Dr. Gorka Barrenetxea provides us with a practical case of secondary infertility that occurs more commonly than one may think. A couple, throughout their lifetime, can have children with 20, 25, 30 and 35 years, but when they decide to have a second or third child, they may encounter trouble conceiving due to the passage of time itself, Dr. Barrenetxea states.
4. IVF or In-Vitro Fertilization - IVF means eggs are collected and fertilized outside the body, in a laboratory. This is followed by transferring the embryos into the uterus. This advanced technology has resulted in many successful pregnancies in women who had lost hope. During IVF - In-Vitro Fertilization, women can choose to freeze their healthy eggs for future use.
Luteal phase abnormalities: The luteal phase is the part of the cycle that follows the release of the egg from the ovary. It may be inadequate in one way and this is called a luteal phase defect. The corpus luteum produces the hormone progesterone. Progesterone is essential for preparing the endometrium to receive the fertilized egg. Several things can go wrong with progesterone production: the rise in output can be too slow, the level can be too low, or the length of time over which it is produced can be too short. Another possibility is a defective endometrium that does not respond properly to the progesterone. Luteal phase defects can be investigated either by a properly timed endometrial biopsy or by monitoring the progesterone output by taking a number of blood samples on different days after ovulation and measuring the progesterone level. 
For most couples having difficulty achieving a pregnancy their chance of achieving a pregnancy is not zero, it is just lower than the average rate of conception—unless both Fallopian tubes are completely blocked, there is no sperm, or the woman never ovulates. Ovulation induction (or superovulation) with IUI helps patients to achieve pregnancy rates closer to the natural per cycle chance of pregnancy for women in their age group who do not have infertility (see fig 1).
The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation).[71] Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the cumulative clinical pregnancy rates are increased with cleavage stage transfer.[30] Transfer day two instead of day three after fertilisation has no differences in live birth rate.[30] There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births having from embryos cultured until the blastocyst stage compared with cleavage stage.[71]

While I’m not on the list to receive a Nobel Prize for mathematics any time soon, I do have enough understanding of how probabilities work to know that roulette isn’t a very viable long term career choice. Figuring that if I could make this costly error in analysis, there must be at least a few others out there that have, or will, make the same mistake as me…
Intracytoplasmic sperm injection (ICSI): This procedure involves direct injection of a single sperm of the male partner into the eggs of the female for fertilization. Just like IVF procedure, in ICSI, the sperm and egg are collected from both the partners. The only difference is the fertilization process as in IVF the sperms and egg are mixed naturally, and in ICSI the sperms are injected into the egg using a needle.
Typically, genetic parents donate the eggs to a fertility clinic or where they are preserved by oocyte cryopreservation or embryo cryopreservation until a carrier is found for them. Typically the process of matching the embryo(s) with the prospective parents is conducted by the agency itself, at which time the clinic transfers ownership of the embryos to the prospective parents.[89]
Epigenetic testing may allow patients to forgo the cost of multiple rounds of IVF by predicting whether embryos will fail. Equipped with this information, couples can have their IVF cycles optimized to account for embryonic versus fertilization issues. This represents a significant leap for the medical community given that 36% of couples struggling with unexplained infertility are currently over-treated.
Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 5-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.
In the well-established fertility treatment of IVF, unlike IUI, the meeting of sperm and egg takes place outside the body, in the laboratory (in vitro). This gives fertility practitioners a lot more control over the selection of a genetically normal embryo that has the best chance of establishing a successful pregnancy. IVF is the fertility treatment with the highest likelihood of taking home a healthy baby. These are the stages involved in IVF:
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]

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.

In the US, up to 20% of infertile couples have unexplained infertility. In these cases abnormalities are likely to be present but not detected by current methods. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.[59] However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.[60][61]


Intrauterine insemination (IUI) is one of the simpler, “low-tech” treatments for infertility and the starting point for many individuals and couples who are having difficulty with conception on their own. Patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation are often good candidates for IUI.
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?
Secondary infertility can be traced to either partner or both partners. About one-third of cases originate in women and about one-third originate in men. In the remaining one-third, the cause is due to a combination of factors or isn’t known. Increased age, complications from a prior pregnancy or surgery, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse, and smoking are all examples of secondary infertility in women and men.
In the United States, overall availability of IVF in 2005 was 2.5 IVF physicians per 100,000 population, and utilisation was 236 IVF cycles per 100,000.[166] 126 procedures are performed per million people per year. Utilisation highly increases with availability and IVF insurance coverage, and to a significant extent also with percentage of single persons and median income.[166] In the US, an average cycle, from egg retrieval to embryo implantation, costs $12,400, and insurance companies that do cover treatment, even partially, usually cap the number of cycles they pay for.[167] As of 2015, more than 1 million babies had been born utilising IVF technologies.[27]
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro ("in glass"). The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. After the fertilised egg (zygote) undergoes embryo culture for 2–6 days, it is implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
Secondary infertility is the inability to conceive a child or carry a pregnancy to full term after previously giving birth. To classify as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization. Secondary infertility typically is diagnosed after trying unsuccessfully to conceive for six months to a year. A related condition is recurrent pregnancy loss where patients and couples are able to conceive but are unable to carry to term.
Fertility is often something people do not consider until they are actively trying to start a family, or in many cases after they have started having trouble conceiving. What many don’t realize is that couples ages 29-33 with normal functioning reproductive systems only have a 20-25% chance of conceiving in any given month. Add in any number of infertility factors from either gender and those chances can decrease significantly.
Within the Orthodox Jewish community the concept is debated as there is little precedent in traditional Jewish legal textual sources. Regarding laws of sexuality, religious challenges include masturbation (which may be regarded as "seed wasting"[129]), laws related to sexual activity and menstruation (niddah) and the specific laws regarding intercourse. An additional major issue is that of establishing paternity and lineage. For a baby conceived naturally, the father's identity is determined by a legal presumption (chazakah) of legitimacy: rov bi'ot achar ha'baal – a woman's sexual relations are assumed to be with her husband. Regarding an IVF child, this assumption does not exist and as such Rabbi Eliezer Waldenberg (among others) requires an outside supervisor to positively identify the father.[133] Reform Judaism has generally approved IVF.[129]
At the same time, in older women, the IVF success rates can vary dramatically, and that’s why it’s so important to focus only on live births. For example, a clinic may have a very high pregnancy rate among older women, but a low live birth rate. Or, the rates may be quite high – 40% or even 50% – but only after four or five rounds. That makes a very big difference, especially in the overall cost of treatment!
However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the pelvic cavity for pelvic scarring and endometriosis. Laparoscopy surgery is no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to - leaving many more couples in the unexplained category.
Wondering if it’s time to seek fertility help from a specialist? Your age can help clue you in to the answer. If you’re younger than 35, it’s perfectly normal for it to take six months to a year to conceive. If, after a year, you haven’t accomplished your conception goal, you’ll want to talk with your practitioner and/or get a referral to a fertility specialist. If you’re older than 35, experts recommend that you seek help from a fertility specialist after six months of regularly trying to conceive without birth control — and you may even want to go after three months. If you’re over 40, you’ll probably want to start off your quest for a second pregnancy with a fertility evaluation from your doctor. Ditto if your partner is over 40, since 35 to 40 percent of fertility problems can be traced back to the man, and a guy’s age affects the quality of his sperm.

Take a look at your lifestyle. Have any of your habits changed since you conceived baby number one? For instance, is your diet still on track, or is there room for improvement? Getting your eating plan up to baby-making speed may help you close in faster on conception. Has your caffeine consumption gone up now that you’re a mom? That’s understandable, but too much caffeine isn’t great for fertility. Has your smoking habit returned? If yes, it’s time to kick butt, since smoking ages your eggs and decreases fertility. Are you getting way too little sleep? That may be likely, especially if your first child is keeping you up at night, but skimping on sleep can mess with your hormones — and possibly your fertility. If any new unhealthy habit has slipped into your lifestyle, now’s a great time to put the brakes on it. And it’s not just about your habits. Is your partner kicking back one too many beers each night? That could be affecting his sperm quality. Ditto for smoking or an unhealthy diet. If your partner’s lifestyle needs a little fine-tuning, make efforts to get his back on track, too.


West states that the "hardest thing about secondary fertility issues is that you want a sibling for your child." Fiona, who has a son of five and has been trying to conceive a second child for two years, says she can no longer look out of the window at her son playing in the garden. "It breaks my heart. He just looks so alone out there. All I want is a sibling for him but I don't think it's going to happen."
Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction.[17] Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.[18] Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[19]
Wondering if it’s time to seek fertility help from a specialist? Your age can help clue you in to the answer. If you’re younger than 35, it’s perfectly normal for it to take six months to a year to conceive. If, after a year, you haven’t accomplished your conception goal, you’ll want to talk with your practitioner and/or get a referral to a fertility specialist. If you’re older than 35, experts recommend that you seek help from a fertility specialist after six months of regularly trying to conceive without birth control — and you may even want to go after three months. If you’re over 40, you’ll probably want to start off your quest for a second pregnancy with a fertility evaluation from your doctor. Ditto if your partner is over 40, since 35 to 40 percent of fertility problems can be traced back to the man, and a guy’s age affects the quality of his sperm.
The likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over - and greatly increased in women over 38. The reason for this is that there are more likely to be egg quantity and quality problems as women age. Since we do not have a "standard category" called egg factor infertility, these couples sometimes get lumped in to the "unexplained" infertility category.
Acknowledge your feelings. When dealing with secondary infertility, it’s very common to feel shock or denial. After all, making one baby might have been a piece of cake for you, so you probably assumed that having a second one would be easy, too. Your friends and even your doctor may also downplay your current infertility problems (telling you not to take it so hard or to “just keep trying”) since you had no trouble before. But secondary infertility is much more common than most people realize. So allow yourself the chance to accept the idea that you may be battling secondary infertility — because once you do, you can tackle the problem head-on.

^ Chavez-Badiola, Alejandro; Flores-Saiffe Farias, Adolfo; Mendizabal-Ruiz, Gerardo; Garcia-Sanchez, Rodolfo; Drakeley, Andrew J.; Garcia-Sandoval, Juan Paulo (10 March 2020). "Predicting pregnancy test results after embryo transfer by image feature extraction and analysis using machine learning". Scientific Reports. 10 (1): 4394. Bibcode:2020NatSR..10.4394C. doi:10.1038/s41598-020-61357-9. PMC 7064494. PMID 32157183.
s ohledem na poslední informace ohledně šíření koronaviru 2019-nCoV jsme zavedli zvýšená hygienická opatření za účelem ochrany pacientů i personálu kliniky. Klinika i nadále poskytuje zdravotní péči v plném rozsahu, avšak u pacientů ze zasažených oblastí, případně pacientů, kteří tyto oblasti v poslední době navštívili, bude léčba odložena. V případě příznaků respiračních onemocnění žádáme pacienty, aby před příjezdem na kliniku kontaktovali svého lékaře, případně koordinátora a dohodli se na nejvhodnějším postupu.
A surge in LH triggers your ovaries to release an egg. The surge usually happens 36 hours before the egg is released. Ovulation kits check LH levels in your urine to help you pinpoint the day of ovulation. These kits, which you can buy at the drugstore, are convenient and highly accurate. You may want to test 1-2 days before you expect the surge so you can note the rise in LH.
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.
In a bid to understand my chances of IVF success, I took a quick dive through the vast information available from these sources and came away thinking I had the information I needed. I skipped merrily along thinking things looked pretty promising after reading my chances of IVF working the first time was somewhere around the 40% mark. I naively thought that meant I had an 80% chance if I did two cycles, and that I’d definitely have a baby after three rounds at the most. Unfortunately as later reflection revealed, math and statistic just don’t work like this…

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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