Arathi and Suhas Rao were a happily married couple with a perfect family — Arnav, 11, and Saurav, 5, till a tragic incident changed their life suddenly. They lost their younger son — naughty, bubbly Saurav to a freak road accident. Arnav became quiet and withdrawn, missing his little brother every moment, Arathi went under depression and Suhas tried to bury himself in work.  That was when the Raos decided that they needed to bring another member into the family to learn to start living again. Unfortunately, it was easier said than done. Despite all their efforts, Arathi was unable to conceive.  She was suffering from secondary infertility and completely unaware of it.

Statistics say that  approximately 20 per of women suffer from this condition at some point in their life which means that they will not be able to bear a second or third child despite having borne children earlier. What makes it more frustrating is that women keep trying to conceive without realising they have a medical problem. “Secondary infertility is a condition that most Indian women are not aware of,” says Dr Kamini Rao, one of Bangalore’s leading infertility specialists, explaining that they live under the misconception that they are fertile having given birth to a child earlier. When a depressed Arathi came to Dr Rao, her condition was adding to the stressful situation the family was already under. They needed results fast because not being able to conceive was adding to her depression and also at 31, her egg count was fast lessening. However, treatment could only be started after a reason for her infertility could be decided.

Doctors say there are many reasons why a woman who has been able to bear children earlier is not able to do so again. Some of these could be as simple as not having time or energy for sex at her most fertile time of the month (around day 13 of her cycle) because of  work pressure, difference in the working hours/ schedules of the partners, demands of a difficult first child. With more and more women handling demanding careers and balancing this with managing the house and family, this has become a very common reason for infertility. Also, since age of marriage is going up women decide to conceive late and though most of us like to ignore our mothers when they harass us to start or add to the family early, any gynaecologist will tell you that as age advances for a woman, it becomes more difficult to conceive. According to Dr Rao, women are at their most fertile in their mid-twenties to early thirties. Infertility starts casting a greater shadow after 35 and more so after forty” .

“Secondary infertility could even happen because of complications arising out of genital tuberculosis, pelvic infections, severe endometriosis, polycystic ovarian disease, tubal factors, deteriorating reserve in the ovaries with advancing age etc, “ she says. Sometimes, the male partner might have a medical problem.

To determine the exact cause of the infertility, baseline investigations are carried out at fertility clinics. In Arathi’s case a hormonal profile and scan were done. The husband had to undergo semen analysis and culture. Dr Rao found all the tests were normal and then decided to do a tube patency test or Hysterosalpingogram. In this, a dye is made to pass through the fallopian tubes of the patient to check if there is a blockage anywhere. Though an uncomfortable procedure for the patient, the test helps to pinpoint the exact place of blockage so that a surgeon can then clear it.

In Arathi’s case, the tubes were found to be patent and she was immediately started on a conception procedure.

Once the reason for infertility is pinpointed, treatment can be started. That is why it is suggested that if a woman has not been able to conceive despite a year of trying to do so, she should seek medical help.

Couples are often recommended to decide on a time frame by which the woman will try to get pregnant or consider alternatives like surrogacy or adoption. Or, they can choose the number of tries they will give a particular treatment like In Vitro Fertilization (IVF) which is expensive as well as emotionally and physically draining. Having a limit in the minds often helps in finding closure and accepting destiny. Jaideep Singh and Akansha, a couple in their early forties gave IVF two tries after which they decided to adopt a baby girl. “It was such a painful procedure to try for conception every time and then realise it was not happening. Conceiving a second time had become such an obsession that I would sit and cry for hours every time I had my periods,” says Akansha. Their daughter Snigdha has completed the family and the Singhs regret why they did not think of adoption earlier.

With Arathi, ovulation was induced and gonadotropin injections given to help the follicle to grow. The follicle was ruptured medically on day thirteenth of her cycle and on confirming the rupture by a scan, intrauterine insemination was done using a prepared semen sample. Hormones were given to support it and a pregnancy was confirmed the next month. Arathi had a healthy pregnancy and delivered a healthy baby girl on February 28, this year. The little one made Arnav laugh again and she filled up some of the sad empty space left behind by Saurav.

- Keep an eye on your weight. Most women will gain weight after delivering a baby. Excess weight gain is the most common reason for women finding it difficult to conceive again.

- Get infections treated as early as possible to prevent secondary infertility. Many times, vaginal infection can cause infertility.

- Don’t wait longer than 2-3 years to conceive again after the initial pregnancy. Age is the most common cause for infertility problems. Waiting too long before trying to have another baby causes problems in conceiving naturally. After the age of 35, the likelihood of conceiving decreases rapidly. Since some women go through menopause at an early age, this may also be a cause of secondary infertility.

-Diet, regular physical activity and relaxation are the most important solutions for preventing secondary infertility.