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biggest predictor [of secondary infertility] is age,” he says. Between the ages of 18 to 32, you’re at your optimum fertility, and from 32 to about 37 there is a gradual decline. After 38 there is a steep decline in fertility, and by about 42, in most women, this marks the end of their reproductive career, he says.
As you get older, there is a decrease in both the quality and quantity of your eggs. In his opinion, women get a false reassurance that they will be able to fall pregnant in their late 30s. “To conceive naturally at 40 within one or two months is the exception to the rule,” he remarks. It seems sexist, but in this regard the woman’s age is of far more importance than the man’s, as a man’s reproductive lifespan has no definitive time limit. In men, after the age of 50, there is slight increase in DNA defragmentation, which might affect the quality of the sperm, “but usually we don’t see that,” says Dr Venter. Other causes of secondary infertility can include damage or blockage to the fallopian tubes, uterine scarring, ovulation problems, endometriosis or fibroids. Obesity and being overweight or underweight also play a role in fertility.
WHAT’S TOO LONG?
If you’ve been having unprotected sex for longer than a year without conceiving, it’s time to seek professional help, says Dr Venter. At 20 years old, it takes on average four months to conceive, by the time you’re 30, it will take up to eight months and after 35, it can take on average, up to 18 months to conceive. This is not just an indicator of a decrease in sexual activity, but is also a reflection of the quality of the egg, explains Dr Venter. The older you are, the higher the likelihood that there are other complicating factors, like endometriosis and fibroids. “We always advise couples above the age of 30 that if they haven’t conceived within six months, they should be aware and seek help earlier,” he says.
WHAT NOW?
If you can’t fall pregnant, start by going to see a medical specialist. Ask your doctor what your ovarian reserve is, says Dr Venter. This describes the capacity of the ovaries to produce eggs capable of fertilisation that results in a successful pregnancy. There are tests and scans you can do that can give you an indication of what your ovarian reserve is. “I always start by looking at ovarian reserve, because that’s one thing we can’t treat – you can’t reverse time,” says Dr Venter.
Also ask whether you’re doing it (sex, that is) at the right time – particularly if you’re a busy professional couple who spend limited time together. “Our approach is to do follicle tracking so that when you ovulate, you have intercourse. This is called timed intercourse,” says Dr Venter. If there aren’t issues with ovarian reserve or poor quality eggs, then most couples would conceive within the first four months of trying, he says. If that doesn’t work, then it’s time to consider fertility treatment and IVF (in vitro fertilisation, where the egg and sperm are combined in a lab and then the embryo is transferred into the uterus).
TREATMENT OPTIONS
Secondary fertility is treated the same as primary fertility, says Dr Venter. Regardless of who is treating you, there should be a structured programme with a step by step approach and a time limit to each step, he advises. However, “if your diagnosis is poor ovarian reserve, then the treatment should be more aggressive, meaning that you should move to IVF more quickly,” he adds.
As a woman’s age increases, so does her chance of miscarriage. For women who suffer repeated miscarriages (more than two consecutive losses after eight weeks), the first step is to investigate the quality
– Claire, mother of two
of the egg, because poor quality eggs do not fertilise normally and have a higher likelihood of chromosomal abnormalities, which will inevitably end in a miscarriage. Investigations will also rule out uterine scarring from previous interventions, tubal damage as well as a higher incidence of thrombosis. If there is uterine scarring, endoscopic surgery may be recommended to restore the anatomy. IVF is the usual treatment route in this instance, and this may include chromosomal testing before the fertilised embryo is replaced. If you’re struggling, get help sooner rather than later to help guarantee success. YB
Most married couples recognise that their relationship goes through stages, from the “can’t keep their hands off each other” early years, and the trials and stresses of new jobs and babies, through the often troublesome times of teenagers, and (ideally) on into the less turbulent waters of later life.
Indeed, change is inevitable in every marriage, and these changes include the really big ones like the arrival of children, health concerns, money matters and career issues. It’s the way couples handle these changes that can mean the difference between make and break.
There are a few recognisable phases to a marriage (or long-term relationship), says clinical psychologist Thandazile Mtetwa, who practises at Ngezwi Psychological Services in Gauteng. “There’s no time frame for these stages. Some couples stay longer on one or the other stage, but they can’t successfully proceed to the next stage without resolving the previous one.”
PREPARATION PHASE
“This is a phase that most couples skip,” says Thandazile, who points out that lots of energy goes into preparing for the