Secondary Infertility

Secondary Infertility (SI) is defined as the inability to conceive or have a live birth after previously having a child. The reasons for SI can be the same as primary infertility. Talking to a doctor after one year of trying (6 months for those over 35) is the best course of action.

Some causes of SI can be male factor including sperm imperfections, complications from previous pregnancies, or female factor such as ovulation issues or tubal diseases.[1]

Seeking psychological or therapeutic counseling can help relieve some of the sorrow and provide support to those who suffer from SI.[2]

Chemical Pregnancy

Other Kinds of Pregnancy

A chemical pregnancy (CP) – also called a biochemical pregnancy – occurs when there is a loss of pregnancy shortly after implantation. In these cases, the pregnancy will show up on a home test but miscarry before an ultrasound can take place. A CP always occurs close to implantation of the embryo in the uterus.

Sometimes a woman will have a CP without knowing it. Others may have period-like cramps and bleeding shortly after a positive test.[3]

CPs account for 50-75% of all miscarriages. However, unlike other miscarriages, you can start trying against your next period cycle.[4]

Ectopic Pregnancy

An ectopic pregnancy (RP) occurs when a fertilized embryo attaches outside of the uterus. Implantation usually happens in the fallopian tubes. The rate of EP s about 1~2% of all pregnancies (in industrialized countries.)[5]

If an EP occurs, the pregnancy is not viable. It must be removed either by medicine or by surgical procedure. Leaving an ectopic pregnancy is very dangerous and may result in a ruptured tube. The symptoms of EP include nausea, vomiting, sharp pain on one side, dizziness, or pain in your shoulder.[6]

Treatment for Ectopic Pregnancy

If the pregnancy is caught early enough, an injection of methotrexate can be administered. This drug stops the embryo’s growth, leading to the body’s absorption of the cells. A single dose of methotrexate has been shown to be safe and effective for treatment of EPs.[7]

For other cases were surgery is required, this is done by laparoscopy. This procedure is minimally invasive – a doctor will make a small incision near your belly button and insert a laparoscope into the abdomen to remove the RP.

Tubal damage

If your fallopian tube is damaged or ruptured, the tube may need removed. This procedure is called a salpingectomy. You will still be able to conceive with one remaining tube, though it may be a bit more difficult than normal. If the salpingectomy removes the only remaining tube, in vitro fertilization (IVF) will be required in order to conceive.

Molar Pregnancy

A molar pregnancy (MP) occurs when an abnormal group of cells that usually grow in the placenta (called trophoblasts) develop in the womb instead. This growth is called a “hydatidiform mole” – hence the name. The two types of MP are:

Complete MP – the chromosomes that come from the mother are not found, resulting in all 46 chromosomes coming from the father. In this case, there is no embryo or fetal tissues, only appearing as fluid-filled cysts instead.
Partial MP – an embryo may grow, but it will not be able to survive due to having 69 chromosomes (2 sets from the father and 1 from the mother) instead of 46 chromosomes (one set each.)[8]

Symptoms of a MP include:

Severe nausea or vomiting
Dark bleeding or discharge that may contain small, grape-sized lumps
Pelvic pressure or pain

A doctor can examine you to find other signs, such as rapid or lacking uterine growth, anemia, high blood pressure, or hyperthyroidism. A MP can be determined from an ultrasound.

Treatment for a Molar Pregnancy

Although medication is available if the growth is too large, the recommended treatment is a dilation and curettage (D&C). In this procedure, a thin tube is passed into your womb to remove the abnormal cells.

The doctor will monitor you for six months to a year after the procedure as some abnormal cells may still remain. If too much tissue is left, a condition called gestational trophoblastic neoplasia (GTM) may arise. Persistent GTN can be treated with either chemotherapy or a hysterectomy. GTN occurs in about 20% of complete MPs and around 5% of partial MPs.

It is not recommended to get pregnant during the six month to one year waiting period. However, if everything is clear after this time, you can start again whenever you are ready.[9][10]

[1] ESHRE Early Pregnancy Guideline Development Group. 2017. “RECURRENT PREGNANCY LOSS.” European Society of Human Reproduction and Embryology, 1–61. ESHRE RPL Guideline_28112017_FINAL.pdf.

[2] Sarrel, Philip M., and Alan H. DeCherney. 1985. “Psychotherapeutic Intervention for Treatment of Couples with Secondary Infertility.” Fertility and Sterility 43 (6). Elsevier: 897–900. https://doi.org/10.1016/S0015-0282(16)48618-8.

[3] Higuera, Valencia, Wilson, Debra Rose. 2017. “What Is a Chemical Pregnancy?” Healthline. 2017. https://www.healthline.com/health/pregnancy/chemical-pregnancy.

[4] Cassata, Cathy. "Chemical Pregnancy." Everyday Health. May 19, 2015. Accessed April 28, 2018. https://www.everydayhealth.com/chemical-pregnancy/guide/.

[5] Mol, Femke, Annika Strandell, Davor Jurkovic, Tamer Yalcinkaya, Harold R Verhoeve, Carolien AM Koks, Paul JQ van der Linden, et al. 2008. “The ESEP Study: Salpingostomy versus Salpingectomy for Tubal Ectopic Pregnancy; The Impact on Future Fertility: A Randomised Controlled Trial.” BMC Women’s Health 8 (1). BioMed Central: 11. https://doi.org/10.1186/1472-6874-8-11.

[6] NHS. 2016. “Ectopic Pregnancy.” NHS Choices. 2016. https://www.nhs.uk/conditions/ectopic-pregnancy/.

[7] Stovall, T G, F W Ling, and L A Gray. 1991. “Single-Dose Methotrexate for Treatment of Ectopic Pregnancy.” Obstetrics and Gynecology 77 (5): 754–57. http://www.ncbi.nlm.nih.gov/pubmed/2014091.

[8] “Molar Pregnancy.” 2017. March of Dimes Website. 2017. https://www.marchofdimes.org/complications/molar-pregnancy.aspx.

[1]Mayo Clinic Staff. 2017. “Molar Pregnancy.” Mayo Clinic. 2017. https://www.mayoclinic.org/diseases-conditions/molar-pregnancy/symptoms-causes/syc-20375175.

[2] NHS. 2017. “Molar Pregnancy.” NHS Choices. 2017. https://www.nhs.uk/conditions/Molar-pregnancy/.