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Secondary Infertility

Could Secondary Infertility Happen to You?

By Pat Dimmig

Dr. Luciano recommends a woman seek professional help after four months if she is over 39, after six months if she is between 35 and 39 and after nine to 12 months if she is younger than 35. However, there are times when a couple should not wait, and immediate intervention is needed. "If you have irregular periods, that suggests the lack of ovulation," he says. "Very painful periods and pain with intercourse suggests the presence of endometriosis or other pathology of the reproductive organs. Significant vaginal discharge with burning or discomfort suggests a vaginal infection. For the man, painful ejaculation suggests infection. When a man has a decreased libido or impotence, it suggests a hormonal or testicular problem."

Traci LaRosa of Wahiawa, Hawaii, had no problems conceiving her first child. Her second child was conceived after nine months of trying. After passing that mark while trying to conceive No. 3, she decided they needed to seek a doctor's help. "We went to a doctor that did a bunch of blood work and a semen analysis on my husband," LaRosa says. "It all came back fine. The doctor didn't follow through after that, or order any other tests, so I was a little disappointed. He assumed everything was fine and it would just happen.

"Luckily, we moved and my current doctor ordered more preliminary tests," she says. "When those came back fine, he ordered an HSG (a test where they inject dye into the fallopian tubes and then X-ray to see if there is a blockage). The test showed a block in one tube. He then did laparoscopy surgery. The blockage wasn't as bad as initially thought, so we then began Clomid and the intrauterine insemination when I ovulated. We don't know if it was successful yet."

LaRosa's experience withher first doctor begs the question, What should be expected of a doctor and the first visit to a fertility specialist? First, make sure that the doctor is trained and experienced in dealing with infertility. "The best assurance of this is the completion of a fellowship and certification by the Board of Reproductive Endocrinology and Infertility," Dr. Luciano says. "Also, inquire how much experience the doctor has in treating infertility and what the success rates are for different causes. Most specialists will readily provide the information."

Dr. Luciano believes the first visit should be fairly extensive. "The initial visit should include a complete medical history for both partners and a complete physical exam for at least the female partner," he says. "A vaginal ultrasound is very informative and should be performed at the same time as the pelvic examination. The various potential causes of infertility are discussed. The evaluation and the reasons for the blood test, radiology tests, etc. are explained to the couple at this visit. A general outline of the entire evaluation is described and provided to the couple, preferably in writing. When the couple leaves after their initial visit, they should have a clear understanding of the physiology of conception, the infertility evaluation and the time frame by which the evaluation will be completed."

Want to see more?

• The Infertility Marketplace: How Success Rates Are Advertised
• The Facts to Relax: Coping with the Stress of Infertility
• Dollars and Sense: Affording Infertility Treatment
• Check out our Article Library.
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