Getting Pregnant For Dummies. Sharon Perkins

      Unless (or even if) your last child was born six weeks ago, time does march on! And from an infertility point of view, that’s never a good thing. One of the primary reasons for secondary infertility is the age of the mother. But put this into perspective. If you had your first baby at 27 and now are trying for number 2 at 30, age is not the issue. However, if you had your previous child at age 38 and now you are 41, age becomes a major issue.

      Age-related male infertility can also be a consideration, although Father Time does seem to be a bit more forgiving when it comes to the dads. Regardless of whose age we’re discussing, by definition, both you and your partner (should both parties remain the same!) will be older when you try to conceive your next child. As we have seen in preceding chapters, fertility declines throughout the years, so the baby that popped up so easily in your 20s may not be as forthcoming in your 30s or 40s. The longer the interval between children, the more likely that time is not on your side. The fact that you have conceived, carried, and delivered a baby are certainly positive predictors of your ability to do so, but realize that many cite the age of the mother as the primary reason for reproductive success. Is this true? Only time will tell.

      

One interesting way to look at the effect on age is to look at the IVF data that the Society for Assisted Reproductive Technologies (SART) publishes. SART divides people using IVF into age-based categories. If you take the average delivery rates for each age category and graph them, they are almost a straight declining line. For the under-35 crowd, the average is about 45 percent per try. For the 45-and-over crowd, the average is 0. So for the ten years that this represents (35–45), there is a 45 percent drop, which because it is linear means that each year represents a 4.5 percent loss in fertility potential when using IVF. Based upon this logic, at age 38 your chance of a live birth using IVF is close to 20 percent per try, but by age 40 this has declined to 10 percent. So, in just two years your chance of success has been cut in half.

Remember, your age isn’t an admonishment. Family planning is all about the spacing of children to fit with your lifestyle, finances, and capabilities. Having children back-to-back is not necessarily the best thing to do, for your health and well-being and that of your family. Most physicians recommend a minimum of one year in between pregnancies in order to allow your body to heal. Considering that sex is a no-no for the first six weeks after delivering, those who have a ten-month difference in the age of their children are ignoring someone’s advice. While age is certainly a large factor in planning your family, it can’t be the only thing.

      So what now? You’re older and having problems. As with primary infertility, if you are over the age of 35 and have not conceived after trying naturally for six months, it may be time to visit your primary care physician, OB/GYN, or reproductive endocrinologist. They will likely run the same battery of tests on you that they would on a patient who presented with primary infertility. Be patient. You want a thorough report, not a speedy one. Two weeks won’t make a difference!

      Changes in health

      As with primary infertility, your overall health does make a difference. While you may still be living the clean life, it doesn’t mean that your body hasn’t undergone changes all its own. Have you had an increase or decrease in your weight? As we discuss in detail in Chapter 9, BMI (body mass index) can certainly play a part in your fertility or lack thereof. Have you suddenly become a marathon or long-distance runner? This too can affect your metabolism and your body’s responses, including the reproductive ones. While these can be positive health changes, they can also upset the delicate balance to which your body may be clinging. Take a look at any lifestyle changes, good or bad, and discuss them with your physician to see if therein lies the culprit.

      Occult, or not yet uncovered, chronic or acute illness can also play a role in reversing your fertility. Diabetes, autoimmune disease such as lupus, thyroid problems, and a host of other issues, large and small, can also affect your ability to conceive and may be brewing without your knowledge. If you haven’t had a complete physical workup, as well as a gynecological one, now would be the time.

      Are you fresh from your first, or last, pregnancy? Still breastfeeding? Or burning the midnight oil trying to rock Junior to sleep? Again, even subtle changes such as a shift in your sleep patterns can wreak havoc on your system, which can leave your fertility in less than fighting shape.

Another thing to consider and discuss with your OB/GYN is any lasting effects from your previous pregnancy(ies). Could you have developed adhesions as a result of a caesarian section? While it is possible to develop adhesions, this is relatively uncommon. One study reviewed the literature and reported a 10 percent increase in infertility after a C-section. However, if the delivery was complicated, then subsequent pregnancies may be difficult. For example, retained placenta requiring a D&C, especially if there was an infection, may cause uterine scarring. Did you have problems with excessive bleeding that may indicate unresolved issues? Make sure that you check out as normal from your last foray into baby making before jumping into the next.

      The other large category of problems in secondary infertility is the status of the pelvic organs: Are you having abnormal bleeding (especially between periods) that may be indicative of a fibroid or a polyp in your uterus? Have you had any kind of abdominal surgery since your last delivery (appendectomy, gall bladder surgery, ovarian cyst removal)? All surgery is associated with a risk of scarring (adhesions), which may either block the fallopian tubes or pull them away from the ovaries so that they cannot pick up the ovulated eggs. The good news is that all of these conditions can be identified with the use of appropriate diagnostic tests that your doctor can order.

      

Throughout the process of secondary infertility, make it a point to take optimal care of yourself through nutrition, rest, and exercise. You will need to be in tiptop shape to handle children in multiple forms; this would be a good time to start the process.

      Changes in partners

      No, we’re not suggesting you go out and look for a new partner if you’re not getting pregnant the second time. But you may be focusing on the wrong part of the equation, if you’re only thinking about what‘s different with you this time around. Remember, primary infertility is split fairly evenly between women’s issues, men’s issues, and those issues that are shared by both. If you have changed partners since your last child, perhaps the problem lies with your other half. Has he recently taken up running marathons? Has he developed a passion for spending hours in the Jacuzzi? Has he built a Finnish spa in the backyard that he loves to sit in and binge-watch Netflix?

      Just as with you, your partner’s health status can change over time as well, having a less-than-desirable effect on his contribution to the baby mix. If you’ve been checked out in all areas, maybe it’s time to check, or recheck, dear old dad.

Dealing with the Emotional Pain

      “I’ll be happy when …”

It’s easy to place caveats on joy, particularly when it comes to getting what you want. Remember when you thought/said/prayed/swore that if you could only conceive this one child, you would never ask for anything again? Like many “foxhole prayers,” it’s easy to forget previous promises. It’s human nature.

      While some couples are more relaxed the second time around, others bring the same intensity to conceiving number 2 (or number 3!). As with everything in life, it’s how you see the situation … is the cradle half empty or half full?

      Longing for another child

      “Another child is a bonus,” a friend once said in describing her desire to have another child. She and her husband are forever grateful for their beautiful daughter, and their one and only has given them their dream and a wonderful life to go along with it.