When Parents Can’t Conceive

Secondary infertility can be especially frustrating.
Fertility in women peaks between the ages of 20 and 24, decreasing relatively little until ages 30-32, then declining progressively more rapidly. Fertility rates are 26-46 percent lower in women ages 35-39, and as much as 95 percent lower between ages 40 and 45 .

Infertility is frustrating, sometimes emotionally devastating. But secondary infertility — problems conceiving after a couple has at least one child — can be especially infuriating. Couples reason that if they’ve had one child, why shouldn’t they be able to conceive another?

“We didn’t really try with Jake, so we never thought there would be a problem,” says Jamie Holmes, of Newark, DE. She had planned to have five kids, but after giving birth to Jake, at age 25, a second child wasn’t so easy to come by. It took several years of doctors, drugs and procedures before her second son, Alex, was born five years later.

“People assume that just because you’ve been pregnant once before you’ll be able to do it again,” says Alice Domar, PhD, director of the Domar Center for Mind Body Health in Waltham, MA. The fact is that ten percent of all couples face infertility, and surprisingly, more than half of them are secondary patients.

What causes secondary infertility?

Aging is the primary factor in infertility. “Fertility declines with age, significantly after age 40, though it starts to decline in the mid-30s,” says Samantha Butts, MD, an assistant professor of obstetrics and gynecology at the University of Pennsylvania. The primary reason for this is that a woman’s eggs become less viable as she gets older.

“At 35, I wasn’t really thinking the clock was ticking,” says Terry Ruppert, a mom of three boys from Audubon, PA, who sought fertility treatments in her 30s. Age affects men’s sperm count too, but not nearly as dramatically as women’s.

Male factors are involved in at least 40 percent of infertility cases. Dr. Butts points out that society often thinks of infertility as a “woman’s burden,” but in fact it is a couple’s condition together.

Sexually transmitted disease cases continue to increase in the U.S. STDs, especially if left untreated, can cause damage that impairs fertility.

Smoking has been proven to decrease a woman’s fertility, because it has a direct effect on the viability of her eggs.

Being overweight impairs fertility and is a risk to both mother and baby in pregnancy.

Insurance Coverage

Thirteen states, including New Jersey, mandate coverage of infertility treatments. If you don’t live in one of these states, “don’t assume you’re not covered until you investigate,” says Dr. Domar. Many insurance policies do not 100 percent exclude fertility issues, leaving room for interpretation, so do your homework.

Web Resources
• The American Society for Reproductive Medicine, www.asrm.org
• Fertility LifeLines, www.fertilitylifelines.com
• The National Infertility Association, www.resolve.org

How is it treated?

It’s difficult to quantify the success rate of fertility treatments, but if you’ve already achieved a pregnancy, your chances are encouraging, says Dr. Butts.

Before treatment begins, both partners usually are evaluated for the cause of the infertility. If anything is found, the condition is treated. Monitoring of fertility treatments sometimes requires as many as ten doctor’s visits per month, with frequent blood work and ultrasounds.

Common infertility treatments include:

Clomid. An oral medication that stimulates ovulation.
Cost: Less than $100 per month.

Injectable hormones with or without artificial insemination (AI), procedures done in the doctor’s office. With AI, the man’s sperm is injected into the woman’s uterus through a catheter at the optimal time of her cycle.
Cost: “Hundreds to thousands of dollars per cycle,” says Dr. Butts, depending on how much monitoring is done each month.

In Vitro Fertilization, uniting the sperm and the egg in a Petri dish and then transferring the fertilized egg into the woman’s uterus for implantation. Only 2-3 percent of infertility patients require this aggressive treatment.
Cost: $10,000-$15,000 per attempt.

When should you seek help?

It usually takes a few months to get pregnant, even for typically fertile couples.
Current guidelines suggest seeking medical help:

After 12 months of trying if the female partner is younger than 35
After 6 months of trying if the woman is 35 or older
After 3 months if the woman is over 40

Because of aging and other factors, the sooner you seek help, the greater your chances for success. Sometimes a cause can be quickly identified. “Don’t assume that you can’t be helped,” says Dr. Domar. It is estimated that 85 percent of infertility cases can be treated with conventional medicine or surgery.

Local Moms’ Experiences

Clomid worked. At age 35. Terry Ruppert’s fertility specialist “prescribed clomid and thoroughly monitored my cycle with regular blood work and ultrasounds. Just as the ‘final’ try (3 cycles) before IVF, I became pregnant,” she recalls.

The stork took over. Cyndi Godlewski of Sewell, NJ, tried injectable hormones among other treatments for 18 months in an attempt to get pregnant with her second child. “The hormones were making me so Jeckyl & Hyde,” she recalls. So she decided to take a break for her daughter’s November birthday and the Christmas holidays, and you guessed it — she got pregnant on her own during the break.

Injections were successful. After she and her husband tried to conceive their second child for a year, Jennifer Wojciechowski of Newtown, PA, consulted an infertility specialist. She tried an oral medication for nine months without luck. Then the specialist switched her to injections. “My first month on injectable infertility drugs, I got pregnant,” she says. A nurse at an OB/GYN’s office, she recalls how difficult it was seeing pregnant women every day as she tried to conceive.

Suzanne Koup-Larsen is a local freelance writer.

Categories: Maternity