Doctors see increase in couples having trouble conceiving second child

Swati* and Suresh Kadam* couldn’t wait to have another child around the time their daughter turned two. Little did they know at the time that they in were for disappointment.

Over the next four years, the Colaba residents wound up at their family doctor’s clinic many times, each time with renewed hope of finally finding an end to it.

What frustrated them more was the inability to conceive despite having “normal” childbirth previously.

“The doctor wasn’t able to give us a conclusive reason for it. We were made to go through several medical tests, but nothing substantial showed up on the report,” explains Suresh, who works as a manager of a south Mumbai hotel.

The two then approached Cama and Albless Hospital, where the condition — secondary infertility — was bandied about.

The Kadams’ case isn’t rare. Several health experts are seeing an increase in the number of couples who are not been able to conceive a second time around.

Dr Nandita Palshetkar, an in vitro fertilisation expert at Lilavati Hospital in Bandra, claims that 10% of all patients with fertility problems who visit the super-speciality hospital in a year suffer from secondary infertility.

At the state-run Cama hospital, 80-90 infertility cases in a year are found to have this condition.

Dr Rishma Dhillon-Pai, a senior gynaecologist at Jaslok Hospital in south Mumbai, says although the condition is “common”, it’s difficult to nail one particular reason for it with a just a test; a number of physical conditions can lead to it.

Endometriosis — the presence of endometrium elsewhere than in the lining of the uterus — is the most frequent cause of such infertility among women. Irregular ovulation, Fallopian tube disease, uterine scarring from a previous childbirth and stress are other factors which may prevent conception.

The onus, though, isn’t on a woman alone. A decrease in a man’s sperm count or motility can also lead to infertility.

Age affects both sexes — even a five-year gap can make a huge difference to a woman’s fertility cycle and a man’s sperm count.

The condition cuts across social classes. “It is not an affliction of the rich or the poor,” says Dr Rajashri Katke, senior gynaecologist and superintendent of Cama hospital.

She busts the myth that a previous childbirth is a reflection of a couple’s fertility. “Such couples think they have a ‘normal’ fertility, but this isn’t always the case. That’s why it is important for both the man and woman to have a complete infertility check-up as soon as they feel they’re having trouble conceiving.”

The treatment for secondary infertility is the same as that for infertility — once all conditions which can affect fertility are ruled out, doctors advise assisted reproductive technology like in vitro fertilisation.

Suresh, who used to occasionally smoke and drink, hopes that once the couple’s test results are out, their treatment can begin soon.

(Names have been changed to protect patients’ identities)

Failure to launch
In women: Advancing age, polycystic ovarian syndrome, endometriosis, pelvic inflammatory disease, fibroids, uterine scars from previous surgeries, obesity, exposure to certain medication, chronic medical disorders — diabetes mellitus and hypertension
Endometriosis can result in tissue growth on the ovaries, behind the uterus, the bowels or the bladder. Rarely does it grow on other parts of the body. It’s not known what causes it.

It is often treated with painkillers and hormone therapy. Severe cases may need surgery
In men: Low sperm count, varicocele, ejaculatory disorder, radiation exposure, advancing age, smoking, alcohol consumption.

A sperm count is considered low when there are fewer than 15 million sperms per millilitre of semen. It decreases the chances that one of the sperms will fertilise the egg. Drug abuse, tobacco and alcohol consumption, as well as certain illnesses and infections, can lead to a drop in the count.