The stress of secondary infertility on an individual's life and relationships can be significant. It can be hard to find support from family and friends, especially when a woman or couple already has/have children. Sentiments such as, "you should be grateful for what you have," or, "just keep trying," almost never serve as useful advice or support. Couples and single parents can even experience resentment from other couples with infertility who are unable to even have their first child.
Additionally, couples may turn to assisted reproductive technology, the most common of which is in vitro fertilization (IVF). Other techniques may include special injections or using a donor's eggs or sperm. Complications can sometimes occur, the most common being bleeding or infection; ovarian hyperstimulation syndrome, in which the ovaries become swollen and painful; and multiple pregnancies.
The Clearblue Fertility Monitor is for couples who are trying to get pregnant and want to track ovulation. It has a touch screen monitor that is easy to use, stores information that you can share with your doctor. It can also help you detect the most common signs of infertility by showing you what your fertile days are. If you have no fertile days, then you may be dealing with female infertility.
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.
Secondary infertility is similar to other types of infertility and shares many of the same signs. However, in secondary infertility you’re unable to conceive or carry a baby to full-term after having a previous successful pregnancy. Infertility can be caused by either the man or woman. Treatment options can include medications to induce ovulation, in vitro fertilization (IVF) or surgery.
Risk of multiples. IUI with fertility medication carries a significant risk of multiple pregnancies, including higher-order multiples (triplets or more). A good clinic will carefully monitor your follicles to make sure that only a safe number are mature before the IUI, but they cannot entirely eliminate the risk. Recent advances in IVF (including blastocyst transfer) mean that most modern fertility clinics now transfer only one or two embryos per IVF cycle. As a result, the risk of multiple pregnancies for IVF patients is much lower than it used to be.
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]
The laboratory – This is when the harvested eggs are fertilized by an embryologist. Once fertilized, they’re grown 3-5 days until they’re able to be transferred into the woman’s uterus. Prior to the transfer, the embryos can be genetically tested. Although testing isn’t right for everyone, it’s useful for some people as it may help prevent miscarriage, passing on known genetic disorders, and can also be used to choose the sex of the child.
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.
The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g. Britain, Belgium) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of less than 2,500 grams (5.5 lb).[35]

For any woman or couple facing infertility, the task of deciding on your next steps can feel very daunting. Of course, there’s no substitute for the advice of a fertility specialist, but a general idea of what to expect can help give you confidence. You might be wondering what is the difference between In Vitro Fertilization (IVF) and  IUI, or artificial insemination?

Step on the scale. Have you put on some extra pounds since your last baby was on board? Or maybe you’ve lost a lot of weight (because after all, who has time to eat when you’re running after a little one)? Your weight can impact your fertility, so getting as close as possible to a healthy BMI can also help get you closer to that second pregnancy you’re hoping for.


I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More

^ Siristatidis C, Sergentanis TN, Kanavidis P, Trivella M, Sotiraki M, Mavromatis I, Psaltopoulou T, Skalkidou A, Petridou ET (2012). "Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer—a systematic review and meta-analysis". Human Reproduction Update. 19 (2): 105–23. doi:10.1093/humupd/dms051. PMID 23255514.

Availability of IVF in England is determined by Clinical commissioning groups. The National Institute for Health and Care Excellence recommends up to 3 cycles of treatment for women under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for women who are older than 40 years old.[156] CCGs in Essex, Bedfordshire and Somerset have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment. According to the campaign group Fertility Fairness at the end of 2014 every CCG in England was funding at least one cycle of IVF".[157] Prices paid by the NHS in England varied between under £3,000 to more than £6,000 in 2014/5.[158] In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.[159]
No matter how many times you've been asked, "When will you have another baby?" the query still stings. Try coming up with a quick comeback—like 'We actually love having an only child'—and commit it to memory, says Dr. Davidson. Another heartbreaker: your child's pleas for a sibling. Try, "You're so wonderful we don't need anyone besides you." Or maybe admit, "We'd like nothing more than to make you a big brother. We hope it'll happen."
Artificial insemination, including intracervical insemination and intrauterine insemination of semen. It requires that a woman ovulates, but is a relatively simple procedure, and can be used in the home for self-insemination without medical practitioner assistance.[171] The beneficiaries of artificial insemination are women who desire to give birth to their own child who may be single, women who are in a lesbian relationship or women who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment which prevents full intercourse from taking place.
IVF increasingly appears on NHS treatments blacklists.[160] In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.[161] By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible women under 40.[162] Policies could fall foul of discrimination laws if they treat same sex couples differently from heterosexual ones.[163] In July 2019 Jackie Doyle-Price said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.[164]

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."

One in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Infertility is defined as the inability to get pregnant after regular sexual intercourse without the use of any contraceptive methods for 6 months for those 35 years old or over, or 12 months for those under 35.(1)  Under normal circumstances the ability to get pregnant is at the most 25% each month. This number declines over time and starts to decline more rapidly once a women reaches her thirties, so that by age 35, the likelihood of getting pregnant each month is down to about 15%, and by age 40 it’s down to less than 10%.
IVF increasingly appears on NHS treatments blacklists.[160] In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.[161] By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible women under 40.[162] Policies could fall foul of discrimination laws if they treat same sex couples differently from heterosexual ones.[163] In July 2019 Jackie Doyle-Price said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.[164]
For five to six days following fertilization, the developing embryos are cultured in the laboratory until the blastocyst stage of development has been reached. This represents growth of about 200 cells. We at RMA culture embryos exclusively to the blastocyst stage, because published data demonstrates that extended embryo culture results in improved implantation rates and pregnancy outcomes. This means we will never do an embryo biopsy – or an embryo transfer – at three days, or anything less than the blastocyst stage.

Success rates vary with the number of embryos transferred. However, transferring more and more embryos at one time does not increase the chance of live birth significantly, but may only increase the risk of a multiple pregnancy, and its associated risks. The impact of the number of embryos that are transferred also varies with the age of the woman.  
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.

Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
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.
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.
Studies show that sperm count and sperm movement decrease as men age, as does sexual function. But there isn't a cutoff age that makes a man too old to father a child. One study found that it took men age 45 or older longer to get a woman pregnant once the couple started trying. If your partner is older, you may want to talk to your doctor about ways to boost your chances.
We also care about not only your physical well being, but also your emotional health. In fact, these issues as important enough to us that one of our core team members is a psychologist. Julianne Zweifel is an expert in addressing the mental aspects of secondary (and primary) infertility and she can promote emotional well being in a way that few others have the training or experience to do. If you should feel you do not wish to talk a specialist, but are struggling emotionally, please at least let other team members know-the more we hear from you, the easier it is for us to help.  

If you fit one of these profiles, your fertility team may agree that it makes sense to attempt IUI before considering IVF. Before you begin IUI, it’s good to have a conversation with your partner and doctor about how many cycles you want to attempt. Many people place a limit of three failed IUI cycles, but others may try up to six before moving on.
The stress of secondary infertility on an individual's life and relationships can be significant. It can be hard to find support from family and friends, especially when a woman or couple already has/have children. Sentiments such as, "you should be grateful for what you have," or, "just keep trying," almost never serve as useful advice or support. Couples and single parents can even experience resentment from other couples with infertility who are unable to even have their first child.

Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta
Of course, if you have a history of infertility or any factors that might impede fertility, it makes sense to arm yourself with the right help right from the start. Once you make that appointment with a fertility specialist, you and your doctor will follow the same treatment plan that would be put into place if you were dealing with primary infertility.
1. Educating About Infertility - Educating yourself about infertility is the first step towards your treatment. We believe that educating the patients about the problem associated with their pregnancy and the available treatment options can empower them to make better choices. When you understand better about the reproductive process, you will be able to decide when to seek help. We aim to achieve a healthy pregnancy for every patient.
In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as cumulus cells) and prepared for fertilisation. An oocyte selection may be performed prior to fertilisation to select eggs that can be fertilized, as it is required they are in metaphase II. There are cases in which if oocytes are in the metaphase I stage, they can be kept being cultured so as to undergo a posterior sperm injection. In the meantime, semen is prepared for fertilisation by removing inactive cells and seminal fluid in a process called sperm washing. If semen is being provided by a sperm donor, it will usually have been prepared for treatment before being frozen and quarantined, and it will be thawed ready for use.
Treating secondary infertility, like primary infertility, will depend largely on any underlying medical conditions. Through the Couples Clinic at UW Health's Generations Fertility Care, both members of the couple undergo a routine evaluation. Since infertility is not simply a woman's problem, evaluating both members ensures the most effective treatments can be recommended.  
Bachelor's Degree in Medicine & Surgery from the University of Navarra, with specialty in Obstetrics and Gynecology from the University of the Basque Country. He has over 30 years of experience in the field and works as a Titular Professor at the University of the Basque Country and the Master's Degree in Human Reproduction of the Complutense University of Madrid. Vice-president of the SEF. More information about Gorka Barrenetxea Ziarrusta

One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "I watched my daughter take her first steps and thought, 'Maybe I'll never have this again,'"‰'' Bozinovich says. (Her problem was never pinpointed, but, happily, she went on to have two more children.) That is tough, the experts agree. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"‰"
Since each couple is unique in the cause of infertility, the answer as to whether ICSI or conventional IVF is more beneficial could vary. A retrospective cohort study published in 2015 is the most comprehensive study so far comparing the two strategies with different infertility factors, which will be the focus here1. A few other smaller-scale studies will also be discussed.
Most parents have a mental image of their ideal family, and if they find themselves unable to make that happen, it can be devastating. Infertility is heartbreaking and stressful, whether you have a child or not. In fact, being a parent adds a layer of complexity. For one thing, parents are immersed in the world of kids, so it's impossible to avoid all the babies and pregnant bellies that remind you of what you're missing. Plus, "parents with secondary infertility don't often get much sympathy, so they end up feeling as though they don't have a right to be sad," says Marie Davidson, Ph.D., a psychologist at Fertility Centers of Illinois. In fact, they're often told to appreciate the child they have (as if they don't). Finally, many parents feel guilt on two fronts: for not giving their child a sibling and for directing some of their focus and resources away from that child.
Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age, antral follicle count and level of anti-Müllerian hormone.[60] The resulting prediction of e.g. poor or hyper-response to ovarian hyperstimulation determines the protocol and dosage for ovarian hyperstimulation.[60]
The eggs are retrieved in a simple process which takes about 15-20 minutes and is carried out in the doctor’s office under light sedation. The ovaries are accessed through the vaginal cavity and each of the follicles containing an egg is punctured. The fluid containing the eggs is aspirated through a very fine needle. The patient rests for a brief time and can then go home with an escort. Usually, the patient feels back to normal the day after.
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]
3. Painful Periods: We’re not talking about normal cramping here. But, severe pain that stops you in your tracks and even causes nausea or vomiting. Alone this may not be a sign of infertility, but combined with other symptoms like pain during intercourse, blood in the urine or during bowel movements, or irregular periods, can be signs of endometriosis–a condition that accounts for 20-40% of female infertility cases.
Give in to the grief. While you probably feel incredibly disappointed and sad about your infertility problems, you may feel guilty giving in to those emotions. Parents facing secondary infertility often feel they don’t have the “right” to feel sad about their struggles because they should be grateful for the child they already have. But if you want more children and are having trouble getting pregnant again, you are just as entitled as anyone else to feel depressed or angry. The last thing you need when you’re coping with secondary infertility is to let guilt weigh you down even more.
In a lab, your eggs are mixed with sperm cells from your partner or a donor — this is called insemination. The eggs and sperm are stored together in a special container, and fertilization happens. For sperm that have lower motility (don’t swim as well), they may be injected directly into the eggs to promote fertilization. As the cells in the fertilized eggs divide and become embryos, people who work at the lab monitor the progress.
The second study by Huang et al. demonstrated nearly equivalent pregnancy rates between the three medications. Furthermore, the twin risk was not significantly elevated in any of the three groups. The key difference between these studies is that the dose of gonadotropins was higher in the AMIGOS study (150 units) than the Huang study (75 units). A higher dose often means more eggs ovulated and a greater risk of twins or more.
One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "I watched my daughter take her first steps and thought, 'Maybe I'll never have this again,'"‰'' Bozinovich says. (Her problem was never pinpointed, but, happily, she went on to have two more children.) That is tough, the experts agree. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"‰"
A recent controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Women's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.[111][112] The California Medical Association had initially sided with Brody and Fenton, but the case, North Coast Women's Care Medical Group v. Superior Court, was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.[113][114]
People who have suffered primary infertility tell me that the only way they can get by is to avoid everything and anything to do with babies. But for the secondary infertility sufferer, this is not an option. You are confronted on a daily basis at the school gates by pregnant women, people with babies, large families squashed into multiple buggies. School drop-off becomes a terrible tableau of everything you want but cannot have.
Intercourse must take place frequently, particularly before and around the time of ovulation, and the couple must have been trying to conceive for at least one year (6 months if the woman is over 35 years old). Using these criteria, about 10-20% of all infertile couples have unexplained infertility. However, the percentage of couples classified as having unexplained infertility will depend upon the thoroughness of testing and the sophistication of medical technology. 
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]

Headaches and mood swings: Headaches and mood swings are common IVF treatment side effects. Over-the-counter medications can ease headaches, and while no medication can help with mood swings, knowing that they’re a normal part of IVF treatment helps. If you find mood swings are disrupting your day, be sure to seek out self-care practices such as enjoying alone time, reading a book, taking a nice bath, or sharing feelings with a friend or loved one.
I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include abdominal pressure and pain, pelvic pain, pain during intercourse, and pain during bowel movements. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Few American courts have addressed the issue of the "property" status of a frozen embryo. This issue might arise in the context of a divorce case, in which a court would need to determine which spouse would be able to decide the disposition of the embryos. It could also arise in the context of a dispute between a sperm donor and egg donor, even if they were unmarried. In 2015, an Illinois court held that such disputes could be decided by reference to any contract between the parents-to-be. In the absence of a contract, the court would weigh the relative interests of the parties.[190]
^ Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM (2013). "The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis". Human Reproduction Update. 19 (6): 696–713. doi:10.1093/humupd/dmt026. PMC 3796945. PMID 23814102.
A Cochrane review came to the result that endometrial injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.[30]
While PGD was originally designed to screen for embryos carrying hereditary genetic diseases, the method has been applied to select features that are unrelated to diseases, thus raising ethical questions. Examples of such cases include the selection of embryos based on histocompatibility (HLA) for the donation of tissues to a sick family member, the diagnosis of genetic susceptibility to disease, and sex selection.[97]
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