Navigating the unknown

Have you been diagnosed with unexplained or secondary infertility? Dr Devashana Gupta, Medical Director at Repromed (repromed.co.nz), explains what they mean and the treatment options available.

When should I contact a fertility specialist?

This really does depend on your age and how long you’ve been trying to conceive. A general rule is that if you’ve been trying to conceive and haven’t become pregnant after 12 months, it’s a good idea to seek help. If you’re over 35 years old or you have a health condition that may impact your fertility, we would suggest you might want to seek help sooner. You can ask your GP to refer you, or self-refer to a fertility clinic to get investigations underway.

What is unexplained infertility?

Unexplained infertility is a term used in the medical field when a couple is having difficulty getting pregnant, but there’s no obvious reason why from the test results.

Around 15-25% of heterosexual couples experience unexplained infertility, but this doesn’t mean it’s impossible to conceive – it just might take longer or require a different approach.

Being diagnosed with unexplained infertility means there is no identifiable cause, however, there are a number of factors that can reduce fertility, including:      

  • infrequent sexual intercourse, especially just before ovulation (i.e. when the cervical mucus is clear stretchy and receptive to sperm);
  • cigarette smoking;
  • excess or insufficient weight;         
  • excessive alcohol and drug consumption;
  • excessive caffeine consumption.

What is secondary infertility and is it common?

Secondary infertility is common and happens when you have difficulty getting pregnant or carrying a pregnancy to term after you’ve already started your whānau with one or more children. It can take people by surprise if they didn’t have trouble conceiving their first child, but is understandable as age impacts the quality of eggs.

One of the biggest factors that contributes to secondary infertility is age, but there may also be other factors at play including:

  • hormonal disruption/imbalance after the first pregnancy;
  • the time it took to conceive the first pregnancy;
  • family history, including the age of the mother’s mother when she was menopausal.

What are some other reasons for couples having difficulty conceiving?

Outside of unexplained infertility and secondary infertility, there may be a number of other reasons. Physically, some people may experience difficulty conceiving if there are, for example, blocked or damaged fallopian tubes, poor quality semen, or a lack of regular ovulation.

Stress can also be a factor. Not only can stress reduce your sex drive, but it can also affect ovulation and sperm production. Although it’s said that in general, infertility causes stress, rather than the other way around, stress can still have an impact when trying to conceive.

What tests will be run?

To try to figure out what is causing difficulties when you’re trying to conceive, fertility specialists will run several tests, often called ‘investigations’. These tests include a semen analysis, an assessment of ovulation and ovarian reserve, a pelvic ultrasound, and a check to see whether the fallopian tubes are open or not. 

What are the next steps?

Once the tests have been completed, our fertility specialists will look at what treatments may be available depending on the results of the tests.

Sometimes it can be as simple as starting a pre-conception health programme that focuses on nutritional, lifestyle, and environmental factors to optimise reproductive health.

Other times, a more specific treatment like lipiodol (flushing of the fallopian tubes), IUI (Intrauterine insemination), or IVF (In vitro fertilisation) will be recommended.

Are there any lifestyle changes that can help?

There are many lifestyle factors that have been proven to influence or enhance your chances of getting pregnant, both before and during fertility treatment. It takes 100-120 days for eggs and sperm to mature, so what you do in the four months prior to conception has an impact.

A few key changes include following a healthy diet and avoiding processed and sugary foods; doing regular low-impact exercise; reducing your stress levels; taking a pre-natal supplement to include folic acid and folate; and limiting exposure to chemicals. 

Where you can seek support?

If you’re experiencing difficulties when trying to conceive, talking to a fertility counsellor or joining a support group is a great next step. Fertility NZ (fertilitynz.org.nz) has fantastic support groups all around New Zealand to help those who are facing challenges when trying to conceive. Given that around 1 in 4 New Zealanders experience fertility issues, it may help to know that you’re not alone and that support is available to you whenever you need it.

Megan’s journey with unexplained infertility

Our fertility struggles feel like a distant memory but also still so fresh. The irony of all the years spent actively avoiding becoming pregnant, yet when we decided that we wanted to start a family, the thought of it never happening was much, much worse. There was never an explanation as to why I was not getting pregnant. I had numerous scans which all came back normal and even had an exploratory surgery for possible endometriosis, which also came back clear. My husband’s “samples” looked fine, so doctors couldn’t really give us any reason at all.

While we were going through all of this, the clock kept ticking! I went through so many emotional struggles as I watched friends and relatives get pregnant and go on to start their families. My younger brother and sister-in-law had two kids in the time we were trying. Friends had babies “before” they felt ready, others moaned about how miserable they felt to be pregnant and the rage burned inside me as it all felt so unfair!

After ruling out different causes and paying for IUI privately, we were fortunate enough to be given an appointment at one of the top fertility clinics in London, where we were living at the time. Fortunately for us, we met the funding criteria and after the 12-month wait from our referral to our initial appointment, we were provided funding for one round of IVF (egg collection and embryo transfer) and an additional two frozen embryo transfers, if necessary.   

But the rollercoaster wasn’t over. My egg collection was incredible – 33 eggs, 21 of which fertilised and 10 of which made it to good quality day five embryos. So chances were good, but that was still not a guarantee. Our first few embryo transfers (both fresh and frozen) didn’t stick and the worry and stress continued. Counselling was provided by the IVF clinic and this was so worthwhile as it was a chance for us both to chat about the stress and emotional toll it was taking on us. 

After so many unsuccessful attempts, the stars aligned and I was pregnant with twins! After the journey it took to get to this point, I was so fortunate to have a fairly smooth pregnancy and delivery with a healthy boy/girl pair born at the end of 2019. After nearly five years of trying to conceive, our family was complete!

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