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“Can I suffer from infertility after I have had my first child?”

This was the question that Dr Ann Tan, an obstetrician and gynaecologist practising in Mount Elizabeth Hospital addressed at I Love Children’s (ILC) fertility talk, held at Waterway Point on Saturday, 15 July as part of ILC’s Know Your FERTILITY WELLNESS campaign.

What is secondary infertility?

Secondary infertility occurs when the couple struggle to get pregnant again after they have successfully had a previous pregnancy.

Causes

The two main reasons which cause secondary infertility are:

1. Age of couple

Age impacts fertility negatively, where the optimal time to have your second child is preferably a year to eighteen months after the first child.

Following this time frame may give couples a higher chance of success at getting pregnant again, as well as have an easier time parenting the second child.

“If you are 37 years old and above, it is advised to try for your second baby as soon as you can.” – Dr Ann Tan

2. Medical Issues

Health problems such as diabetes and thyroid issues can lead to secondary infertility. Complications in a woman’s first pregnancy can also be the cause of secondary infertility.

For instance, some women may develop fibroids, cysts or endometriosis after their first pregnancy. This will inadvertently affect the chances of getting pregnant again.

Women are recommended to do a simple blood test to determine the number of eggs in their ovarian bank or reserve.

Dr. Ann also encourages men to get the quality and function of their sperms checked. Like eggs, sperms decrease in quality and function according to age, genetic makeup, stress and lifestyle habits such as drinking and smoking.

“The DNA carried by the sperm can be affected by stress and unhealthy habits which increases the chances of secondary infertility. – Dr Ann Tan

Treating secondary infertility

Due to its varied causes, especially medically-related ones, secondary infertility can be more challenging.

The good news is, couples can gain a greater awareness about this condition by equipping themselves with information on how best to manage it.

This includes maintaining a healthy diet, getting enough rest, going for a fertility health check and not putting off getting pregnant again after having the first child.

“Secondary infertility can occur in both men and women.” – Dr Ann Tan

Ladies, here are some tips for you to keep your egg cells healthy:

Vitamin D
Support your ovulation functions by getting your daily dose of Vitamins including Vitamin D, either by going out in the sun or taking oral supplements. Folate and other minerals are also equally important to ensure good quality of the eggs.

Iron
Increase the flow of oxygen to your egg cells by including Iron rich foods such as red meat in your diet. Dark green vegetatbles are also a good source but the iron is harder to be absorbed by the body. 

Good fat
Ensure your hormones are healthy by consuming good fat such as olive oil and avocados.

Q&A

1. I had a dilation and curettage done twice. Can I get pregnant the third time?

Yes. Dilation and curettage (D&C) procedures are usually carried out with much care so as not to cause scarring inside the womb. 

Monitor your menstruation flow after the procedure. If your flow changes and lessens, go for a check-up ensure there is nothing wrong with your womb.

The more important question is the reason for your miscarriage. Determine the cause of that first miscarriage if you can before trying to get pregnant again.

 

2. Can I get pregnant if I have a blocked fallopian tube?

If you have one blocked tube, yes. 

Be mindful that if you have one tube that is blocked from infections, there are chances that the other tube may have same issues too. 

So, if you have been trying actively to get pregnant for a while without success, go for a fertility health check.

If you have two blocked tubes, you would need to consider assisted reproductive technologies to get pregnant. 

 

3. Can I get pregnant while breastfeeding?

When you breastfeed during the first few months, you generally do not get your menstruation. This means that your body is not fertile. However, one ovulates before menses return so there is a small chance of conception before the menstruation resumes.

So it is recommended that you wait for your menstruation to come back before trying to conceive again. 

 

4. I have a regular menstruation cycle but my flow is very light. Does that mean I have a lower fertility rate?

If this is a new occurrence, then your hormones might have changed possibly due to a lowered ovulation function. Go for a check-up to know for sure.  

 

5. I had an open surgery to remove a cyst. Can I deliver naturally? 

If you did nothing to your uterus, then you can conceive naturally. It’s only when you have a scar on the uterus that doctors do not encourage a natural birth.

The uterus is a size of a pear. If you have a surgery to remove a fibroid that is more than 5 cm, you might end up with a big scar on your uterus. 

So, when this uterus balloons up with a big baby, that scar is lengthened and will be strained during labour. This increases the risk of the scar giving way. Patients in such situations are encouraged to do caesarean sections instead of normal births.  

 

I Love Children thanks Dr Ann Tan, obstetrician and gynaecologist practicing in Mount Elizabeth Hospital for her input.

Dr Ann Tan is also the Medical Director at Mount Elizabeth Fertility Centre.

 

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