These days, more and more celebrity couples find it to have a second baby after the first one. There are also those who have only 2 and can’t have more than that. This can be emotionally devastating for women who go through this experience and their partners. Several couples these days have to wait for longer years before arrival of a new baby and this is usually frustrating, considering the fact that having the first child was much easier and would never have envisaged this problem. . For many women, their desire for more children is overwhelming. Their frustration with not being able to have more children is often mixed with feelings of guilt, despair and obsession. This situation is known as Secondary Infertility, which is getting more common these days. It takes most people by utter surprise. Reason? Those who have easily conceived, carried, and delivered a baby suddenly find themselves wondering about their fertility. In this report, City People Fashion Editor, BOLA AKINBOADE spoke to Dr Abayomi Ajayi of Nordica Fertility Centre, Lagos who gave an overview on this fertility issue and the causes.

ABOUT SECONDARY INFERTILITY
Secondary Infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. Especially when the birth of the first child does not involve any assisted reproductive technology or fertility medications. Infertility is defined as a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages. This can be caused as a result of problems in both partners. 　

CAUSES
Some major scientific causes of Secondary Infertility are discussed below.

AGE
The major cause is age, the older you get, the harder it is to get pregnant, and if you delay, it makes it even harder. Fertility begins to decline when a woman reaches her mid-30s, and rapidly declines after her late 30s. As a woman ages, her ovaries produce fewer eggs. In addition, the quality of the eggs is poorer than those of younger women. Older women have a higher risk for eggs with chromosomal abnormalities, which increase the risk for miscarriage and birth defects. Older women are also more likely to have health problems that may interfere with fertility

For the men too, age-related sperm changes in men are not abrupt, but are a gradual process. Aging can adversely affect sperm count and sperm mobility (the sperm’s ability to swim quickly and move in a straight line). The genetic quality of sperm declines as a man ages

LOW SPERM COUNT
Low sperm in the man will lead to inability of conceiving. A sperm count of less than 20 million/mL is considered low sperm. Azoospermia refers to the complete absence of sperm cells in the ejaculate, and accounts for 10 – 15% of cases of male infertility. Partial obstruction anywhere in the long passages through which sperm pass can reduce sperm counts. Sperm count varies widely over time.

ENDOMETRIOSIS
Endometriosis is a woman’s condition in which cells that line the uterus grow in areas outside of the uterus, such as the ovaries. The condition can interfere with a woman’s ability to become pregnant. It is a noncancerous condition in which cells that normally line the uterus (endometrium) also grow on other areas of the body, causing pain and irregular bleeding. Endometrial cysts may cause infertility in several ways: If implants occur in the fallopian tubes, they may block the egg’s passage; Implants that occur in the ovaries prevent the release of the egg; Severe endometriosis can eventually form rigid webs of scar tissue (adhesions) between the uterus, ovaries, and fallopian tubes, thereby preventing the transfer of the egg to the tube.

PELVIC INFLAMMATORY DISEASE
Pelvic Inflammatory Disease or other conditions that can cause scarring and blocking of the fallopian tubes can lead to inability of the woman to be able to conceive. Pelvic Inflammatory Disease (PID) is a major cause of female infertility worldwide. PID comprises a variety of infections caused by different bacteria that affect the reproductive organs, appendix, and parts of the intestine that lie in the pelvic area. The sites of infection most often implicated in infertility are in the fallopian tubes and the severity of the infection, not the number of the infections, appears to pose the greatest risk for infertility.

EARLY MENOPAUSE
Women with a history of early menopause may be at a higher risk. Premature ovarian failure is the early depletion of follicles before age 40, which, in most cases, leads to premature menopause. It is usually preceded by irregular periods, which might continue for years. In this condition, follicle-stimulating hormone (FSH) levels are elevated, as they are during perimenopause. Premature ovarian failure is a significant cause of infertility, and women who have this condition have only a 5 – 10% chance to conceive without fertility treatments.

FIBROID
Benign fibroid tumors in the uterus are extremely common in women in their 30s. Large fibroids may cause infertility impairing the uterine lining, by blocking the fallopian tube, or by distorting the shape of the uterine cavity or altering the position of the cervix

POOR SPERM MOTILITY (ASTHENOSPERMIA)
Sperm motility is the sperm’s ability to move. If movement is slow, not in a straight line, or both, the sperm have difficulty invading the cervical mucus or penetrating the hard outer shell of the egg. If 60% or more of sperm have normal motility, the sperm is at least average in quality. If less than 40% of sperm are able to move in a straight line, the condition is considered abnormal. Sperm that moves sluggishly may have genetic or other defects that render them incapable of fertilizing the egg. Poor sperm motility may be associated with DNA fragmentation and may increase the risk for passing on genetic diseases.

SEXUALLY TRANSMITTED DISEASE
As you grow older, chances of Sexually transmitted disease increases. Repeated Chlamydia trachomatis or gonorrhea infections are the sexually transmitted diseases most often associated with male infertility. Such infections can cause scarring and block sperm passage. Human papilloma viruses, the cause of genital warts, may also impair sperm function. Chlamydia is also the no 1 cause of infertility in women too.

WEIGHT
Being overweight or obese (fat levels that are 10 – 15% above normal) can contribute to infertility in various ways. Obesity is also associated with polycystic ovarian syndrome (PCOS), an endocrinologic disorder that can cause infertility. While being underweight, that is, body fat levels 10 – 15% below normal can completely shut down the reproductive process. Women at risk include: Women with eating disorders, such as anorexia or bulimia. Women on very low-calorie or restrictive diets are at risk, especially if their periods are irregular. Strict vegetarians might have difficulties if they lack important nutrients, such as vitamin B12, zinc, iron, and folic acid.

ENVIRONMENTAL FACTORS
Exposure to environmental hazards (such as herbicides, pesticides, and industrial solvents) may affect fertility both in the men and women. Estrogen-like hormone-disrupting chemicals are of particular concern for infertility in men and for effects on offspring of women. Phthalates, chemicals used to soften plastics, are under particular scrutiny because they may disrupt hormones.

STRESS AND FERTILITY
Neurotransmitters (chemical messengers) act in the hypothalamus gland, which controls both reproductive and stress hormones. Severely elevated levels of stress hormone can, in fact, shut down menstruation in women.

DIAGNOSIS
For women younger than 35, if there are no other problems, they’re having normal menstrual function, haven’t used contraception for a year and still can’t conceive, that’s when it’s considered secondary infertility. In women older than 35, it happens if you have no other problems, have normal menstrual function, have gone 6 months without contraception and haven’t conceived.

TREATMENT
Doctors use the same treatments for secondary infertility as they would for patients who have trouble conceiving a first child. Generally, you start with a work-up, then fertility drugs. If those don’t work, they ‘ll try artificial insemination and then in vitro fertilization, which is the most effective and last treatment option.