Maggie McKay (Host):
If you are planning to welcome a second child into your family, but finding it
difficult to get pregnant, you may be experiencing secondary infertility, a
condition that affects millions of parents according to the National Center for
Health Statistics. We're here with Dr. Zainab Alnoor, a board-certified OB-GYN
physician at EvergreenHealth to discuss secondary infertility, what it means
and its causes.

Host: This is Checkup Chat with EvergreenHealth. I'm
your host, Maggie McKay. Dr. Alnoor. Thank you so much for your time today to
discuss such an important topic that affects families worldwide. Good to have
you here.

Dr. Zainab Alnoor: Thank you so much for having me.

Host: Just to start, can you please tell us what the
difference is between primary and secondary infertility or

Dr. Zainab Alnoor: So, primary infertility is a
condition where a couple are unable to conceive after trying for about one year
of unprotective intercourse without using any birth control. Now, we usually
say one year in somebody that's less than 35 years old. For women over 35, we
tell them about six months. Now, secondary infertility is when someone is
unable to conceive, but they've had actually a birth in the past or previously.
And that the same criteria goes for secondary infertility. So if you've given
birth before, but again, you're trying for a pregnancy and you're less than 35
years old, it's been a year of unprotective intercourse and you're not
conceiving or if you're over 35 and it's been six months.

Host: And what causes secondary infertility? And are
there risk factors that increase your chances of developing it?

Dr. Zainab Alnoor: Yeah. So, causes of secondary
infertility, honestly, is mostly the same as primary infertility. So, there are
male factors. About 40-50% of couples that are unable to conceive is because of
a male factor. Male factor is usually either not enough sperm or sperm that's
not moving in the right direction. And the female factors are multiple levels.
One is hormonal, something with the ovaries, so anovulation usually. There are
structural factors like the uterus. It's an organ that makes us get period,
carry a pregnancy. So if you have a structural abnormality there, a polyp, a
fibroid or you have what we call bicornuate uterus or a septum, these can
affect women getting pregnant. There is our fallopian tube, so a tubal factor.
Fallopian tubes could be scarred or blocked, and that prevents the egg from
going into a uterus and getting women pregnant. So, those are really the main
factors that could be worked up.

Now, there's also multifactorial where some people have more
than one cause occurring at the same time. And then, there's unexplained. Now
30% of infertile couples have actually unexplained infertility. So usually,
when we do the workup, we do the same for secondary as for primary. Now, the
risk factors for developing infertility, of course, if you have a history of
infertility, so they kind of already know, and so they might consider workup
sooner, better than later. In women over 40, we don't recommend waiting. We
actually start the workup right away. Very commonly, woman's ovarian reserve is
low. Egg quality is low when they're over 40. So if they're trying to conceive,
even if it's their second child, we tell them to get worked up and maybe some
help. In women having irregular periods, usually skipped periods or no periods,
they're probably not ovulating, so they might have a harder time getting
pregnant. So, that increases their chance of them having infertility. If they
already have a known structural factor, like problems with their uterus or
their fallopian tubes, if they have endometriosis like severe endometriosis,
stage III or IV, that's another risk factor. And of course, known male
infertility as well. So, these are some of the risk factors that might make you
think, "Okay, you might have a hard time getting pregnant a second time
around."

Host: Do you do workups on the men as well?

Dr. Zainab Alnoor: We can start basic workup. So, part
of our workup is to get a good history and we do ask women or their partners
their medical history, any medications they're taking. We can order a semen
analysis, so kind of start the workup. And again, if it's something that
requires more intervention, then we would send them or recommend them go see a specialist
in male infertility.

Host: And if parents had a hard time getting pregnant
with their first child, does that mean they're likely to get secondary
infertility?

Dr. Zainab Alnoor: Not necessarily. Actually, sometimes
it's hard to get pregnant the first time, but much easier the second time. But
I think the most important thing is the reason for that infertility the first
time around. So again, if they have a structural problem, blocked tubes, a
known male factor, of course, the second time will be hard. But if they were
unexplained or it's just an ovulatory issue, sometimes the second time around
is much easier.

Host: And what if they had a successful first pregnancy?

Dr. Zainab Alnoor: Again, same thing. If they've had a
successful first pregnancy, I think their chances of having a successful second
pregnancy is higher. So, we still give them the same amount of time, less than
35 unprotective intercourse for a year; more than 35, six months. If they're
still not pregnant, then they would just go into the workup just the same way,
and review their history, medication that they're taking, how long has it been,
how old they are, because I think that will affect why they're not getting
pregnant the second time.

Host: Are there treatment options available?

Dr. Zainab Alnoor: Yes, for sure. Again, if you already
know the cause, then you know what worked the first time so you can try it the
second time around. These days, there are many options out there to help women
get pregnant. I think it's pretty rare that we cannot do anything for them. I
mean, there are many options out there, simple as medication or treating a
condition or a simple surgery versus egg donation and things like that. So,
there are treatment options and everybody can get a good workup and at least
know their options.

Host: So when it comes to symptoms, doctor, are there
symptoms of SI and when should families begin to seek care for it?

Dr. Zainab Alnoor: Well, symptoms of secondary
infertility, if you are obviously trying for pregnancy and are unable to and
the symptoms, like I mentioned previously, if you're having irregular periods,
it's probably harder to know when you're ovulating and getting pregnant; if you
do have a history of blocked tubes, then you know, obviously, you're not going
to be able to get pregnant the second time without some help; endometriosis, if
that has gotten worse over time; male factor, things like that.

Host: Are there any other topics that you'd like to
share that we didn't cover?

Dr. Zainab Alnoor: I think that any woman that is trying
for pregnancy, it's a very good idea to go see your OB-GYN, get a good physical
exam, good medical history, review of your medication, basic blood work to make
sure that you're normal and healthy. And then again, if you are having a hard
time getting pregnant, there are basic hormonal testing. We can do an
ultrasound for the uterus, looking at your fallopian tube, doing male history
for the partner and semen analysis, just getting basic workup to see what's
going on so we can help women.

I think also in our area, some women do not know this, but you
do not really need a referral to see a fertility specialist. Now, your OB-GYN
can do basic workup. But if you need more interventions, like something called
IUI or IVF, you can see a fertility doctor and, usually, you're just going to
call them and make an appointment. And finally, nowadays, especially in our
area as well, some insurances do pay for fertility workup and some treatments.
Back in the day, it was all out-of-pocket pay, but now some insurances do pay
for that. So, definitely check with your insurance company to see if they have
any fertility coverage that you could use.

Host: And what would you say to patients who are
discouraged, who are really having a hard time getting pregnant over and over?

Dr. Zainab Alnoor: Well, definitely go and see somebody
that is familiar with infertility and getting, like I said, the exam and the
workup to see what's going on. Nowadays, there's many options out there that
people can really know why they're infertile and get some help. Now again, some
of them can be expensive or they cannot do, but at least they know their
options.

Host: So, thank you so much for sharing your expertise
on this sensitive topic. We so appreciate you.

Dr. Zainab Alnoor: Of course. Thank you so much for
having me.

Maggie McKay (Host): Again, that's Dr. Zeinab Alnoor.
And if you think your family is having concerns about infertility, you are not
alone. The OB-GYN specialists at EvergreenHealth are here to help you decide
whether you might benefit from specialty care of treatment. For more
information or to find a women's health specialist, please visit
evergreenhealth.com. And that wraps up this episode of Check-Up Chat with
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