The problem of infertility in the second pregnancy. Dr. Chun-I Lee will answer the question for you

• What’s the main reason for wanting to have a second child but cannot due to infertility?

Do you have the problem of wanting to conceive a second child but cannot get pregnant? Generally we classify this as secondary infertility. That is, you were pregnant once, but is now unable to conceive again. This makes up for about 40% of the cases in infertility clinic. Patients often question themselves why they can naturally conceive the first child but not the second child? Quite often we can see couples desperately trying to conceive for 3 to 6 years but with no result. The causes of secondary infertility include the problem of aging. In the modern days, many people have their first child when they are already over 30 years old. But when they want to get pregnant again few years after that, they find that the older they get, the function of their ovary deteriorates and the quality of their eggs becomes poor, thus affecting conception. Furthermore, is the decrease in the frequency of sexy between couples. Many couples both work during the day and care for their children at night. They are both tired and stressed. In the past, they may have sex once or twice a week, but this may evolve to twice a month.

Some patients already have polycystic ovary syndrome or endometriosis. What happened was when they are pregnant with the first child, everything was normal, but afterbirth, advanced age plus fatigue, diet and other reasons may have exacerbated the symptoms and cause abnormal ovulation. Reasons such as caesarean section, ectopic pregnancy, and other, may have caused adhesion, fallopian tube obstruction, thus affecting fertilization and embryo implantation. Moreover, many men think that men have a strong reproductive ability where it is not difficult for them to have a child at the age of sixty or seventy, they also have the idea that when they already gave birth to a child, and the sexual function has not changed, then naturally there should be “no problem.” Although the speed at which men's reproductive function deteriorate is slower than women’s, if their lifestyle habits are not good where their habit of smoking and drinking have not changed, then spermatogenesis will also be affected, and the quality of the sperm will decline, which of course will affect the chance of conception. This is especially apparent as one ages, maybe the body is beginning to have chronic diseases, such as high blood pressure, diabetes, hyperlipidemia, and so on, which may all affect sexual desire and fertility. Therefore, one should put all the blame on the wife for their inability to conceive.

Modern day females have late childbirth where they have their first child at a too old and age. Thus is becomes relatively more difficult to conceive a second child.
 

• How to prepare a fertility plan?

Clinical data and research on human ovaries clearly indicated that women’s fertility ability and ovarian reserve begin to decline rapidly after the age of 35-36 years old and that even if they get pregnant, the rate of miscarriage rises rapidly. This change is even more obvious in people over the age of 40. Therefore, it is recommended for women who have a fertility plan, to best complete their birth plan before the age of 35. We can often see situations where after the first childbirth, due to work and looking after the child, they took too long a gap to have a second child, that they could not conceive. Or that many couples unexpectedly fell pregnant again shortly after giving birth to their first child, but because they were not ready for it, they chose to have an abortion. As a result, it led to future gynecological problems and infertility. We sincerely recommend that you plan beforehand and decide whether or not to have a second child. It is best that the two births are separated by 2 years and that the childbirth is best done before the age of 35 years old. If having normal sexual activity, one does not conceive after more than a year, then it is recommended that you seek the assistance of an infertility specialist as soon as possible.
 

• What tests and treatments should I do if I am really infertile?

If there is a suspicion of infertility, couples can go to the hospital's infertility department or reproductive center for blood testing and ultrasound examination. The wife can have a better understanding of her own ovarian reserve and health status of her egg, as well as whether there are problems such as polycystic, endometriosis or other gynecological diseases that may hinder conception. The husband can have a better understanding of such key values as sperm count, mobility, and penetrating power, where they will have a thorough understanding of the main causes for their infertility. The doctor will give advice according to the test results. If natural conception is really not possible, then they have the option of IVF method to assist fertility.
 

• What technology can assist advanced maternal aged couples to conceive a baby?

Women who give birth at the age of 35 years old are generally referred to as advanced maternal aged women. Basically, women remain fertile before reaching menopause. The only difference is that women’s egg quality plummets after the age of 37 years old, and pregnancy rate is also affected by age. Before 30 years of age, women have a success rates for natural pregnancy of about 25% every month. It is about 10% between 30 to 40 years old. The chance of getting pregnant after the age of 40 is less than 10%.

As for the rate of miscarriage, it is even higher. The rate of spontaneous abortion among pregnant women aged 20-24 is 8.9%, and the proportion for pregnant women over 45 years old becomes as high as 74.7%. This is coupled with the problem that for the advanced maternal aged, when their sperm and egg are fertilized they are more prone to autosomal abnormality. Thus their probability of giving birth to children with abnormal chromosomes increases significantly. If when carrying out with IVF, before the embryo is implanted, the two technologies, that of pre-implantation genetic screening (PGS), and embryoscope time-lapse system, are used, then the above-mentioned problems faced by the advanced maternal aged women can effectively be solved. Before embryo implantation, pre-implantation genetic screening is performed before the fertilized egg is implanted into the uterus, whereby 5-6 cells are taken out for chromosomal examination in order to select a normal embryo for implantation into the uterus, thus improving the conception rate. This will increase the success rate of the original implantation of an embryo from 20% to 50%, and the implantation of two embryos will also increase from 30%-40% to 85%. This is different from the prenatal genetic test done by the general advanced maternal aged women or mothers with special pregnancy.

Prenatal genetic testing extracts the amniotic fluid or chorionic for carrying out chromosome testing after pregnancy. Before embryo implantation, genetic screening needs to extract the cells from where the embryo develops into the placenta, and have to avoid the place where the embryo develops into a fetus, so as not to hurt the fetus.

This is the key point to this technology. The big data artificial intelligence provided by the embryoscope time-lapse system is a bit like applying time-lapse photography to the observation of embryo, where the machine can observe the growth of embryo non-stop 24 hours a day. This is because in the process of embryo development, development that is too fast or too slow is not conducive to the subsequent pregnancy by embryo implantation. The time point of changes in embryo development is a reference basis for observing the quality of the embryo, and remedies the inadequate past technology of observing the appearance of the embryo at fixed time period. Through the microscope head of this machine, the development process of each embryo can be observed, including areas such as the appearance of the embryo, the dynamics of the division, the presence or absence of debris, and so on. It take pictures every ten minutes and make it into a continuous image slide show, so that researchers can quickly and accurately grasp the big data and make analysis from it. They will find embryo developmental defects from these images, and then select the best quality embryos with normal chromosomes for implantation. This will significantly reduce the miscarriage rate and increase the pregnancy rate.

Another situation faced is that women nowadays get married late and give birth late, and when they are older, they may be faced with ovarian failure. For many women over the age of 40 have multiple failed IVF treatments, or young women in their 30s undergone radiotherapy and chemotherapy due to cancer, or have had ovarian surgery when they were young which affected their ovulation, or having difficulty to conceive or is infertile, or having family genetic diseases, will adopt the method of donor eggs to achieve conception. For those who have reached the age of 35 but are still without a partner, or for couples who have no fertility plans, or those who have already gave birth to a first child but are still uncertain whether or not they want to have a second child, in order to avoid the situation where you may want to give birth in the future but is unable to, we also recommend that you freeze the eggs as soon as possible, so that at the time when you want to give birth in the future, you will have a better chance of having a successful childbirth.
 

• What is the doctor's suggestion about the problems that may be faced when giving birth at an advanced maternal age?

Taiwan’s reproductive medical technology ranks first in Asia with the pregnancy rate ranking second in the world, preceded only by the United States. The technology is already very mature and advanced, where giving birth at an advanced maternal age is no longer an unattainable dream. The fetus of advanced maternal aged pregnant women is more prone to incidences such as premature delivery, fetal growth retardation, low birth weight, or have the risk of intrauterine fetal death, neonatal death, and so on. 2 times higher than that of ordinary maternal women. That is why we highly advise advanced maternal aged and ultra-advanced maternal aged women that during their pregnancy, they should fully cooperate with physicians in their pregnancy checkups, so that the doctors can monitor the status of mother and child at all times, to ensure the safety of the mother and the child during pregnancy and childbirth. In addition, considering the physical and psychological challenges faced by advanced maternal aged women in the upbringing of their children, it is recommended that women give birth early if possible.



Speaker : Dr. Chun-I Lee, Lee Women's Hospital

⋙ Experiences

• Reproductive endocrinology and infertility doctor of NTUH
• Attending Physician of Reproductive Endocrinology and Infertility, Chung Shan Medical University Hospital
• CEO of Lee Women's Hospital
• Director of enetic inheritance of Lee Women's Hospital

⋙ Major

• Infertility medication and surgery
• IVF
• Egg Freezing
• Egg Donation
• Obstetrics and Gynecology