What Is Secondary Infertility?

Many assume that if they’ve had a baby before, getting pregnant again should be smooth sailing — but fertility is rarely that straightforward. Factors like age, hormonal changes, or health conditions can sometimes make it more complicated to get pregnant, even if you’ve had a successful pregnancy in the past. 

If you’re trying for another baby but struggling to conceive naturally (i.e. having regular unprotected sex), you may have what’s known as secondary infertility. It can be unexpected and frustrating, and many couples feel as though there’s less social support available when they’ve already had a previous pregnancy. 

Secondary is far from uncommon, though. Keep reading to learn more about it, including what solutions are available. 

What is secondary infertility?

Infertility can be primary or secondary. Primary infertility means a couple has never been able to conceive, while secondary infertility happens when a couple who has had a previous (or several) successful pregnancies struggles to get pregnant again. 

It's normal to assume that if you’ve managed to get pregnant before, conceiving again won’t be an issue, but the same factors that contribute to primary infertility can also cause secondary infertility — with age being a big factor.

Getting pregnant isn’t as easy as we were led to believe growing up. It relies on ovulation, fertilization, and successful implantation of an embryo in the uterus (all complex processes) happening without a hitch. Any hiccup in these steps can make it harder to conceive. 

Some common factors that contribute to secondary infertility include:

• Age-related fertility decline: A woman’s fertility naturally starts decreasing after 30, affecting both egg quantity and quality. Testosterone levels in men also decrease with age, which can affect sperm quality, count, and motility.
• Early menopause: Some women experience menopause before age 45 due to lower estrogen and hormone levels, making conception difficult.
• Blocked or damaged fallopian tubes: These can be caused by endometriosis, pelvic inflammatory disease (PID), past ectopic pregnancies, or scar tissue from surgery.
• Uterine conditions: Uterine fibroids or other structural issues may make it difficult for an embryo to implant properly.
• Polycystic ovarian syndrome (PCOS): This common hormonal disorder can lead to irregular ovulation, making conception tricky.
• Weight fluctuations: Being significantly overweight or underweight can disrupt ovulation and fertility in both men and women.‍
• Unexplained infertility: Sometimes, doctors can’t pinpoint an exact reason, which can be frustrating but doesn’t mean pregnancy is impossible.

How is secondary infertility diagnosed?

If you have been pregnant before, you’re under 35, and have been trying for a year without success, or over 35 and have been trying for six months, it might be time to check in with a doctor.

To get to the bottom of the issue, your healthcare provider may recommend:

• Semen analysis: Checks for male factor infertility biomarkers, such as sperm count, movement, and quality.
• Blood tests: Evaluate hormone levels that influence ovulation.
• Ovulation tracking: Confirms if you’re ovulating regularly.
• Ultrasound scan: Provides a closer look at your uterus and ovaries.
• HSG (hysterosalpingography): An X-ray to check for any scarring or blockages in your fallopian tubes.

Treatment options for secondary infertility

The good news is that there are many options for helping you conceive again. The right treatment depends on what is causing the difficulty.

Medications

Certain medications can help encourage ovulation:

• Clomid or letrozole: These drugs stimulate ovulation in women who aren’t ovulating regularly.
• Gonadotropins: Injectable hormones that boost egg production.
• Metformin: Often prescribed for women with PCOS to help regulate their cycles.

Surgical procedures

If there are structural issues, surgery might be an option:

• Fallopian tube surgery: Clears blockages that may be preventing conception.
• Fibroid removal: Removes growths that might interfere with implantation.
• Laparoscopy for endometriosis: Helps reduce the effects of endometriosis on fertility.

Assisted reproductive technology

Assisted reproductive technology (ART) can be a game-changer for couples dealing with secondary infertility. ART includes advanced fertility treatments that help overcome challenges in conception, especially when natural methods aren’t working. Some types of ART include: 

• Intrauterine insemination (IUI): This procedure places sperm directly into the uterus during ovulation, increasing the chances of fertilization.
• In vitro fertilization (IVF): IVF is one of the most effective fertility treatments available. It involves retrieving eggs, fertilizing them in a lab, and transferring the healthiest embryos back into the uterus.
• Intracytoplasmic sperm injection (ICSI): If sperm quality or low sperm count is an issue, a single sperm is directly injected into an egg before implantation, increasing the odds of success. 
• Egg and sperm donation: For couples facing severe fertility challenges, using donor eggs, sperm, or embryos may be a good option.

Secondary infertility can cause a lot of emotional stress and put a strain on your relationship. Just because you've previously given birth doesn't mean your emotions aren't valid if you're struggling with the reality of secondary infertility. Ask your healthcare provider for recommended support groups, and don't be afraid to seek out emotional support from a therapist or counselor.

FAQ

How is secondary infertility different from primary infertility?

Primary infertility refers to couples who have never conceived, while secondary infertility affects those who have had one or more children but now struggle to get pregnant again.

What are the signs of secondary infertility?

The main sign that you're experiencing secondary infertility is difficulty getting pregnant again despite having conceived before. Sometimes irregular or missed periods can hint at ovulation problems, or you might experience heavy or painful periods that could point to conditions like fibroids or endometriosis. In some cases, there might not be any clear signs other than difficulty conceiving, so talking to a healthcare professional can really help identify any underlying issues. 

What’s the most common cause of secondary infertility?

The most common cause of secondary infertility is age-related fertility decline. As women get older, the number and quality of their eggs decrease, making conception more difficult. This decline becomes more noticeable after age 35. Other common factors include ovulation disorders like PCOS, blocked fallopian tubes from previous infections or surgeries, and male infertility issues such as low sperm count or poor sperm quality. Since several factors affect fertility, a combination of causes can sometimes contribute to secondary infertility.