Secondary Infertility: What is my best chance of getting pregnant again?

Are you trying to get a bun in the oven, but want to know more about your chances and what you can do to help the process (versus just blind shooting)? As all mums and mums-to-be know, it’s important to have realistic expectations about fertility. While having a knowledge buffer about fertility rates can, on the one hand, help relieve stress, it can on the other hand, also prevent dangerous complacency.

Pregnancy rates for each age group is a good place to start. For example, the chances of getting pregnant in your 20s are 20-25% per cycle, that is, 25% of women will get pregnant on each cycle of unprotected intercourse.

Age:               Pregnancy Rate: 
20s                   20 to 25%
Early 30’s        15%
35 to 40           10%
Over 40            less than 5%
Over 45            less than 1%

The perception of secondary infertility can frequently be caused by the randomness of conception and ageing. Basically, if you’re lucky enough to be in the first 15% getting pregnant at 34 (we got pregnant on our first try) and the last 10% when you are trying for your second baby at 37 (we have been trying for eight months and we are still not pregnant) you are still within the normal range, although it might not feel like it.

Unbalanced stories in the media can skew our thinking about the right time to have a family. For every miracle pregnancy at 50 years of age that is given air time or column inches, hundreds of women who try and fail to conceive go unreported. Celebrity pregnancies reported in the press may also be hiding the truth as to exactly how conception was achieved.

Equally to blame is the syndrome of perfectionism around childbearing. Some prospective parents wait to achieve social, economic and emotional perfection whilst ignoring the biological bottom line: a “perfect nest” means nothing without any eggs!

So, what’s a mama to do?

1) Get your timing right and don’t wait too long

If you’re absolutely sure you want children and want to maximise the chances of achieving the family you want, start as soon as you can. For women with regular cycles, we recommend trying to conceive at 34 years of age if you want two children, 33 for three children and 35 for one child.

If you have irregular cycles or known conditions that might affect your fertility, such as blocked tubes, PCOS, endometriosis or a past history of serious medical problems, start at least a year earlier. Remember, pregnancies are not always easy or complication-free, so give yourself plenty of time to get over a miscarriage or other complications.

2) Take control

If you haven’t found Mr. Perfect at age 30 (or even Mr. Passably-OK), consider freezing your eggs.

If you have found Mr. Perfect and are over our recommended timeline by two years, but still can’t commit to trying for a baby, consider freezing your embryos.

Both these options presume you have good financial resources, the ability to travel (the Ministry of Health does not allow eggs to be frozen without a medical reason) and can take at least three weeks off work.

Let’s say these boats have sailed and you are now 39. You had your first baby at 37 and were guilted by the WHO into breastfeeding for two years but now you’ve been trying to get pregnant for the past six months without success. You need to take action!

3) Self help

Stop breastfeeding. As un-PC as this sounds, breastfeeding for prolonged periods in older mothers is a major contributor to secondary infertility. Be clear about the consequences and your priorities. Does your child need six more months of breast milk or a sibling?

Stop travelling. The work and travel schedule of both parties can interfere with your chances of pregnancy. Commit to a number of tries per six months. Get organised and plan your time. Use ovulation predictors if they work for you.

De-stress. Go on holiday, do regular exercise, acupuncture, yoga, tai chi, hire another helper — whatever it takes, do it!

4) Professional help

Still not pregnant? At this point, you need a diagnosis and a management strategy. Diagnosis of secondary infertility can be divided broadly into two groups.

The lucky first timers are couples with underlying primary infertility problems (PCOS, low sperm count and endometriosis) but the first time around these problems were offset by youth and dare we say, enthusiasm. The absence of youth as well as the interval progression of the underlying condition may reveal itself as secondary infertility on the second attempt at pregnancy.

The unlucky second timers, on the other hand, are couples that had no underlying fertility issues but in the intervening time between pregnancies something changed. For example, a caesarean delivery causes a reduction in pregnancy rates compared with vaginal delivery. There are also complications related to miscarriages and ectopic pregnancies.

The biggest enemy is delay and denial. How aggressive you are depends on your age. If you have not gotten pregnant within six months of trying, get help. Have a timeline and a plan for investigations and treatment and if you’re still not pregnant after a year, IVF is probably necessary.

5. Management

Management can involve a little bit of tweaking as opposed to full on IVF. Be clear with your gynaecologist what you are prepared to do. Look at your strengths and weaknesses, that is, can you afford to throw money at the problem or are you better throwing time and effort at the problem?

Get support and make sure you have the emotional reserve to go through the tough fertility treatments. Most good practices will have a psychologist to help you if you need it. Make sure the person giving you advice does not have a conflict of interest or if they do at least make sure they own up to it. Consider IVF in other countries as it may be cheaper! Remember if you are not married you cannot undergo IVF in Singapore, so bottom line? Plan ahead and consult a doctor early.

Good luck!