If you have a chronic disease (diabetes or lupus, for example) or condition (such as heart problems), have had pregnancy or delivery problems in the past, or you are over a certain age, your doctor may want you to have further evaluation by another specialist before you begin treatment. Sometimes this is as simple as going to the doctor that handles your disease/condition to get what we call “medical clearance,” or the go-ahead, to start fertility treatment. Medical clearance lets the clinic know that your condition is under control and that another specialist has looked at you and the proposed treatment so that all risks are identified and managed. Here are two other specialists that you may be asked to see.
Looking for input from maternal-fetal medicine (MFM)
MFM (maternal-fetal medicine) is a subspecialty of obstetrics. An MFM has done a four-year residency after medical school and then a fellowship of three to four years. All MFMs are board certified obstetricians. MFMs manage complicated maternal and fetal medical problems. Women with severe diabetes, heart disease, neurological disease, and so forth are managed for their medical condition. Frequently, MFMs work with the OBs to co-manage a person, with the OB actually doing the delivery. The most common path to an MFM is a referral from an OB or reproductive endocrinologist (RE) who has identified a problem that needs expert management. If a person knows that she is high risk for pregnancy, she may seek out an MFM without seeing a general OB first. IVF pregnancies may be considered high risk (especially multiples), but they can generally be comfortably managed by a general OB.
Pursuing genetic counseling
Genetics seems to be everywhere today, from prenatal carrier screening, a family history of a genetic disease, or a defined genetic disease with either parent, to a genetic disease of the developing fetus. Any one of these issues may be better served by genetic counseling. The field of genetics is moving so fast that the generalist or even the REI can’t keep up with all the recent developments. Genetic counselors are extremely helpful in informing patients about the significance of genetic problems. Chapter 3 tells you more about genetics and your genes.
Chapter 5
It Worked the First Time! Tackling Secondary Infertility
IN THIS CHAPTER
In the immortal words of Baseball’s Yogi Berra, “It's déjà vu all over again!” For many, Yogi’s words perfectly describe the struggle with secondary infertility, or difficulty getting pregnant a second time … or a third.
Although exact numbers are difficult to pin down, according the most recent U.S. government statistics, (HHS.gov accessed November 2019) one in ten women ages 15–44 experience infertility. This means that 6.1 million women in the U.S. experience infertility, and 12–13 out of every 100 couples experience infertility.
In this chapter, we define secondary infertility and then take a closer look at its emotional impact, as well as what you can do to deal with the merry-go-round of infertility — take two.
Facing Secondary Infertility
Defining secondary infertility is not as straightforward as it may seem. Also, the term secondary infertility can be applied to a number of different situations. The Department of Health and Human Services (HHS) of the federal government defines secondary infertility as “infertility in a woman who has had one or more pregnancies, but cannot become pregnant again.”
Secondary infertility can occur whether the first conception was difficult or easy. It can be due to female issues, male issues, or a combination of both. One problem with the definitions is just what is meant by pregnancy. Does pregnancy mean a rise in the HCG shortly after a missed period? Does pregnancy include first trimester losses? Does pregnancy mean having a normal, healthy child at term? Considering that the purpose of the exercise is to have a full-term, live birth, it would seem that the most appropriate definition of pregnancy would be just that — a pregnancy that ended in the delivery at term of a healthy child.
The situation is complicated by the history of the previous pregnancy. Was the pregnancy conceived within a normal time frame and thus the couple were considered to have normal fertility? Or was the pregnancy conceived only after a diagnosis of infertility was made and the pregnancy was a result of treatment? The history helps determine what course of action is most appropriate to try for the next pregnancy.
For people who conceived spontaneously within six months to a year of trying, the diagnosis of infertility is made if they have been trying for six months to a year for another pregnancy and they have not achieved a pregnancy. After all, infertility is infertility, whether you call it primary or secondary. The significance of this is that once the term infertility is applied, the course of action is the same whether it is primary or secondary: use diagnostic tools to make a diagnosis. However, if the couple had the diagnosis of infertility for the successful pregnancy, then the course of action is determined by that diagnosis. It is not always necessary to reinvent the wheel! Other problems may have arisen in the meantime, but many problems will persist. The approach is to make sure nothing else has changed and then apply the previous diagnosis to determine what the best course of action will be.
For example, if there is a severe male factor in a young couple and it took IVF with ICSI to achieve a pregnancy, it most likely will require the same process for another child. If the diagnosis was polycystic ovarian syndrome, then it may actually be more difficult to conceive again. Possible reasons for this are that age may play a role, but many women gain weight when pregnant and it is difficult to lose this weight. Increased weight may make the PCOS more difficult to treat.
Frequently, couples seek consultation because of secondary infertility, and they feel they are unique and alone … this only happens to them. They start to question themselves, and this can lead to a feeling of isolation and guilt or of not being as good as someone else. If you find yourself in this bad head space, take note: Secondary infertility is common! The actual number of people experiencing secondary infertility is hard to determine, but estimates indicate that at least 30 percent of couples seeking help for infertility have secondary infertility.
Whatever the exact nature of the definition, few disagree that secondary infertility, whether an adjunct to primary infertility or a new challenge all its own, can be a confounding and painful experience that can prevent many from creating the complete family of their dreams.
Wanting an Heir and a Spare?
