I’ve Been Pregnant Before, Why Is It So Hard This Time?

Today, the dialogue around fertility has become more mainstream.

One in six Canadian couples suffer with fertility issues. For women some factors include infrequent ovulation, tubal damage from infections or diseases, endometriosis, and egg quality and quantity due to many people choosing to delay childbearing. For women, our eggs are our age, and as we get older, fertility rates decline and miscarriage rates increase.
The average age of couples having their first child is increasing, and therefore as people start their families later, secondary infertility (infertility associated with second pregnancies and beyond) is more common. The good news?  Advances in assisted reproductive technologies can assist both fertility and also assist family planning to preserve better quality, younger eggs and embryos for future pregnancies.

ENDOMETRIOSIS

Endometriosis can affect fertility and is a condition that progresses with age. The best treatment for Endometriosis is pregnancy; the high progesterone levels during pregnancy prevent progression of the disease. While the first pregnancy may not be as difficult to conceive, later ones may be. Issues such as tubal disease, uterine scarring after infections, surgical procedures or complications from a previous pregnancy can also make second pregnancies more difficult.

Ladies take note: equality of the sexes extends to fertility too! Men and women are equally responsible for fertility. Sperm concentration and other factors related to the male reproductive system can affect couple fertility. Motility and quality of ejaculate can also be a factor, however, these can be overcome with assisted reproductive technologies. Some men do not ejaculate sperm due to genetic, hormonal, or acquired reasons, however, if they still produce sperm it can often be extracted from the testicle through modern methods. Furthermore, some males may not produce sperm at all due to a variety of factors. For example, exposure to steroids, such as testosterone and bodybuilding supplements, will reduce sperm counts and recovery can take up to two years. Lucky for men, a whole new batch of sperm is produced every 60-90 days!

THE SECOND TIME AROUND…

The reality of the times is many people have second families with new partners. These partners may be women whose fertility has begun to decline or men who have previously had vasectomies. Men who have had a vasectomy may choose to have a reversal, and while this can be successful, they can also fail or cause low numbers of swimming sperm and antisperm antibodies.  Couples who are considering vasectomy reversal for the male partner should have a full evaluation of both partners prior to the procedure since female age may suggest whether or not a reversal or IVF is indicated.

SO WHAT CAN I DO?

LOTS!  Educate. Be aware. Plan. Whatever the circumstances, getting pregnant is easier when you are younger. If you are concerned, get evaluated sooner. If you know you may have an issue, or the second pregnancy is taking longer than expected – ask for help. Fertility workups and consults are covered in Canada.

FAMILY PLANNING

If you are considering spacing your family or starting later, think about inquiring about the help of assisted reproductive technologies, such as egg or embryo freezing to optimize the egg quality and success rates for later. Dr. Sonya Kashyap, medical director of Genesis Fertility Centre in Vancouver, can help with some of the best independently verified success rates for both technologies in North America.

GENETIC SCREENING

Techniques such as comprehensive chromosomal screening (preimplantation genetic screening) boast implantation and ongoing pregnancy rates exceeding 70%. The most common reasons for reduced fertility and increased miscarriage rates with age are abnormal embryos, which have imbalanced chromosomes. Screening embryos to determine which are ‘most likely’ to be viable may reduce miscarriage rates and accelerate time to delivery in older women.

By Dr. Sonya Kashyap MD, MSc Epi, FRCSC, FACOG | Medical Director
Genesis Fertility Centre

Dr. Sonya Kashyap is the medical director and IVF and egg freezing specialist at Genesis Fertility Centre, and assistant professor of the division of reproductive endocrinology and infertility at the department of Obstetrics and Gynecology at UBC. Combining heart and science, Genesis Fertility helps thousands of couples and individuals start and grow their families; the clinic has become a trusted destination for male and female fertility services, and Dr. Kashyap has proudly achieved some of the highest independently verified success rates in Canada and the US since 1995. A leader in her field, she sees her work as an incredible privilege and responsibility. Over the years she has worked with some of the most talented leaders in the world-wide fertility community, and she and thousands of families have benefited from their depth of knowledge.

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