Last updated: March 9, 2020
Richard Honaker M.D.
Primary Care Physician
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Fertility can be a struggle even after the birth of a child. Secondary infertility is common, frustrating and can be hard to diagnose. Learn everything a doctor wants you to know about the struggle to conceive after a live birth.
Many parents assume that after the birth of their first child, adding to the family will be easy. Yet an estimated 3 million women struggle with secondary infertility in the U.S.
What is Secondary Infertility?
Secondary infertility is the inability to become pregnant or carry a baby successfully after previously conceiving and giving birth to a child. It is defined as a couple who has successfully carried a child to term but is unable to conceive again after a year of trying.
Secondary infertility can be surprising and stressful. It can carry many of the same causes as primary infertility such as:
- Impaired sperm production, function or delivery in men
- Fallopian tube damage, ovulation disorders, endometriosis and uterine conditions in women
- Complications related to prior pregnancy or surgery
- Risk factor changes for you or your partner, such as age, weight and use of certain medications
What Causes Secondary Infertility?
There are many possible explanations when it comes to fertility issues. The reason that you are unable to conceive as a couple could be due to issues within the woman’s reproductive system, the male’s reproductive system or a combination of both. In some cases, your doctor may not be able to determine a reason that you are unable to conceive. This is referred to as unexplained secondary infertility.
Secondary Infertility can be traced to either the man or woman, or a combination of both:
- In about 30% of cases the cause is in men.
- About 40% of cases the cause is in women.
- 2 times out of 10, the cause is a mix of factors from both male and female.
- 10% of cases are unexplained infertility
Causes of infertility in women may include:
- Age-Unlike men who are able to fertilize eggs well into their retirement years, women’s fertility decreases substantially as they age. At age 30 91% of women can get pregnant. This number drops to 77 by age 35 and 53% by age 40. (fertility decreases after age 35)
- Unable to produce eggs or unable to produce eggs regularly. This occurs when there is an absence of a menstrual cycle or irregular cycles.
- A sexually Transmitted Infection: some sexually transmitted infections can cause issues with fertility. For example Chlamydia can cause blockages in the fallopian tubes.
- Uterine issues: these can include growths like fibroids or polyps
- Follopian tube problems such as missing tubes or blockages
- Endometriosis (excess of tissue that gathers around the reproductive organs
- Hormonal imbalance
- Early menopause (before age 40)
Causes of infertility in men may include:
- Issues with sperm: These can include poor sperm quality which is determined by their rate of movement and shape.
- A low sperm count, or lack of sperm
- A current or prior sexually transmitted infection (STI), like Chlamydia which can impact fertility
- hormonal imbalances
Read next: 5 Signs you Need to Get Tested for an STI
Other causes of infertility in both men and women may include:
- Chronic illnesses such as diabetes and their treatments
- Being overweight or underweight
- Past treatments for cancer such as radiation, chemotherapy or surgery
- Alcohol and tobacco use
Dr. Kate Killoran explained that while secondary infertility is not always explainable, most healthy couples have a 20% chance of conceiving each month.
“Fifty percent of couples will conceive after six months and seventy to eighty will conceive after a year,” she explained.
While Infertility is defined as failure to achieve pregnancy after a year of unprotected sex, she suggests women over age 35 might want to seek advice after 6 months of trying.
How Common is Secondary Infertility?
Secondary infertility affects an estimated 3 million women in the U.S. each year. Sadly, women are less likely to seek fertility treatment with secondary fertility because of their previous ability to conceive and carry a child.
In comparison about 16 % or one in six couples struggle with primary infertility. This number has doubled since the 1980’s.
Is There a Cure for Secondary Infertility?
There is good news when it comes to secondary infertility according to Dr. Killoran. Having one child means you are more likely to be able to conceive again.
“ However, there is one caveat and that is age. Once a couple has successfully had a child we know the system works and therefore should be able to do it again,” she said. “We also know that age has a direct effect on fertility and women no matter what women are older the second time they attempt pregnancy.”
Furthermore, many causes of secondary infertility are treatable.
In men poor sperm counts can be caused by a varicocele, which is a dilated vein in the scrotum. This issue can be easily treated with a minor procedure which may resolve the fertility issues. In women, weight loss can help ease the symptoms associated with Polycystic Ovarian Syndrome (PCOS). Some tubal and uterine issues can also be resolved with treatment.
Lifestyle Changes to Increase Fertility
“The best way to start your fertility journey is with good self-care. This includes reducing stress, a healthy diet, getting enough sleep, reducing alcohol intake, quitting smoking, and reducing caffeine intake,” she said.
Sedentary lifestyles can reduce fertility and moderate exercise boosts fertility. Just like everything else in life, when it comes to exercise moderation is important. Too much high intensity exercise too often can reduce fertility.
“The appropriate amount and type of exercise may be different for different people, so find your sweet spot,” Dr. Killoran explained.
Tracking your menstrual cycle and ovulation can also improve your chances of conceiving.
Understanding your cycle and knowing when your fertile window is can improve your chances of getting pregnant. An egg only lives for 24 hours after it is released so it is important to have sex around the time of ovulation. The most fertile time for a woman starts about two days prior to ovulation and ends two days after ovulation. Keeping track of your ovulation can help to increase the chances of conception.
Secondary Infertility Treatments and Options
For some couples conceiving naturally is not a possibility. Luckily, there are other options available to make parenthood a possibility.
Fertility treatments can include medication and/or minor surgical procedures. In some cases only one partner will require treatment. In others, both partners may need some medical intervention in order to conceive.
Assisted Reproductive Technology (ART) is the umbrella term for the medications and procedures that can assist with a healthy pregnancy and delivery. These procedures can help sperm fertilize the egg as well as the egg implant in the uterine lining.
Two common fertility treatments are:
Intrauterine insemination (IUI) : Sperm is collected and inserted directing into the vagina during ovulation
In vitro ovulation (IVF): Eggs are taken from the ovaries and fertilized by healthy sperm outside of the body in a lab. Once they have developed into embryos they are placed into the uterus.
In some couples they may need more help in getting pregnant. This can include freezing their eggs, sperm or embryos (also called cryopreservation) surrogate mothers to carry their embryos,and donor sperm or eggs.
The Best Questions to ask Your Doctor if you are Diagnosed with Infertility
Despite the best efforts to live a healthy lifestyle, track ovulation and have sex during their peak fertility days, some couples will be diagnosed with infertility. While this may seem discouraging, as previously stated, many fertility issues can be treated.
If you have been diagnosed with infertility, whether secondary or primary here are some suggested questions to ask your doctor according to Dr. Killoran:
“Make sure you understand the cause of your infertility,” she said. “Are you regularly producing an egg? Is there enough sperm? Can the two of them meet?”
For women, this breaks down to :
- Diminished ovarian reserve (often age-related,)
- Ovulatory dysfunction (PCOS for example- not producing an egg regularly,)
- Tubal factors
- Uterine factors
“For men it’s all about the sperm. Is there enough and are they healthy?”
Once you understand your issues you can ask about your treatment options and their possible success rates. If your infertility is unexplained, you can ask about the possible next steps and what your doctor would recommend to increase your chances of having a healthy baby.
All Your Fertility Questions Answered
It’s never a bad time to ask a question with Your Doctors Online. Our team of medical experts are available 24 hours a day to answer all your questions, review your photos or videos and lend a helping hand.
Don’t kick yourself for forgetting to ask your question at your last important or wait and worry. Connect today with Your Doctors Online and feel better faster.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Richard Honaker M.D.
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