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Try, try again Prenatal Care

Try, try again

It can be harder to get pregnant the second time around, but there are steps you can take to beat the odds.

Now that your firstborn is getting older and you feel like you have gotten the hang of motherhood (finally!), you might be ready to expand your family once again. But, after months of negative pregnancy tests, you begin to wonder: How can it be this hard? We’ve done this before. It’s not like I’m infertile.

Having one baby doesn’t guarantee any mother that she’ll be able to easily conceive again when she’s ready. In fact, if you find that getting pregnant is proving to be more difficult the second time around, you aren’t alone. According to the Centers for Disease Control and Prevention, 830,000 American women ages 15 to 44 experienced secondary infertility from 2006 to 2010.

Although a number of factors can contribute to trouble conceiving after having one child, experts believe that there are viable ways to boost your chances of having a successful subsequent pregnancy. By taking a closer look at the common causes and zeroing in on how to overcome them, concerned couples can put their fears to rest and focus on growing their broods.

Not just a number
According to the experts, the biggest culprit has to do with the age of a mom-to-be. “As we age, egg numbers decline, and the eggs that are available have a harder time managing the chromosomes in early cell division,” explains Philip Chenette, MD, fertility specialist at the Pacific Fertility Center in San Francisco. “A woman trying to conceive her second child at age 40 will find her fertility half as good as compared to age 38.”

Jill Hechtman, MD, an OB/GYN in Tampa, Florida, agrees: “As we age, there is a natural decline in the number and quality of our eggs. We are born with all the eggs our bodies will ever make.” Hechtman compares a healthy 30-year- old with a 20 percent chance of becoming pregnant each cycle to a 40-year-old whose odds drop to 5 percent.

With age also comes an increased risk of other complications associated with an older uterus: fibroids or polyps, irregular or lack of ovulation, scar tissue or chronic endometritis (an inflammation of the uterus). “There is also increasing concern about high blood pressure and diabetes, which become more common as the kidneys and heart age,” adds Chenette.

High-risk concerns
If your first pregnancy was considered high-risk, you may wonder if that sets you up for successive complications. The answer: not necessarily. According to medical experts, high-risk pregnancies do not directly affect future fertility. Just because you were labeled high-risk the first time doesn’t guarantee that that’s how things will play out in round two. Instead it can serve as a tip-off to prevent related complications.

“What [a high-risk pregnancy] may do is suggest the next pregnancy would be high-risk as well,” explains Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine. “For example, the No. 1 risk factor for preterm labor and delivery is indeed previous preterm labor.” Minkin also notes that prior gestational diabetes produces a greater risk of developing repeat gestational diabetes. However, as Minkin points out, this concern can be addressed in advance. “If a woman is overweight and loses the weight, she will reduce her risk.”

Other previous conditions that could serve as warning signs for future pregnancies include a uterine septum (a malformation of the uterine cavity), an incompetent cervix (cervical inefficiency) and fibroids, which can become progressive.

Getting a boost
Once you have ruled out possible medical concerns, experts recommend a number
of ways to actively boost your chances for another positive pregnancy test. For starters, add at least 400 micrograms of folic acid to your diet before conceiving. “It minimizes the chances of neural tube defects,” says Minkin.

Another tip? Maintain your body weight as best you can. “Both too high and too low [weight] can make women not ovulate well,” Minkin says. A sensible, balanced diet is also key to providing your body with essential vitamins and nutrients.

Making important lifestyle changes in fitness and sleep can help improve your chances for conception. “Fertility rates decline at a rate of 2 to 3 percent per month which, over time, becomes a significant barrier to fertility,” explains Chenette. He advises cutting down on your alcohol intake, quitting smoking and getting plenty of rest, along with keeping your BMI under 30. “If you feel you need to lose weight, seek guidance from an experienced nutritional consultant, and balance exercise and calorie intake to keep your body in check,” he adds.

Standardized tests
A variety of prescreening options can alert women to possible fertility issues in advance. “Blood tests [can] check for ovarian reserve and function, but [they] have not been proven to reliably predict the possibility of becoming pregnant,” cautions Hechtman.

Alternatively, doctors may recommend a complete fertility assessment, which Chenette believes is “critical to determining treatment routes.” This includes a semen analysis, ultrasound, physical exam and blood test for ovarian reserve, and prepregnancy health screening.

For those looking to take matters into their hands, consider purchasing an at-home ovulation predictor test kit (to determine how well you are ovulating) and/or a fertility kit. “This gives a ballpark idea of how the ovaries are, with active eggs available,” says Minkin. “If that [test] shows that ovarian reserve is somewhat diminished, I would encourage a woman to speak to her gynecologist.” Your doctor can offer tailored advice on how best to proceed.