periods, that can make anticipating ovulation unpredictable and make it more challenging to conceive.

Women with irregular periods may be suffering from polycystic ovary syndrome, which disrupts ovulation and leads to infertility.

4. Womb abnormalities
Dr Teo recounts the case of Madam C, a 34-year-old who failed to conceive again despite trying for three years after a normal delivery of her daughter. She had experienced heavy menstrual bleeding for two years. An ultrasound scan revealed multiple fibroids growing in her womb cavity (which led to a distorted womb), as well as near her right fallopian tube, which caused a blockage. After laparoscopic (keyhole) surgery, her fibroids were removed
she conceived eight months later and delivered a healthy baby boy.

 

5. Endometriosis
Endometriosis refers to a condition where tissue lining the uterus interior also rows outside, such as on in the fallopian tubes or ovaries. Typical symptoms include pelvic pain of varying severity, menstrual cramps and painful intercourse.

Dr Teo’s patient, Madam L, 36, had been trying to conceive again for four years. However, she suffered from severe menstrual cramps and discovered that it was because of pelvic endometriosis after laparoscopy. After surgery, her menstrual cramps became less severe. She conceived eight months later and delivered a full-term baby.

6. Adhesions
Caused by infection, inflammation diseases, or previous surgery, these are internal scars or abnormal bands of scar tissue that join organs or parts of organs abnormally. Adhesions may cause infertility as they kink the fallopian tubes, preventing the egg and sperm from meeting, or disrupts the implantation of a fertilised embryo in the womb.

7. Poor diet
A poor diet can affect a woman’s ovulatory function. A high-carb diet isn’t advisable as studies have found high insulin levels seem to stifle ovulation. Consider high-fibre foods from more diverse grains (such as millet, quinoa or buckwheat which contains d-chiro-inositol, a compound that improves ovulation) and minimise trans fats found in fried, processed or baked foods. Experts advise that even prior to getting pregnant, you should eat the right foods to prep your body, so include the right nutrients, especially folic acid.

Secondary infertility isn’t too different from primary infertility, with similar causes. Seek help if you can’t conceive after more than a year of regular intercourse if you are less than 35 years old or more than 6 months if you are 35 years or older.”

8. Medication
Medication may affect woman’s ability to ovulate or a man’s sperm count. While most medication may linger in our body for a few days, some, such as chemotherapy drugs or birth control drugs, remains in the system for a longer time. This means that your body may take time to revert to its optimal fertility. So, do check with your doctor regarding the drug’s impact on your pregnancy plans.

9. Lifestyle choices
Smoking and alcohol consumption could reduce your pregnancy chances. Limit caffeine to no more than a cup a day, avoid extreme exercise (such as intensive training for marathons), exposure to environmental pollutants such as pesticides. Get sufficient rest
late nights affects hormone production and put you at higher rest of infertility. Although stress does not prevent you from getting pregnant, practise relaxation techniques for optimal health.

“Secondary infertility isn’t too different from primary infertility, with similar causes. Seek help if you can’t conceive after more than a year of regular intercourse if you are less than 35 years old or more than 6 months if you are 35 years or older,” advises Thomson Medical Centre’s obstetrician and gynaecologist Dr Pamela Tan.

Strategies to boost your chances of conceiving again

Dr Steven Teo, obstetrician and gynaecologist from STO+G Laparoscopy & Fertility Practice, at Thomson Medical Centre, suggests the following tactics to improve your chances of conceiving again.

* Maintain a healthy weight for both partners and keep fit by engaging in regular moderate exercise.

* Start a menstrual diary to monitor how regular your cycles are ― note down your rise in basal body temperature, changes in cervical mucus and possible symptoms such as any pelvic pain.

* Engage in regular sexual intercourse, especially during the ovulation window (between days 11 and 18 of your cycle).

* Review the use of medications with your doctor to control any pre-existing medical conditions (such as thyroid disease, diabetes, asthma and gout).

* Avoid alcohol and smoking.

Photos: iStock

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