Why am I finding it hard to conceive baby number two?

A woman in anguish in the hospital.

Photo credit: FOTOSEARCH

What you need to know:

  • It may occur due to complications from the previous pregnancy or childbirth
  • It is advisable for you to be reviewed by a gynaecologist

Dear doctor,
I gave birth four years ago and I haven’t gotten pregnant again even though I have been trying for more than two years. I’m wondering what the problem could be. I had used the one-year implant which I removed when my son was one-and-a-half years old. I haven’t used any other contraceptive since that time. Could this be the cause?

Dear Anne,
You may be experiencing secondary infertility, which is defined as the inability to get pregnant or carry a pregnancy to term after having previously given birth. This is diagnosed if there is no conception after one year of having regular unprotected sex. It can affect one or both partners. It is just as common as primary fertility, where there is difficulty conceiving the first time.

It may occur due to complications from the previous pregnancy or childbirth, or complications from a previous surgery. It can also happen due to hormonal disorders or illnesses that affect the reproductive organs, for instance causing blockage of the fallopian tubes or affecting sperm production.

Secondary infertility may also be as a result of some medications. Some factors that can increase the risk of infertility are alcoholism, smoking, obesity, severe weight loss, extreme physical or emotional stress, and being over 35 years of age.

With every contraceptive, the return to fertility (how soon you can get pregnant after stopping the use of that method) differs, depending on the type of contraceptive and also depending on the individuals. Hormonal contraceptive methods may have a delay of several weeks to several months in return to fertility, though for some individuals, the return to fertility may be as fast as one or two weeks after discontinuing the contraception — including after discontinuing the implant.

It is advisable for you to be reviewed by a gynaecologist. Check-ups may include a pelvic ultrasound to check the pelvic organs, a hysterosalpingogram (HSG) to check the fallopian tubes and a hormone profile to check the hormones. Your partner may also need to have a seminalysis and a hormone profile, as necessary.

Based on the findings, treatment may be given. For example, you may be given medication to facilitate ovulation or to control hormones. You may need surgery if there is scarring, endometriosis or the fallopian tubes are blocked. Your partner may also be put on medication. If this is unsuccessful over a period of time, you may also benefit from assisted conception through intra-uterine insemination or in vitro fertilisation.

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