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.

 

An overview

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.”

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.

[previous|page|next]

Read on about the challenges couples go through with secondary infertility.

 

Hard times

A couple experiencing secondary infertility can go through several challenges, both as individuals and as parents. “The emotional experience is often a mixture of depression, anxiety, grief, guilt, jealousy, self-blame,” among other negative feelings, according to Dr. Alvarado-Matignas. She adds, “Partners may have different reactions and coping mechanisms which lead to alienation and blame towards each other.” In the quest to find the “culprit” to their infertility, the wife and husband may even become suspicious of one another, especially if a more deep-seated problem (e.g., infidelity) has been there all along.

Currently, there are no officially organized support groups who can specifically address the emotional needs of secondary infertility patients and their families. Dr. Alvarado-Matignas notes, “Compared to primary infertility, secondary infertility tends to receive less acknowledgement and social support, because most people think that there is no grief or crisis encountered with it since the couple already has a child.”

Dr. Tan-Espiritu agrees, “We usually don’t talk about infertility. It’s not a sickness that’s an emergency or threatening. But it’s actually devastating for the couples.”

Dr. Tan-Espiritu also brings up the issue of time, and how much of it is spent on treatments that go on for months on end, sometimes to no avail. “Every month they’re disappointed. The treatment becomes time consuming and stressful.” Family members, especially the parents, can add to the pressure of having children. “The couple is told that they should be happy with one child, so in the end, they’re torn,” she says. Dr. Alvarado-Matignas adds, “Stress brought about by the combination of anxiety, depression, grief, and the financial burden from costly procedures and medications, also puts unbearable strain on a couple’s relationship.”

Secondary infertility also involves and affects the only child. Added to the pressure he may be putting on his parents to have a sibling, Dr. Alvarado-Matignas says, “There is also a sense of loneliness and isolation on the child’s part.” He may misinterpret the growing resentment between his parents as dissatisfaction with him. And because they cannot give the child what he possibly wants (i.e., a sibling), the child may be spoiled to a point, says Dr. Mendiola. Adds Dr. Alvarado-Matignas, “Parents tend to be overly protective and attentive to their only child, compromising the child’s need for independence.” The child can also be on the losing end, as his “needs may be compromised because of the time and money spent for several procedures or treatments by the parents.”

 

Click here for expert advice on how to deal with secondary infertility.

[previous|page|next]

Read on for expert advice on how to deal with secondary infertility.

 

How to deal

One of the first things Dr. Tan-Espiritu requests from patients is for the husband to always be present at every consultation and all throughout the treatment. “I insist that they always consult as a couple. The husband should be enlightened that he can also be part of the problem,” she says. She even encourages patients to bring their parents along for the whole family to better understand the problem. In turn, they can all be part of the solution.

Access to the right kind of information is most especially important for women, who, unlike males, have to consider their biological clock. Dr. Mendiola says, “When a woman reaches the age of 38, her fertility rate goes down—all the more when she hits 40 and above. You have to be aware of the possibility of infertility at a younger age so you won’t have as much complications, and so you have more time.” He also reminds couples that it may not be wise to “shop around for doctors” which can take up more of this valuable time, and eventually lead to overlapping and ineffective management. 

Dr. Alvarado-Matignas also gives the following tips for couples and parents:

• Positive communication. Be open to each other about your needs and desires, including the number of children you want, the spacing of each pregnancy, as well as your physical, emotional, and financial capabilities.
• Reconnect sexuality to love, affection, and emotional closeness. It would help if you and your husband unwind and take time off from the “infertility demand.” Keep making love regularly, without undue pressure from the doctor or anybody, but with enjoyment.
• Practice stress management by engaging in recreational activities which you enjoy doing most with your partner.
• Communicate properly and openly with your child in a language he can understand.
• Make your child part of the decision-making process. This way, he will not feel left out, but instead feel that he is an important member of the family. 

 

Click here to read more about treatments for primary and secondary infertility.

[previous|page|next]

Read on about treatments for primary and secondary infertility.

 

Treatments

Recommended treatments for primary and secondary infertility patients usually last for three to six months or “cycles.” Majority of couples get pregnant after three or four cycles. If after six months, the treatment still does not work, a more aggressive approach could be considered.

• Ovulation induction: Doctors prescribe medication (either fertility pills or injections) in order to stimulate follicular development.
• Insemination: Artificial or intra-uterine insemination is done if semen analysis shows any abnormalities.
• Laparoscopy and hysteroscopy: Surgery to repair any distortions in the woman’s anatomy only comes after non-invasive approaches have been considered.
• In Vitro Fertilization (IVF): Usually the last resort, this treatment largely depends on the couple’s budget and how aggressive they want to be. There are, at present, three IVF centers in the Philippines, the first of which (Center for Reproductive Medicine Inc. or CRM) successfully delivered its first IVF baby in 1996.

From one procedure to the next, the chances of getting pregnant should ideally increase. As Rudie Frederick Mendiola, M.D., explains, normal couples without any infertility problems have a 25 percent chance of getting pregnant. If you do insemination, you may increase the chances by 14 to 17 percent, but not more than 20 percent. “Definitely nothing will give you 100 percent,” he says.

In order to save time, especially for high-risk cases, it would be best to go directly to an infertility specialist as soon as problems arise. “Go to someone who can accurately diagnose your condition, i.e., a trained infertility specialist and fellow of the society (PSREI),” says Dr. Mendiola. Ana Lynn Alvarado-Matignas, M.D., adds, “It is recommended that both partners see the experts after a year of regular intercourse. If the female is at least 35 years old, the couple can consult earlier and not necessarily wait for one year.”

 

Click here to read the experiences and stories of real moms about secondary infertility.

[previous|page|next]

Read more on the experiences and stories of real moms about secondary infertility.

 

One and only

Three moms share their insights on secondary infertility

 

Reina, 37, mom to a four-year-old boy

After giving birth to my son in August 2005, my husband and I were on natural family planning. A visit to my ob-gyne late last year showed that my irregular menstruation, obesity, and endometriosis were among the reasons why I was having trouble getting pregnant again. I was eventually diagnosed with PCOS in May of this year.

Quite recently, I’ve been having frequent tummy aches. Since June, I’ve been taking medication to prepare me for fertility pills, as well as to regulate my menstruation, help me lose weight, and correct my hormonal imbalance. But because of the pain, I had to stop taking all these, so there goes my plan to be able to conceive this year.

My husband and I are not really pressured to have another baby, but, of course, we’d love to have another one. Even my son shows signs of wanting a playmate once in a while. One time, he even placed a stethoscope on my tummy to check for a baby! But my husband reminds me that we’re lucky to have our son—

I actually got pregnant barely two months after our wedding.

For women, understand and take care of your body well, and do not ignore physical symptoms however mild or tolerable they may be. For couples, be thankful that you have been blessed with one or more prior pregnancies and never neglect your child or children in your pursuit of wanting another one.

 

Vlesie Nuñez, 33, single mom to Keith, 9

I’ve always had an irregular menstrual period and was diagnosed with PCOS just this year.

My son always goes with me during my checkups. He asks me about the treatments, and I, in turn, explain to him what happens. He even reminds me to take my medicines! By now, he’s used to being by himself, and he doesn’t appear to be looking for a sibling because we usually spend time with my friends who have children around the same age as him.

I already feel blessed to have a child. But if it’s going to happen, then that would be a gift because of my condition. I want to encourage other single parents who have to go through treatment on their own to stay positive and happy despite their condition. It is definitely important to have a positive relation-ship with your child.

 

Louella Gonzalez*, mom to a nine-year-old daughter, with a second baby on the way

I found out I was going through secondary infertility in March, 2005. It was only when I moved to my second and current ob-gyne that I confirmed I had PCOS, which we found out primarily through follicular monitoring.

I was diagnosed with PCOS before the arrival of our first child. My husband was very understanding and supportive during the work-up period. It was a breeze because my husband and I both wanted the same thing—to have a baby.

My doctor never failed to assure me that things would be okay and they really turned out fine. It took me a month of treatment before I conceived my daughter.

I thought it was a just luck but it turns out, it also took me a month of treatment to conceive the baby I am now carrying.

• For women with PCOS, there is hope. Seeking proper treatment and following your doctor’s advice increase the chances of things working out just fine.
• It pays to have a very supportive husband who will help make realities easier to accept. He will also remind you when to take your medication or accompany you the next time you need to visit your doctor.
• Overcoming secondary infertility is a partnership between the couple and their ob-gyne. There has to be a perfect match. You need to have faith in your doctor and believe that he can help you. That’s what happened to me.

*Names have been changed to protect their privacy

 

CONTACT

Philippine Society of Reproductive Endocrinology and Infertility (PSREI) and the Philippine Obstetrical and Gynecological Society (POGS)
Address: 56 Malakas Street, Diliman, Quezon City Tel no: 921.7557; 435.2384 to 85; E-mail add: pogs@pldtdsl.ne
Website: www.pogsinc.org/web/

 

Center for Reproductive Medicine Inc. (CRM)

Address: 11th Floor, Raffles Corporate Center, F. Ortigas Jr. Road, (Emerald Avenue) Ortigas Center, Pasig

City Tel no: 915.1049; Telefax: 915.1048

E-mail: crm_ivf@yahoo.com

Website:

www.crmivf.webs.com

 

Sources:

• Regina Tan-Espiritu, M.D., obstetrician-gynecologist; reproductive endocrinology and fertility specialist; fellow, Philippine Obstetrical & Gynecological Society; fellow, Philippine Society of Reproductive Endocrinology and Infertility; fellow, Philippine Society of Gynecologic Endoscopy; consultant, Department of Obstetrics and Gynecology, University of the Philippines-Philippine General Hospital; clinical associate professor, UP College of Medicine Clinic Schedules
• Anna Lynn R. Alvarado-Matignas M.D., obstetrician gynecologist; reproductive endocrinology and infertility specialist; gynecologic endoscopist
• Rudie Frederick Mendiola, obstetrician gynecologist; teproductive endocrinology and infertility specialist

 

Photo from sxc.hu