Let’s Talk About Secondary Infertility

 Secondary infertility is very real and we need to talk about it. If you’ve been unable to get pregnant and have been trying (having unprotected sex) for 12 months without success (or for six months if you’re over 35), this is considered infertility. But what if you’ve been able to get pregnant before?

For those who have never been pregnant, it’s called primary infertility, but if you’ve had a successful pregnancy in the past and are now having trouble, it’s considered secondary infertility.  

And it’s not uncommon. One third of all IVF cycles are from cases of secondary infertility. While aging is not the only cause (surgery, scar tissue and endometriosis are factors, too), it does add to the challenges. After we hit our mid-30’s, the chances of spontaneous conception per cycle decline relatively quickly (that darn “biological clock” situation). By the time we’re in our 40’s, the chance of spontaneous conception is often five percent per cycle or lower.

Quick science lesson: As we age, our bodies are exposed to oxidative stress (via pollution, food, sun exposure) and it becomes tougher for us to combat. Oxidative stress is caused by an imbalance of free radicals and antioxidants in your body. Antioxidants neutralize the free radicals and prevent damage to your molecules. Your body’s cells produce some antioxidants naturally, and you can get more from food and supplements (more on this later).   

As our body prepares to ovulate an egg (it takes about 100 days for a premature ovarian follicle to grow and develop into a fully matured egg), its DNA is incredibly prone to damage, and our bodies can’t repair it as well as we get older.

Oh, and let’s not forget about the partners with sperm - male factor is attributed to 35-50% of infertility cases. Sperm are extremely susceptible to damage and oxidative stress from environment, diet, lifestyle, and yes - aging. A recent shift in the fertility space is that there is now more research highlighting sperm quality and its decline with age and its impact on pregnancy. For folks with sperm, aging causes other changes that can affect the ability to conceive, such as decreased cardiovascular health. Unhealthy diets and lifestyle choices affect penile blood flow and can cause erectile dysfunction. This occurs almost 20% more often in couples with secondary infertility versus primary. This is also a wake-up call to check in on cardiovascular health: the arteries in the penis are incredibly small, so when they stop functioning properly, it can mean that your larger arteries (including those around the heart) are at risk.

What can we do to prevent egg and sperm damage?

Whether or not aging is a factor, there are ways to improve egg (and sperm) quality:

1. Start taking a prenatal with Folic Acid/Folate and a higher volume of B12

Vitamin B12 and Folate are used to make and control DNA. The nutrients found in a high-quality prenatal (like Bird&Be’s!) provide the necessary cofactors for proper cell and DNA division. Folic Acid, Vitamin B6 and B12 also all work together in a process called methylation. This is a process with multiple functions including turning genes on and off, and helping to detoxify harmful chemicals. You need A LOT of B12 in your prenatals - only 2% of the total B12 in there gets absorbed, so it needs to be amped! We recommend 1 mg.

2. Avoid reproductive toxins like smoking and alcohol.

Cigarette smoke and nicotine contain thousands of chemicals that increase oxidative stress, decrease egg quality, interfere with egg movement along the fallopian tubes, and cause uterine changes that prevent implantation.

For sperm, the consequences are very significant, as preconception smoking is linked to greater sperm DNA mutations and chromosomal abnormalities. These decrease the chance of a successful pregnancy, but in the event of conception, there is an increased chance of childhood cancers, developmental malformations, and infertility.

3. Reduce or eliminate saturated fats and trans fats, processed and red meat, processed sugars and simple carbohydrates.

This means (mostly) ditching the fried, fast and processed foods, margarine, and white breads. Check labels: canola oil and sunflower oil are not your friend here. Avoid smoked or charred meats which can introduce more oxidative stress and need to be detoxified by your liver.

4. Double down on fruits and veggies.

Fruits and vegetables are a great source of fiber and some, like berries, are high in free-radical-fighting antioxidants. The anthocyanin pigment, which gives berries their red and purple color, is an antioxidant also found in varieties of vegetables like purple cauliflower and red cabbage.

5. Supplement with antioxidants

If you’re in your thirties or have been flagged with poor quality sperm or eggs, consider boosting your antioxidant intake. Supplemental CoQ10, L-Carnitine, Vitamin E, and NAC are all antioxidants that can improve egg and sperm quality. Each of these ingredients, in therapeutic doses, is found in Bird&Be’s Power Prenatals (for both eggs and sperm) so you can get started with fertility support at home quickly.

CoQ10, the darling of the fertility world, works its magic directly in our mitochondria (cellular ‘batteries’). CoQ10 helps the mitochondria pump out more energy, while also providing antioxidant protection to prevent mitochondria from getting damaged. Make sure you’re dosing at least 200 mg per day - and up to 600 mg per day if you’re in fertility treatment. You have the option of both doses via Bird&Be’s Power Prenatals.

L-Carnitine is an antioxidant that helps shuttle the CoQ10 into the mitochondria so they can get to work. Preconception supplementation with L-Carnitine has been shown to improve egg development and egg quality.

Vitamin E is a great antioxidant for eggs, sperm, uteruses, and penile blood flow (whichever you have!). It helps protect against blood vessel damage and plaque build-up in the arteries. Better penile blood flow means more effective erections and ejaculation, and in the uterus it means better conditions for implantation.

What else should I know before trying to have another baby?

If you fall into the category of secondary infertility, it’s time for a fertility work up. Talk to your doctor or self-refer to a fertility clinic that can give you a proper assessment. This will include full-profile hormonal testing on certain days of your cycle (usually cycle day-3 and cycle day-21), including FSH (follicle stimulating hormone) and AMH (anti-mullerian hormone), which are both used to estimate your ovarian reserve. 

The person providing the sperm also needs to undergo testing. Sperm testing via a semen analysis is a relatively non-invasive, easy test to screen for abnormal sperm counts and swimming ability (motility). An additional test called DNA fragmentation can be added on to check for DNA breaks in the sperm DNA.

If you’re on a waitlist or want immediate answers, you can now get at-home sperm test kits to screen for issues with motility, concentration and quality. Produce a sample from the comfort of your own home and find out if low motile sperm concentrations are decreasing your odds of conception.

In the meantime, keep tracking your cycles and watch for red flags like irregular or very long cycles (like going more than 35 days without any menstrual bleeding). If you’re using an at-home ovulation predictor test kit (OPK) and you’re not seeing a regular LH (luteinizing hormone) surge or a strong positive; or alternatively, always seeing a positive, that’s another flag to see your doctor as soon as possible.

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