After giving birth to her first child 11 years ago, Julia Indichova was trying desperately — and unsuccessfully — to have a second.
Doctors said she had no chance of conceiving another child, because of her age, 42, and a high hormone level.
Indichova was facing something known as "secondary infertility." The term refers to infertility in women who became pregnant at an earlier stage of their life but are now having difficulty conceiving. By some estimates, the problem accounts for one-third of all visits to fertility specialists. An estimated 3 million couples struggle with secondary infertility, almost double the number from 1995.
Indichova succeeded in finding her own path to becoming pregnant for a second time, which for her consisted of practicing both vegetarianism and yoga. She has written a book about her experience, Inconceivable: A Woman's Triumph over Despair and Statistics, and teaches classes to other mothers dealing with secondary infertility.
Late Start on Motherhood
Dr. Sami David, a fertility specialist from Mount Sinai Hospital in New York who has treated many women with secondary infertility, said the numbers are on the rise for a reason.
"It is often because women are waiting longer to start having children," David said. Most of his patients had their first child when they were about 35, then waited several years to have a second. But by ages 39 or 40, it becomes more difficult to conceive.
Often, doctors can pinpoint the problem by looking at the woman's medical history, along with the man's.
"Find out if anything has happened to either of their lives or their health in the interim," David said. "[Women] might have hormonal problems, or the quality of their eggs may have declined."
Doctors will typically ask whether a woman's menstrual cycle has changed, and measure her hormones with blood tests. Progesterone is the most important hormone involved in pregnancy, and a low progesterone level is the most common cause for secondary infertility. The low levels occur either because of a woman's age or from too much strenuous exercise, David said.
Process of Elimination
There is usually more than one factor to blame, so you have to go through the possibilities and eliminate them one by one, David said. The man could be causing the problem.
"If the man has a varicose vein, a vein around the testes, the sperm may be adequate on their first achievement of a pregnancy," David said. "Then subsequently, three or four years later that same vein is now creating semen that is not quite as good quality. So you have to turn towards the male in the partnership as well and see if he is still as good as he was, say, three years, four years, earlier."
The cause could also be the husband having a genetic disorder which results in chromosomal damage, or a thyroid problem that can make a man's testosterone level drop. It could also be environmental: Jacuzzi baths can affect a man's sperm.
"Then you look into other possibilities, infections," David said. "Even the minor infections may cause difficulty."