We don't know what causes most cases of secondary infertility, says Jamie Grifo, M.D., Ph.D., program director of the New York University Fertility Center, in New York City. "The majority of the time, though, it reflects the fact that you're older now, so it's simply more difficult to get pregnant." The reality is that for women, fertility peaks at age 25 and drops by half between ages 30 and 40. As we age, egg quality declines and we're more likely to develop fibroids and endometriosis, which contribute to infertility. Other factors such as adding extra weight, taking new meds, or having surgery since your last pregnancy can be an issue. It may also be that your partner's sperm quality or production is now poor.

In order to have a successful IVF pregnancy, the first few weeks need special care. When you undergo IVF, you will be continuously monitored throughout the process by skilled doctors. Constant supervision reduces the complications associated with pregnancy. By understanding the IVF process and following your doctor’s instructions, you can enjoy the journey of your healthy pregnancy.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Problems with your periods or menstrual cycle is a sign of ovulation problems – and if you aren’t ovulating, you won’t get pregnant. Menstrual problems are the most obvious sign of infertility in women – but they don’t necessarily mean you’re infertile. Most women have some type of problem with their period: light flow, heavy flow, clotting, irregularity caused by stress or weight fluctuations, hormonal changes, etc.
Although menopause is a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uteruses have been appropriately prepared receive embryos that originated from an egg of an egg donor. Therefore, although these women do not have a genetic link with the child, they have a physical link through pregnancy and childbirth. In many cases the genetic father of the child is the woman's partner. Even after menopause the uterus is fully capable of carrying out a pregnancy.[109]
Many people of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.[134]

Monitoring of egg development is usually done with E2 and LH blood hormone tests and ultrasound scans of the ovaries to determine when the egg is mature. The ultrasound allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre- to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.
PCOS: Polycystic ovarian syndrome (PCOS) is an ovarian issue that can cause irregular menstrual cycles and make it difficult for women to ovulate — a crucial part of the conception and pregnancy process. Women with PCOS do not release eggs regularly, and their ovaries often have many small cysts within. IVF is a strong option for women with PCOS, since it can help their bodies ovulate to achieve pregnancy.

Problems with the uterus: There are many conditions related to the uterus that can cause secondary infertility. Scarring can occur during a dilation and curettage (D&C) or Cesarean delivery that can create adhesions inside the uterus that interfere with future pregnancies Fibroids or polyps are benign (non-cancer) growths inside the uterus that can impair pregnancy. A retained placenta can cause infection and uterine scarring.
Success varies with many factors. The age of the woman is the most important factor, when women are using their own eggs. Success rates decline as women age, specifically after the mid-30’s.  Part of this decline is due to a lower chance of getting pregnant from ART, and part is due to a higher risk of miscarriage with increasing age, especially over age 40.  
There are multiple strategies for causing ovulation in clomid or letrozole resistant patients. Some of these include adding medications such as dexamethasone or metformin to the treatment regimen. Another approach is changing to gonadotropin injections. Rather than tricking the brain into sending a stronger signal to the ovaries to cause follicle recruitment, gonadotropins directly stimulate the ovary to recruit multiple follicles.
Kym Campbell is a Health Coach and PCOS expert with a strong passion for using evidence-based lifestyle interventions to manage this disorder. Kym combines rigorous scientific analysis with the advice from leading clinicians to disseminate the most helpful PCOS patient-centric information you can find online. You can read more about Kym and her team here.
Nonmedicated cycle with IUI: Also known as natural cycle IUI, a non-medicated cycle with IUI is often used by single women or same-sex female couples who are not directly experiencing infertility, but rather a lack of sperm. This treatment involves tracking the development of the egg that is naturally recruited during a menstrual cycle and then introducing the donated sperm. You will come into the office for two to four monitoring appointments to track egg development and cycle timing.

iui versus ivf : While approaching an IVF specialist in order to conceive baby, infertile couples come across several options through which they can achieve their goal. These include IUI, IVF and surrogacy. People wishing to carry their child and avoid using a surrogate get to choose between IVF and IUI. But here comes the big dilemma which procedure to choose?
Along with being physically demanding, fertility treatments can also spark a roller-coaster of emotions each month, including hope, anger, disappointment, sadness, and guilt. Just the sight of a pregnant woman can evoke strong negative and stressful feelings. During this time, those struggling with infertility may pull away from friends and family who remind them of their difficulty with reproduction; some of their closest relationships may suffer. 

A woman normally produces one egg during each menstrual cycle. However, IVF requires multiple eggs. Using multiple eggs increases the chances of developing a viable embryo. You’ll receive fertility drugs to increase the number of eggs your body produces. During this time, your doctor will perform regular blood tests and ultrasounds to monitor the production of eggs and to let your doctor know when to retrieve them.
3-6 months of treatment with Clomid pills (clomiphene citrate) might improve fertility by as much as 2 times as compared to no treatment. This is a very low level infertility treatment. Infertility specialists do not usually recommend Clomid treatment( without insemination) for unexplained infertility for women over the age of about 35. Most fertility specialists do not use it (without IUI) on any couples with unexplained infertility. If a woman is already having regular periods and ovulating one egg every month, giving Clomid, which will probably stimulate the ovaries to release 2 or 3 eggs per month (instead of one) is not really fixing anything that is broken - and is not likely to be successful.
Mild IVF[64] is a method where a small dose of ovarian stimulating drugs are used for a short duration during a woman's natural cycle aimed at producing 2–7 eggs and creating healthy embryos. This method appears to be an advance in the field to reduce complications and side-effects for women and it is aimed at quality, and not quantity of eggs and embryos. One study comparing a mild treatment (mild ovarian stimulation with GnRH antagonist co-treatment combined with single embryo transfer) to a standard treatment (stimulation with a GnRH agonist long-protocol and transfer of two embryos) came to the result that the proportions of cumulative pregnancies that resulted in term live birth after 1 year were 43.4% with mild treatment and 44.7% with standard treatment.[65] Mild IVF can be cheaper than conventional IVF and with a significantly reduced risk of multiple gestation and OHSS.[66]
Bachelor of Arts in Translation and Interpreting (English, Spanish, Catalan, German) from the University of Valencia (UV) and Heriot-Watt University, Riccarton Campus (Edinburgh, UK). Postgraduate Course in Legal Translation from the University of Valencia. Specialist in Medical Translation, with several years of experience in the field of Assisted Reproduction. More information about Sandra Fernández
Mutations to NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a small subset of men with non-obstructive male factor infertility where the cause is unknown. Results of one study investigating a cohort of 315 men revealed changes within the hinge region of SF-1 and no rare allelic variants in fertile control men. Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.[27]
Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. But Iran, which is Shi'a Muslim, has a more complex scheme. Iran bans sperm donation but allows donation of both fertilised and unfertilised eggs. Fertilised eggs are donated from married couples to other married couples, while unfertilised eggs are donated in the context of mut'ah or temporary marriage to the father.[176]
^ Tan K, An L, Miao K, Ren L, Hou Z, Tao L, Zhang Z, Wang X, Xia W, Liu J, Wang Z, Xi G, Gao S, Sui L, Zhu DS, Wang S, Wu Z, Bach I, Chen DB, Tian J (March 2016). "Impaired imprinted X chromosome inactivation is responsible for the skewed sex ratio following in vitro fertilization". Proceedings of the National Academy of Sciences of the United States of America. 113 (12): 3197–202. Bibcode:2016PNAS..113.3197T. doi:10.1073/pnas.1523538113. PMC 4812732. PMID 26951653.
The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.[83] The advantage is that patients who fail to conceive may become pregnant using such embryos without having to go through a full IVF cycle. Or, if pregnancy occurred, they could return later for another pregnancy. Spare oocytes or embryos resulting from fertility treatments may be used for oocyte donation or embryo donation to another woman or couple, and embryos may be created, frozen and stored specifically for transfer and donation by using donor eggs and sperm. Also, oocyte cryopreservation can be used for women who are likely to lose their ovarian reserve due to undergoing chemotherapy.[84]
Studies have indicated that IVF mothers show greater emotional involvement with their child, and they enjoy motherhood more than mothers by natural conception. Similarly, studies have indicated that IVF father's express more warmth and emotional involvement than fathers by adoption and natural conception and enjoy fatherhood more. Some IVF parents become overly involved with their children.[136]

The cost of an IUI is almost certainly less on a per cycle basis, but because IVF has much higher success rates and IUI is a poor option for some, the higher per cycle cost of IVF can actually be more affordable in the long run – in terms of the cost to bring home a baby.  Because most successful IUIs happen in the first three or four-cycle, it eventually becomes very expensive to bring home a baby with an IUI.


Problems in the quantity or quality of eggs: Women are born with a limited supply of eggs and are unable to create new eggs after birth. As women approach their 40s and beyond, the numbers of eggs left in their ovaries decrease, and the remaining eggs have a higher chance of having chromosomal problems. For women where age isn’t a concern, there are other reasons that they might have a low number of good quality eggs, including autoimmune or genetic conditions and prior surgery or radiation.
Fertility expert Zita West has noticed this increase at her London clinic. "The main reason," she explains, "is age. Women are having babies later." Exhaustion also plays a part. "The sleeplessness of life with a small child can't be underestimated," she says. "You might still be breastfeeding, you might be sharing a bed with a toddler, you might be holding down a job at the same time. Basically, there's not a lot of sex happening."
Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process.
Infertility is, in all its forms, a most private, hidden anguish. Nobody wants to discuss the finer points of their reproductive system in public. And the desire to have a child can, if thwarted, be so overwhelming that just a glimpse from a car window of someone with a BabyBjorn can be enough to produce such a flood of tears that you have to pull over. How can you possibly articulate that level of pain to the casual inquirer?
Infertility can have a profound impact on one’s mental health. When men and women find out that they can’t conceive, they may experience the same painful emotions as anyone coping with grief or profound loss. Common reactions include shock, frustration, grief, anger, decreased self-esteem, anxiety, and depression, but feelings about infertility can vary greatly depending on the source of the problems. Men, in particular, find it far easier to deal with a partner’s infertility than with their own.
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