Sekundäre Infertilität: Ursachen, Diagnose und Behandlung

Secondary Infertility: Causes, Diagnosis, and Treatment

In the realm of reproductive health, secondary infertility is often overlooked. While primary infertility receives much attention, secondary infertility affects couples who have already experienced at least one pregnancy. This form of infertility is less known than primary infertility but equally burdensome for those affected.

Definition and Prevalence

Secondary infertility is defined as the inability to conceive again after the birth of a child, despite unprotected intercourse during the woman's fertile days. According to the World Health Organization (WHO), it is described as the absence of pregnancy within 12 months of regular unprotected intercourse in couples who have already experienced at least one pregnancy. Experts estimate that around 7-15% of all couples are affected by secondary infertility.

Causes of Secondary Infertility

The causes of secondary infertility are diverse and often multifactorial:

  • Infections and Immunological Causes: Infections postpartum or during the postpartum period, as well as chronic infections of the reproductive tract or autoimmune diseases, can affect fertility.
  • Anatomical Problems: Changes in the uterus or fallopian tubes after a previous pregnancy or birth can lead to secondary infertility. These include adhesions caused by cesarean section, curettage, placental issues, or other uterine surgeries. Newly developed fibroids and polyps can also prevent a second pregnancy.
  • Age: Female fertility significantly declines with age, especially after the age of 35. Decreasing egg quality and quantity can also lead to secondary infertility.
  • Hormonal Disorders: Imbalances in reproductive hormones can affect the menstrual cycle and ovulation. Irregular ovulation can negatively impact the chance of a successful pregnancy. Polycystic ovary syndrome (PCOS), thyroid disorders, and hyperprolactinemia are common hormonal causes.
  • Male Factors: Changes in sperm quality and quantity can also contribute to secondary infertility. Causes may include varicocele, infections, age-related changes, or lifestyle factors.
  • Lifestyle Factors: Obesity, smoking, excessive alcohol consumption, as well as stress and sleep deprivation, can affect fertility. These factors may increase or persist after a first pregnancy.

Diagnosis of Secondary Infertility

Diagnosis begins with a comprehensive history of both partners. Specific diagnostic tests may include:

  • Hormonal assays: Blood tests to determine hormone levels (FSH, LH, estrogen, progesterone, thyroid hormones, prolactin).
  • Imaging techniques: Ultrasound examinations to assess the uterus and ovaries, hysterosalpingography (HSG) to check tubal patency, and magnetic resonance imaging (MRI) for suspected deeper anatomical issues.
  • Semen analysis: Analysis of sperm count, motility, and morphology in the male partner.
  • Endometrial biopsy: Outpatient removal of uterine tissue to investigate possible infections.
  • Laparoscopy: A minimally invasive procedure for direct examination of pelvic organs, especially for suspected endometriosis or adhesions.
  • Genetic tests: For suspected genetic anomalies that could affect fertility.

Treatment Options

The treatment of secondary infertility depends on the underlying cause:

Medication Therapy: Medications such as Clomiphene, Letrozole, or Gonadotropins can induce ovulation in cases of hormonal disorders. Metformin may be helpful in PCOS.

Surgical Interventions: Laparoscopic surgeries to remove endometriosis lesions or adhesions, myomectomy for the removal of uterine fibroids.

Intrauterine Insemination (IUI): A technique where processed sperm is directly inserted into the uterus to increase the likelihood of fertilization.

In vitro fertilization (IVF): In more severe cases where other treatments are unsuccessful, IVF may be used. This involves fertilizing eggs outside the body and transferring embryos into the uterus.

Lifestyle Changes: Weight reduction, healthy diet, smoking cessation, reducing alcohol consumption, and stress management can improve fertility.

Micronutrients: Taking fertility supplements to promote egg and sperm quality. Scientific studies have shown a positive effect on both sperm count and morphology and mobility, as well as follicle maturation and embryo quality. VILAVIT Female and VILAVIT Male contain all necessary ingredients in optimal dosages.

The Role of Mental Health

In addition to physical aspects, it is important to consider the psychological effects of secondary infertility. Coping with the disappointment and stress associated with the inability to conceive again can be a significant burden for couples. The pain of unfulfilled parenthood is often no less than for those who have not yet had a child. Professional psychological counseling or sharing experiences with friends, family, fertility coaches, or other affected individuals in support groups can provide emotional support.

Secondary infertility is a complex and multifaceted challenge that encompasses not only physical but also emotional aspects. A thorough understanding of the underlying causes through careful diagnosis and tailored treatment is crucial to help affected couples fulfill their desire for children.