Secondary Infertility
Question
I am 34 1/2 years old with a 16 month old child who was naturally conceived (within two months of trying). We have been trying for our second baby with timed intercourse for six straight months and are so far unsuccessful. My hormones are normal, and my husband’s semen analysis is also normal. The only “new” thing is 1-2 days of spotting before my period starts (every 28 days, +urine ovulation kits). Should I be worried about secondary infertility, and should I have more of a work-up done?
Answer
Last Updated: June 26, 2013
You mention you have been unsuccessful at achieving a pregnancy after trying for six months, and that your first child is 16 months old. What you do not mention is if you are breastfeeding, or how long since you returned to cycles, if you did breastfeed. If I do the math right, the baby was only ten months old when you began trying to conceive, and if you were still nursing or had only recently returned to cycles your fertility may not have returned to normal.
You also mention premenstrual spotting before your period begins. Pr-menstrual spotting before your period can be caused by inadequate progesterone levels. Just a day of spotting, or even two, does not necessarily mean that. Checking progesterone levels in a timed fashion, on three, five, seven, nine and eleven days following the identification of what we call your Peak day, can give you a profile of what your hormones are in your luteal phase.
You don’t mention if you are charting your cycles, but if you learn to do that, not only will you be able to focus the timing of intercourse near ovulation and the presence of good quality cervical mucus, but you also would be able to time hormone evaluations so they can be accurately interpreted. The charting is a valuable tool in evaluating fertility.
My suggestion is the first “infertility test” — learn to observe and chart your cycles, creating a record that you and your NFP teacher can review for any indications of suboptimal fertility, and you and your husband can use to identify the best days to conceive. Given you are in your mid thirties, I would not delay too long pursuing an evaluation,should you continue to be unsuccessful in achieving a pregnancy with the added insights gained by charting your cycle. If your charting suggests any abnormalities, you may want to consult early on with a physician trained in interpreting these charts. If your charting is normal, your NFP teacher may suggest fertility focused intercourse for several months first before pursuing such an evaluation.
In general, it is recommended a couple “try” for a year before pursuing fertility evaluation. Using fertility focused intercourse as facilitated by charting your cycles with an NFP Professional, this advice is usually adjusted to six months. If problems are identified, or the couple is in late thirties, it may be appropriate to seek an evaluation even sooner.
Wishing you well!
You also mention premenstrual spotting before your period begins. Pr-menstrual spotting before your period can be caused by inadequate progesterone levels. Just a day of spotting, or even two, does not necessarily mean that. Checking progesterone levels in a timed fashion, on three, five, seven, nine and eleven days following the identification of what we call your Peak day, can give you a profile of what your hormones are in your luteal phase.
You don’t mention if you are charting your cycles, but if you learn to do that, not only will you be able to focus the timing of intercourse near ovulation and the presence of good quality cervical mucus, but you also would be able to time hormone evaluations so they can be accurately interpreted. The charting is a valuable tool in evaluating fertility.
My suggestion is the first “infertility test” — learn to observe and chart your cycles, creating a record that you and your NFP teacher can review for any indications of suboptimal fertility, and you and your husband can use to identify the best days to conceive. Given you are in your mid thirties, I would not delay too long pursuing an evaluation,should you continue to be unsuccessful in achieving a pregnancy with the added insights gained by charting your cycle. If your charting suggests any abnormalities, you may want to consult early on with a physician trained in interpreting these charts. If your charting is normal, your NFP teacher may suggest fertility focused intercourse for several months first before pursuing such an evaluation.
In general, it is recommended a couple “try” for a year before pursuing fertility evaluation. Using fertility focused intercourse as facilitated by charting your cycles with an NFP Professional, this advice is usually adjusted to six months. If problems are identified, or the couple is in late thirties, it may be appropriate to seek an evaluation even sooner.
Wishing you well!
Answered By:
CANFP
CANFP unites under one umbrella all those who use, teach, and advocate for NFP, and our members are our strongest resource: the physicians who provide authentic women’s healthcare, the Practitioners and Certified Teachers of all the natural methods instructing couples in its use, the couples who use NFP and reflect its values in their families and communities, the clergy providing the spiritual formation and context, and the churches, dioceses, hospitals, and profile organizations who collaborate in providing access to these services throughout the state.
