Secondary Infertility: Causes, Diagnosis, Treatment & Tips

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Secondary infertility is defined as an inability to conceive or carry a baby to term in women who have given birth before. Some couples may try for another child sooner or later after one child and may have trouble getting pregnant again.

According to the US Centers for Disease Control and Prevention (CDC), nearly 11% of couples who at least had one child may have secondary infertility. This is responsible for nearly half of total infertility and affects about four million families in the US (1).

Read on to know the causes, treatment, and prevention of secondary infertility.

What Are The Causes Of Secondary Infertility?

Of the many factors that lead to secondary infertility, some are related to female infertility while some to male infertility. Then there are another set of problems that are unexplained (2).

1. Advancing age

Age is a significant factor that plays a role in secondary infertility. A woman is born with fixed number of eggs and starts losing them since puberty or even before. As she get older, this lose gets accelerated and no new ones are formed. Therefore, a long gap after the birth of a child can have an impact on the fertility, if the mother has a late pregnancy.

2. Structural issues in the reproductive system

Endometriosis, pelvic adhesion, prior abdominal surgeries and abnormalities in the fallopian tube can greatly affect the reproductive system and therefore conception.

3. Male factor

Like a woman’s fertility, a man’s fertility also diminishes with time, both in terms of the quality and quantity of the sperm. This could be due to aging, medications or health condition.

4. Weight gain

Excessive weight has a high impact on a person’s ability to conceive. It could impair ovulation and increase the time to get pregnant. It could increase erectile dysfunction and decrease sperm production in men. Smoking also has a similar effect on fertility.

Infections or scars during the previous pregnancy may lead to secondary infertility in some women.

When Should You See A Doctor?

Time plays a key role in fertility; therefore, you need to be proactive in seeking treatment. You should consult a specialist if you (3) (4):

  • Are under 35, and have been trying to conceive for one year without any success.
  • Are above 35, and have been trying for at least six months without success.
  • Have had two consecutive miscarriages.
  • Are over 30 with a history of painful periods, miscarriages, irregular menstrual cycle, or pelvic inflammatory disease. In such a case, you must refrain from waiting for more than one year after having a child.

The Emotional Impact Of Secondary Infertility

When you are dealing with secondary infertility, it is normal to struggle with a gamut of emotions. Inability to conceive the second time can lead to an emotional turmoil, with common emotions you feel being (5):

  • Anger, because you had a child previously but now the happiness is eluding you
  • Frustration, since conceiving was so easy last time but not now
  • Envy, as your friends and relatives have easily had more than one child
  • Isolation, due to the feeling that you cannot fit in any group. Fertility issues can cause a strain on your relationship, and you will feel left out
  • Guilt that you are not able to give your child a sibling
  • Sorrow, realizing you cannot experience another joyful pregnancy
  • Weariness, for not being successful and from scheduling doctor appointments time and again
  • Sadness, for the loss of childbearing opportunities
  • Hurt when you are invited to your friends baby shower or when they announce pregnancies

Amidst all the negativity, you may also feel a little hopeful because every month is a new start.

If you think that you are unable to conceive despite your best efforts, it is time to go to a doctor for a diagnosis.

How Is Secondary Infertility Diagnosed?

The diagnostic procedures are the same for secondary infertility and primary infertility and both the man and woman need to be tested.

Diagnosis is done through a comprehensive analysis of the general health and menstrual pattern. This is followed by extensive tests, including hysterosalpingogram (HSG) to test for fallopian tube blockages (6). An ultrasound may be done to check the uterine condition, if ovulation is happening and ovarian reserve assessment.

For a man, it includes testing for blood disorders and sperm count or semen analysis.

What Is The Treatment For Secondary Infertility?

Treatment for secondary infertility depends on what is causing it. The possible treatment options include:

1. Infertility medications

Oral medications such as letrozole and Clomid (clomiphene citrate) help trigger the ovarian follicles to release eggs. Medications that could be injected include follicle stimulating hormone and luteinizing hormone, which stimulate multiple egg production (7).

2. Intrauterine insemination (IUI)

It involves collecting a semen sample (either from partner or donor), concentrating and then placing it in the uterine cavity at the time of ovulation. This helps in placing the sperm close to the fallopian tube where fertilization takes place (8).

3. In vitro fertilization (IVF)

The egg and sperm are combed in the special laboratory conditions to form an embryo, and then transferred into the uterine cavity.

Sometimes, surgery is needed to improve the chances of fertility and conception.

Rather than relying only on the above treatment methods, you and your partner can also try the natural remedies for treating infertility.

What Are The Natural Measures Against Secondary Infertility?

Following are some natural ways of improving your chances of getting pregnant again.

1. Regular sex

Make love regularly as it can optimize your chances of conception. Do not resist the desire to have sex. Indulge in intercourse whenever you and your partner feel like rather than focusing only on those four to five fertile days. The American Society of Assisted Reproduction (ASRM) suggests having sex once every other day or in two to three days to increase your chances of pregnancy (9).

2. Improve diet and exercise

Both you and your partner should follow a healthy diet and try to maintain an ideal weight. Your ideal BMI should be around 19 to 25, or 20 to 25 as some say, for improved chances of ovulation (10). Let your partner also check all the possibilities to eating healthily and lead a healthy lifestyle.

Refrain from alcohol and smoking as they can have negative effects on fertility. Your doctor may refer you to a rehab center if needed.

3. Accept your emotions

You will go through a range of emotions, but remember you are not alone. Accepting your emotions is a part of the struggle. Try to cope with them by joining any support group, or talking with your doctor about better options.

Medications or alternative treatments work better if you have a positive outlook. Do not lose hope because you might still have a chance to conceive, just like Jennifer did.


A true story of how a woman had a successful pregnancy after secondary infertility treatment (11).

Jennifer and her husband, who were from the US coastal state of Oregon, had a successful first pregnancy. After that, they tried for a year to have another baby but had no success. Doctors diagnosed secondary infertility due to unknown causes.

The couple went for IUI treatment and got pregnant. But that turned out to be a loss, with a miscarriage in the first month of pregnancy. Even after repeated IUI treatments for about six times, they were not successful. Finally, with the second IVF treatment, Jennifer got pregnant and gave birth to twin babies.

There are many like Jennifer, who had suffered due to secondary infertility. But with accurate diagnosis and the appropriate treatment, they could conceive again. And so can you.

Frequently Asked Questions

1. How are miscarriages and secondary infertility related?

Secondary infertility is a feature of recurrent miscarriages. Factors such as maternal age and the total number of miscarriages in the past also play an essential role in determining the role of miscarriages in secondary infertility (12).

2. What is the difference between primary and secondary infertility?

When one has never achieved pregnancy, it is termed primary infertility, and secondary infertility is when at least one pregnancy has been achieved (13).

3. Can a C-section cause secondary infertility?

Some research suggests that women who undergo a C-section may be at a slightly higher risk of developing secondary infertility when compared to those who deliver vaginally (14).

Secondary infertility can be highly upsetting and infuriating. Since you have been pregnant before, it may be difficult to understand why you can’t conceive the second time. It can take a while to get back to healthy living with a nutritious diet, exercise, and a clean lifestyle to reduce further complications. However, a few things that can be done to improve your chances of getting pregnant again are regular sexual intercourse and improvement in your diet and physical activity. Also, you need to minimize exposure to toxins. Lastly, remember that the rest will slowly fall into place when you are physically and mentally fit.

References:

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  1. Atif Abdulhamid Katib et al.; (2014); Secondary infertility and the aging male overview.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132591/
  2. Secondary Infertility.
    https://mihp.utah.gov/after-pregnancy/secondary-infertility
  3. Evaluating Infertility.
    https://www.acog.org/womens-health/faqs/evaluating-infertility#:~:text=When%20should%20I%20consider%20havingafter%206%20months%20of%20trying.
  4. When Should I See a Fertility Specialist?
    https://www.nm.org/healthbeat/healthy-tips/when-should-i-see-a-fertility-specialist
  5. Seyede Batool Hasanpoor-Azghdy et al.; (2014) The emotional-psychological consequences of infertility among infertile women seeking treatment: Results of a qualitative study.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009564/
  6. Suman Puri et al.; (2015); Laparohysteroscopy in female infertility: A diagnostic cum therapeutic tool in Indian setting.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318101/
  7. Fariba Seyedoshohadaei et al.; (2016); Comparison of the Effect of Clomiphene- Estradiol Valerate vs Letrozole on Endometrial Thickness Abortion and Pregnancy Rate in Infertile Women with Polycystic Ovarian Syndrome.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028483/
  8. Ishita Ganguly et al.; (2016); Pregnancy Predictors after Intrauterine Insemination in Cases of Unexplained Infertility: A Prospective Study.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5050366/
  9. Optimizing natural fertility: a committee opinion.
    https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/optimizing_natural_fertility.pdf
  10. Shilpi Pandey et al.; (2010); The impact of female obesity on the outcome of fertility treatment.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2970793/
  11. Center for Women’s Health Patient Stories.
    https://www.ohsu.edu/womens-health/center-womens-health-patient-stories
  12. Christiane Kling, et al.; Two-year outcome after recurrent first trimester miscarriages: prognostic value of the past obstetric history; National Library of Medicin
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829626/
  13. Infertility; World Health Organization
    https://www.who.int/news-room/fact-sheets/detail/infertility#:~:text=Primary%20infertility%20is%20when%20a,diagnosis%20and%20treatment%20of%20infertility.
  14. A P LaSala, A S Berkeley; Primary cesarean section and subsequent fertility; National Library of Medicine
    https://pubmed.ncbi.nlm.nih.gov/3618689/#:~:text=When%20all%20patients%20with%20a,with%20a%20vaginal%20delivery%20
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Dr. Lakshmi Chirumamilla

(MD)
Dr. Lakshmi Chirumamilla is a consultant at Nova IVF Fertility Clinics, Hyderabad. She has experience in core cases of infertility including poor ovarian response, recurrent implantation failure, and male factor infertility. With her expertise and experience, she has cracked complex cases and is known to provide the best patient care. Working since August, 2014 at Nova, she handled international patients... more

Rebecca Malachi

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She has been into health and wellness writing since 2010. She received her graduate degree in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig... more

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