As individuals, we all have our own roles to play in the universe. Parents in particular perform their duties to “go forth and multiply” so to speak, but unfortunately, not everyone can carry out their parts to fruition. Secondary infertility can enter the scene as a surprise intermission, which makes the next chapter of a couple’s life seem light years away—but hopefully not for long.
Secondary infertility in the Philippines According to Regina Tan-Espiritu, M.D., an infertility specialist from the University of the Philippines-Philippine General Hospital (UP-PGH) and fellow of the Philippine Society of Reproductive Endocrinology and Infertility (PSREI), there is no actual data to clearly suggest that secondary infertility cases are increasing in the country. “We cannot account for the exact number because we do not have a census for infertility patients in the Philippines.” In her practice, about 10 percent of infertility cases are secondary.
The number of reported cases is closely related to the general public’s awareness of secondary infertility. Ana Lynn Alvarado-Matignas, M.D., another infertility specialist and fellow of the PSREI, points out that couples are less likely to come forward with secondary infertility because they usually believe “that past fertility ensures future fertility.” Rudie Frederick Mendiola, M.D., an obstetrician-gynecologist at the Capitol Medical Center adds, “The only thing that will make you think that the number of cases did go up is the fact that there is increased awareness.” Based on research, he says, secondary infertility cases did not increase; rather because of more access to information and treatment, more couples have sought help to address this condition.
Infertility is determined if after at least one year, a couple still has difficulty getting pregnant, given that they engage in regular, unprotected intercourse for two to three times a week. What makes secondary infertility different from primary infertility is that the female has either delivered at least one baby or carried at least one pregnancy to term.
Primary and secondary infertility share the same causes and symptoms. The only difference, according to Dr. Mendiola, is “that usually in primary infertility, you have congenital anomalies, while in secondary, you have more of the acquired causes.” It is important to remember that both the man and woman can possibly contribute to secondary infertility. Even though the signs may be more apparent in the female, there are certainly both male and female factors to be considered when pointing out the causes. Dr. Tan-Espiritu emphasizes, “The husband can be asymptomatic. Sometimes, the wife will also not show any symptoms, because there are some conditions that hide themselves and will only be seen when it’s already full-blown.”
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Specialists do three basic things in order to diagnose secondary infertility. The first step is usually semen analysis for the husband. Checking the female’s anatomy via ultrasound is usually the next step. The last one is to test for ovarian reserve. “If the patient is above 35 years old, we can also request for them to go through a series of blood tests,” says Dr. Tan-Espiritu.
Semen abnormalities such as a lower sperm count are among the first signs that can cause infertility. Infections in the couple’s reproductive anatomy can also lead to secondary infertility. “Chronic diseases such as diabetes, hypertension, and asthma can also affect a couple’s fertility,” says Dr. Alvarado-Matignas. Endometriosis can block the ovaries or even the tubes, gradually progressing to cause secondary infertility. Sexually transmitted diseases (STDs) such as chlamydia and gonorrhea can also block tubes, cause pelvic inflammatory disease, scarring and adhesions, which can all contribute to secondary infertility.
A woman’s age is another important factor when dealing with this condition. “Upon the age of 35, she experiences a rapid decline in ovarian reserve,” says Dr. Tan-Espiritu. The number of remaining ovarian follicles or egg cells steadily declines with increasing age. “The woman also becomes progressively less sensitive to medications which can cause delays in the process of infertility treatment,” adds Dr. Alvarado-Matignas.
Another possible cause of secondary infertility is hormonal imbalance, which affects the woman’s menstrual cycle. One such condition that arises out of it is polycystic ovarian syndrome or PCOS. If a woman experiences irregular menstruation, it can be assumed that she does not ovulate regularly. And since she does not menstruate regularly, the woman is not able to produce eggs and therefore cannot get pregnant.
Click here to read on about the challenges couples go through with secondary infertility.