Dr. Sarah L. Keller treats patients at
Infertility and Reproductive Medicine Center
4444 Forest Park , Suite 3100
St. Louis, MO 63108
Phone: 314-286-2400 Fax: 314-286-2455
Question: My husband and I have a four year old, but are having problems getting pregnant again. We are growing concerned. When should we seek help?
Answer: Secondary infertility is the inability to conceive or carry a pregnancy after a previous conception. It is more common than one might think, as it is thought to include up to sixty percent of all couples experiencing infertility.
The causes of secondary infertility are the same as primary infertility which include ovulation disorders, endometriosis, pelvic adhesions, uterine abnormalities such as fibroids, and abnormal semen parameters. Another important factor that may affect fertility is age. The ability to conceive per cycle declines as a woman ages, with the initiation of the decline beginning in the early thirties.
The usual recommendations regarding an evaluation for infertility are to seek help after one year of regular, unprotected intercourse in someone less than thirty-five years of age. In someone thirty-five years or older, the recommendation is to seek help after six months of attempt. However, there are indications to seek help sooner.
The indications to be seen sooner include two or more miscarriages, irregular or absent periods, history of sexually transmitted disease and/or pelvic inflammatory disease, previous abdominal surgery, reversal of surgical sterilization, known endometriosis or painful periods, breast discharge, excess acne or body hair, chronic medical conditions, history of chemotherapy or radiation, and known subfertility in one partner.
It is important to have a healthy lifestyle prior to and while attempting conception. Someone who is attempting pregnancy should be on a minimum of 400 micrograms of folic acid. Some women require more.
In addition, it is important to maintain a healthy weight and eat a well-balanced diet. Women who are trying to conceive should not smoke or use recreational drugs. They should avoid alcohol and limit their caffeine intake.
A basic infertility workup may be initiated by a general OB/GYN doctor. However, a consultation with a fellowship-trained reproductive endocrinologist will provide you with all of the latest treatment options available today.