Qus & Ans: Secondary Fertility Problems

Qus & Ans: Secondary Fertility Problems

I am 33 years old and want to have a second child. My first child is now 10 years old, and I had no problem getting pregnant with him. About two weeks ago I had a laparoscopy with tubal lavuge and laser surgery, and the outcome was this: I have severe endometriosis and blocked tubes. I am also in a lot of pain. My doctors told me the only way I could get pregnant is through in-vitro fertilization. My husband and I cannot afford this procedure, so they are saying the only other solution is hysterectomy. (?!) Help! Is this really my only solution?

The hysterectomy may relieve the pain but will prevent you from ever completing your family! You should consider alternative options to repair the blocked tubes. Endometriosis rarely causes tubal blockage, and more information on your tubal status would be useful. If the tubes are blocked at the cornual (uterine) end, then you could go in for a fluoroscopic tubal recanalisation. If it's a fimbrial block (by the ovaries), you could consider a laparoscopic salpingostomy.

Dr. Malpani
Malpani Infertility Clinic, Bombay, India

I am 26 and have had two tubal pregnancies -- the first resulted in partial removal and the second just being plucked from the tube. After these, I conceived a healthy baby boy who is now 5. My question is this: my husband and I have been trying for many months to conceive a second child, with no luck. Is it because of the tubals that we haven't conceived yet, and can we still conceive "naturally"?

Since you have conceived once after your tubal pregnancy, I would not blame the tubal pregnancies for your infertility. You need a formal infertility workup (including semen analysis, hormonal blood tests and tubal testing) to determine the reason for your secondary subfertility.

Dr. Malpani
Malpani Infertility Clinic, Bombay, India

We have two girls, ages 26 months and 10 months. Since the birth of my second daughter I have neither ovulated nor had any menstrual periods. I am otherwise fit and healthy, and my second was only breastfed for 3-4 weeks. I am not stressed or malnourished, so why is it taking so long for me to return to normal cycles? I have just turned 30.

This is difficult to explain. While secondary amenorrhea (absent periods) is common when you are breast feeding, we cannot determine the reason for the secondary amenorrhea in your case without a work-up. If you had a lot of blood loss during childbirth, you may have a rare condition called Sheehan's syndrome. In any case, your doctor will need to test your hormonal blood levels (FSH, LH, PRL and TSH) to determine the reason for your problem. You may also need ultrasound scans to evaluate the uterus. Please do let me know what the diagnosis is.

Dr. Malpani
Malpani Infertility Clinic, Bombay, India

My husband and I tried to conceive for two and a half years before we finally succeeded. We went through every test there is. The only test that came back abnormal was our post-coital test. After all this testing, we tried intra-uterine insemination (IUI) for several cycles. After no success with that strategy, we used injectable drugs along with IUI, and it worked the first cycle. As a result, we have a beautiful daughter who is 15 months old. We have not used any birth control since she was born. My question is this: will we likely have to go to the same lengths as before to conceive again? Is there any chance that my system has changed since having a baby? And, should we have another post-coital test done? Thank you.

The body does change after pregnancy, but how it changes is so variable that it's not possible to predict what the effect on an individual's fertility will be. If you do not want a baby for now, please use contraception. When you decide you want a second baby, if you don't conceive on your own in six cycles, then go in for IUI with injectable drugs straight away - use the formula that worked for you, rather than waste time on what didn't.

Dr. Malpani
Malpani Infertility Clinic, Bombay, India

I am a 27 year old female. My Husband and I have been married for almost 10 years, we have a beautiful 7 year old daughter. We have been trying to get pregnant for the 14 months. I have had 2 miscarriages that happened early in pregnance. I was on the pill for about 3 years before i got pregnant with our daughter and after i had her i got on the pill again. I was on it for about 6 years. It took me 1 year and 3 miscarriages later to get pregnant with our daughter. All three of us are wanting another child bad. I have recently stop drinking pop(1 month ago).
I have not went to any doctor about fertility drugs or anything like that. Our insurance does not cover that and we really don't have the money to go through all the tests and treatments. I have told that i do have a tilted uterus, and i had my daughter by c-section(because the cord was wrapped around her leg). My Husband and I really want to have another baby before we turn 30(he is 28).
We are looking for some advice and any kind of help with this hard trying time.
Thank you for any answer or feedback.
A Family Waiting....

Dear Family:

Thank you for your note that I read with interest.

Although I don't have your complete clinical history, I understand that you have regular menstrual periods. I believe that you may ovulate regularly as you probably have regular menstrual periods. The assessment and treatment of infertility in a young couple prior to their thirties would mandate some testing such as documentation of your hormonal status and sperm concentration, motility and morphology. Although, our success rates in patients of your age are approximately 87.5% in one treatment cycle, we need to do some testing and eliminate reasons for failure to fertility therapy.

If you want to discuss your infertility in greater detail or begin testing, please call us.

Sincerely,

Jaime Vasquez, M.D.
Voice: (615) 321-8899 ~ FAX: (615) 321-8877

Hello - We have been ttc#3 for 15 months now - we already have two children that we conceived " naturally " , with no problems ( it only took two months of trying for both after stopping the pill ) Currently i am on my fourth cycle of Clomid 50, and my temp charts show great ovulation and no problem with the LP. My question is : if the Clomid doesn't work, what is the next step as far as treatments/tests are concerned?? I have seen two OB/GYNs; one wants to do an IUI, and the other wants to do an HSG. DH has a normal sperm count - 120mill. with 40% motility. What would be the next logical step for us to take?? Other than the semen analysis, we haven't done any other tests. Thanks for your help. Emily

Dear Emily,

The first question is "how old are you". If you are over 35, then you need a day three Estradiol and FSH level. If those studies show compromised levels, then you need a Clomiphene Challenge Test.

Our next step would be do recommend three cycles of COH with IUI, using Humagon, Follistim, or Gonal-F. It would also be optional to do an HSG, however if you have had two children with your husband, then Tubal Factor would be possible but unlikely

Hope this helps.

N. Assad, M.D.
Southwest Fertility

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