Secondary infertility

Infertility is the disorder of the reproductive system, when for a year or more, the attempts to get pregnant are not successful, even despite the regular sexual activity and contraception non-usage.

There is primary and secondary infertility. What differs secondary infertility from the primary one is that the women with this diagnosis had at least one or more successful pregnancies.
Secondary infertility may be caused by the abortion, miscarriage, ectopic pregnancy or difficult labors.

The reasons for secondary infertility include the following:

• Woman’s age: After the age of 30, woman’s reproductive function decreases, as well as the ovarian reserve (i.e. the follicular reserve of ovaries), the quality of eggs becomes poorer, and the chromosomal changes could be observed in eggs (it increases the risk of genetic disorders in the fetus), and the higher number of chronic diseases emerge in the body with age.
• Various neoplasms in in the reproductive organs (benign and malignant): polyps, cysts, fibroids, etc.
• Infectious diseases in the past: Unfortunately, the number of infectious and viral diseases constantly grows in the world, viruses constantly mutate and change thus the human body should constantly adapt and fight against them. Until the new viral diseases are still not studied in full (for example, the virus Covid-19), it is impossible to forecast how they would affect the human body and what organ systems they may negatively impact.
• Antisperm antibodies in woman (woman’s immune system can attack male reproductive cells).
• Complications after abortions, miscarriages, endometrectomy (endometrial damage interferes with embryo implantation and pregnancy does not occur).

Diagnostics

In case of reproductive issues like in the case with any other medical problems, it is necessary to consult a doctor first, in particular, the specialist in gynecology and reproductive medicine. At the appointment, the doctor asks about the medical history, discusses the menstrual cycle, performs gynecological examination, collects the necessary swabs and cytological samples. Very often the cause for secondary infertility is infectious diseases and in order to confirm or confute this cause, it is necessary to undergo the examination to detect chlamydia, ureaplasma, cytomegalovirus, genital herpes, trichomonas, gonorrhea, toxoplasmosis, etc.

Gynecologist also performs an ultrasound examination of the pelvic floor to assess uterus and ovaries, as well as ultrasound examination of the mammary glands. In some cases, the doctor may recommend an ultrasound examination of the thyroid gland and a blood test for thyroid hormones (thyroid hormone, thyroxine). The reason is that the malfunction of the thyroid gland may impact the reproductive system. Thyroid diseases are among the most common endocrine disorders in women of reproductive age and are 10 times more common in women, than in men.

The next stage in infertility diagnostics is the study of woman’s endocrine profile (LH, prolactin, progesterone, AMH, FSH, estradiol).

After considering all the above mentioned causes, the patency of fallopian tubes is studied (hysterosalpingography and hysterosalpingoscopy).

Thus, hysteroscopy (a procedure aimed at studying the internal condition of the uterus with a special optical device) and laparoscopy (diagnostic intervention using a special laparoscope device) may be performed.

Correlation between the thyroid gland and female reproductive health

The female reproductive system directly depends on the function of the thyroid gland: all the necessary processes of egg maturation, ovulation, corpus luteum function, the readiness of the endometrium for embryo implantation, as well as successful pregnancy depend on the functioning of the endocrine system.

The neuroendocrine system is highly complex and is like a chain of connections and any malfunction in any of the constituents may cause problems in another one, including the reproductive system.

This chain could be depicted in the following order: higher regulatory systems, i.e. the CNS (central nervous system), hypos, hypothalamus, adrenal glands, thyroid gland and reproductive organs.

Any disorders in the thyroid gland (such as hypothyroidism or hyperthyroidism) can affect a woman`s menstrual cycle. In girls, these disorders may lead to the absence of menstruation (amenorrhea), delayed sexual development.

Abortion and the secondary infertility

One of the most common causes of secondary infertility in women is past abortion. Abortion is a major trauma and it is hard for a woman’s body to endure it, no matter how good the procedure was performed. In accordance with the studies and statistics, around 50% of the abortions cause secondary infertility.

As a result of surgery, the traumas of the uterus and cervix may cause scarring, which disrupts the further functioning of the uterus, there may be obstruction of the fallopian tubes.

And after the abortion, there may be dysfunction of the pituitary gland (it has a significant effect on the endocrinal system). If during the abortion that was not performed properly and the whole layer of endometrium was damaged, it may lead to serious complications (mature eggs are fertilized and get into uterus, but can’t implant and pregnancy may not occur).

Besides all that, even if the pregnancy occurs, it may be complicated or it may be impossible to carry the child. Improper position of the fetus, placental abruption, premature rupture of membranes and many other consequences can be triggered even by an abortion that was performed a long time ago.

Abortion is a huge stress for a body that is hard to endure both physically and mentally. A woman needs at least 3-4 months to recover after the abortion.
So, secondary infertility treatment, as well as primary, may require sufficient financial, physiological and psychological resources. But the most important is not to give up and believe that everything will be okay. One more essential factor is the timely visit to a doctor.