Secondary infertility: Why it happens and what you can do?

secondary infertility

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 adding to the family will be easy after their first child’s birth. Yet an estimated 3 million women struggle with secondary infertility in the U.S.

What is Secondary Infertility? 

Source: Canva

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?

Source: Canva

There are many possible explanations when it comes to fertility issues. You are unable to conceive as a couple 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 why you cannot 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.
  • In about 40% of cases, the cause is in women.
  • Two 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:

  • Unlike men, who can fertilize eggs well into retirement, 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 a menstrual cycle or irregular cycles are absent.

  • 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.

  • Fallopian 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:

  • Sperm issues: 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, 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 six months of trying.

How common is secondary infertility?

Source: Canva

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 1980s. 

Is there a cure for secondary infertility?

Source: Canva

According to Dr. Killoran, There is good news regarding secondary infertility. 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 directly affects 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, a dilated scrotum vein. 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

Source: Canva

“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 can reduce fertility.

“The appropriate amount and type of exercise may differ 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 your fertile window 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 ovulation. The most fertile time for a woman starts about two days before 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

Source: Canva

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 directly 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 carrying their embryos, and donor sperm or eggs. 

The Best Questions to ask Your Doctor if you are diagnosed with Infertility

a group of doctors with a female doctor in front
Source: Canva

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. 

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