Dr. Dave Greenberg tells us why it can sometimes be harder to get pregnant a second time

It can be surprisingly common for women to have problems getting pregnant for baby number two, even if they didn’t experience that issue the first time. Secondary fertility is “diagnosed” when a woman who has given birth without the use of medical support or fertility medication

a) finds herself unable to get pregnant again, or

b) experiences recurrent miscarriages after trying for one year (if younger than 35), or six months (if older than 35). Here are the common causes:

Irregular Ovulation

This is considered the number one cause of infertility. It’s important for women to understand when they ovulate, how to maximize their chances of getting pregnant.

I recommend using a digital ovulation predictor. The First Response predictor, for example, helps a woman better determine her peak fertile days by detecting her individual luteinizing hormone (LH) surge based on her own hormone levels. This is the only test that remembers individual LH hormone levels and is able to read and track each woman’s unique surge.

Being Over 35

Many Canadian women are choosing to have children later in life which, for some, can result in difficulties getting pregnant due to a decrease in the number and quality of her eggs.

Delaying reproduction often makes it more difficult – though not impossible! Over the last couple of years I’ve delivered more babies to women in their 40s than in their 20s.

I recommend women track their ovulation and embrace the healthiest lifestyle possible before seeking alternative measures. Try these tips:

• Start acting like you’re pregnant before you’re pregnant. Since you’re not going to know the exact moment when it happens, make sure your body is as well-prepared as possible.
• Eat plenty of fruits and vegetables, protein and take a prenatal vitamin that includes the appropriate amount of folic acid when trying to conceive.
• Ditch unhealthy habits like smoking and alcohol; they have a huge impact on the ability to conceive.
• Be sure to get enough calcium and avoid aspartame, caffeine and foods potentially contaminated with listeria or that are high in mercury.
• To reduce stress (especially the second time around), I recommend to my patients “not to try”. Trying sets couples up for the possibility of failure and adds an added layer of pressure and anxiety to the situation.

Sperm Health

Just as women’s eggs decrease in quality and quantity, so too does men’s sperm. Conceiving a baby is 50 percent up to the woman and 50 percent up to the man, so it’s important to check the quality and quantity of the sperm. To improve sperm odds, men should:

• stop smoking;
• avoid hot tubs, whirlpools or saunas;
• avoid wearing tight clothing (or underwear) that may impair the testicle’s ability to produce adequate quality sperm

Unexplained Fertility

In as many as 20 percent of cases, the cause will be attributed to “unexplained fertility”. It can be challenging to confirm whether some factor has been in existence all along and the couple was lucky in getting pregnant the first time, or the factor has become exacerbated over time. Whatever the case may be, it’s important to speak with your doctor to understand the cause and treatments that are right for you. Your doctor can help guide you along the way in your family planning.

Dr. Dave Greenberg practises family medicine and obstetrics in the department of family and community medicine at St. Joseph’s Health Centre in Toronto.

Originally published in ParentsCanada magazine, September 2015.