Secondary sterility

Abstract

The causes of secondary sterility in a couple are varied and may include a strong psychosomatic component. In this article, brief case histories are used to illustrate secondary sterility following abortion, maternal prohibition, and the death of a child. Sterility following abortion still occurs in France, but it is not always due to a tubal problem. During the 1st consultation for infertility the woman should be encouraged to describe the circumstances of the abortion, whether it was performed in secrecy, and her feelings about it. A 24-year-old woman who had had an abortion 2 years previously suffered from irregular cycles and was unresponsive to treatment to regulate ovulation. She became pregnant only after violently reproaching her mother for the mother's role in the abortion. Another woman had an extrauterine pregnancy, premature birth in which the infant died, and stillbirth after 2 induced abortions. She finally gave birth to a healthy term infant. In a 3rd case a Catholic woman of Irish origin felt such guilt after an abortion that she became pregnant again only after 10 years of infertility and an adoption. Some cases of infertility after a 1st live birth are explained by a prohibition on the part of the woman's mother, who herself had only 1 daughter. The reasons advanced by the mother for discouraging a daughter from becoming pregnant are not usually the true reasons, and the prohibition in some cases is difficult to overcome. Women who suffer the death of a child in utero or in infancy sometimes have difficulty becoming pregnant again. It is important to allow such patients to describe the circumstances of the death in detail. Usually at least 18 months must pass before the work of grieving is over. Hospital procedures which seek to shield the parents from the sight of their dead child may actually impair the grief process. A 27-year-old woman suffered secondary infertility and anovulation after the death of her 2nd child from congenital cardiac malformation. She was able to deliver a healthy child only after 2 miscarriages and a difficult pregnancy filled with anxiety, nightmares of death, and psychosomatic problems.