Fertility delay is a frustrating and challenging time for all involved, and not just limited to those hoping to conceive for the first time. Dr Greg Phillipson offers some advice.

In many cases a second, third or fourth pregnancy doesn’t happen as easily as the previous one. If you’ve already carried one child (or more) to term and are experiencing a significant delay in conceiving again, you may be looking at secondary infertility. It’s just as common and just as perturbing as primary infertility (those struggling to achieve their first pregnancy), but with much less mainstream awareness. Generally speaking, people associate infertility with childlessness and as a result there may be less acknowledgement of secondary infertility, and perhaps less support for those struggling to conceive another child.

One in six couples experience secondary infertility, and indeed, single people experience it too. If you’re one of them, well-meaning friends and whānau might jump straight to ‘Have you considered IVF?’. IVF is not the only choice and it’s not suitable for everyone. It is a physically intrusive process and that can be anxiety-provoking for some. It can come with significant financial and emotional commitments too. Additionally, there’s a long waiting list for publicly funded IVF. Those who already have a child are less likely to be covered for publicly funded fertility treatment, but the private system isn’t accessible to everyone who might like to use it. It’s a challenging time for many.

As specialists, the goal is to provide personalised care because every case is different and the causes of infertility are so varied. We discuss all the options, as well as where investigation might be needed. It might be that someone has had two children in their twenties but now at 35 are trying again and struggling. We look at any possible changes to their health since the previous pregnancy – a pelvic infection, surgeries for cyst removal or for endometriosis. Fibroids and polyps can delay or prevent pregnancy too, as can changes to the menstrual cycle and heavy bleeding – which may indicate changes within the uterus that are compromising fertility. But while there are more complicating factors for women, male factors must always be investigated too, particularly if they have had changes to their health or taking medication. This can usually be confirmed by a sperm test, often conducted by their GP.

The major factor that guides decision-making is age. For someone under the age of 35 who is healthy and has regular periods, around 60 per cent of couples will achieve a pregnancy within six months and within a year 80 per cent will achieve pregnancy.

However, those numbers halve by the age of 40 when most couples take more than a year to conceive. This is a natural result of ageing, and not necessarily an indication that something is wrong. If you’ve been trying to conceive for over a year, it may be time to seek answers.

Any fertility delay can create feelings of frustration and confusion, and if a previous pregnancy happened without any effort, this can intensify. Try not to succumb to the self-blame that often creeps in, or feelings of guilt for not acting sooner. Seek the information you need from a reliable source – fertilitynz.org.nz is a good place to start.

 

Dr Greg Phillipson is a gynaecologist and fertility specialist with Certification in Reproductive Endocrinology and Infertility (CREI). He has a wealth of experience in male and female fertility management, early pregnancy care and IVF, and specialises in tubal pregnancies, recurrent miscarriages and vasectomy/sterilisation reversal. coga.org.nz