What is a Secondary Infertility and How Do You Manage It?

According to the CDC, approximately 14 percent of women with one or more prior births struggle to get pregnant or carry a pregnancy to term. If you and your partner have been trying to have another child without success, you may be wondering what changed and if you can fix it. Read on to learn about the most common causes of secondary infertility, how doctors diagnose it, and treatment plans. If you’ve been trying to conceive without success, contact Tidewater Physicians for Women to schedule an appointment with a medical provider. We’ll help you in your fertility journey.

What is Secondary Infertility?

Secondary infertility is the inability to conceive or carry a pregnancy to term after having previously given birth without fertility treatment. It’s common to assume that because you had no trouble conceiving your first child or children, conception will occur naturally going forward, but that’s not always the case. Many couples are surprised to learn that secondary infertility is just as common as primary infertility, affecting about 12 percent of women who are trying to conceive.

Emotional Impact of Secondary Infertility

Secondary infertility can be emotionally devastating for partners who are trying for another child. 

You may experience grief, anger, sadness, guilt, and a range of other negative emotions. Infertility may also impact your relationship with your partner.

Your family, friends, and even your healthcare providers may lack empathy for your situation. You might hear that you should be grateful to have even one child.

These feelings can be amplified if your treatment is not working.

If you are experiencing the emotional effects of secondary infertility, you should consider joining a support group to process your emotions. You should also consider mental health services, such as individual or couples therapy, to process your emotions and facilitate healthy communication with your partner during this emotionally taxing time.

Causes of Secondary Infertility

There are several potential causes of secondary infertility affecting both women and men. In some cases, a combination of these factors are contributing to a single case of secondary infertility.

For Women

For women and people assigned female at birth (AFAB), causes include:

Being 35 or Older 

As you age, the quantity and quality of eggs decline, leading to reduced fertility and an increased risk of chromosomal abnormalities.

Complications From Past Pregnancy or Surgery

Complications from past pregnancy or surgery can cause damage to reproductive organs — like scarring or adhesions in your fallopian tubes or uterus — which can make it difficult for sperm to reach and fertilize an egg.

Weight Gain

Obesity can cause hormonal imbalances that affect your menstrual cycle or ovulation, leading to secondary infertility. Losing weight can help, and your healthcare provider can help you.

Lifestyle Factors Like Smoking or Excessive Drinking 

Smoking and excessive drinking can damage reproductive organs and disrupt your hormonal balance, making it harder to conceive.

Certain Medications

Medications like chemotherapy drugs, some antidepressants, certain immunosuppressants, and long-term use of NSAIDs can interfere with hormone levels, change cervical mucus, damage reproductive organs, or suppress ovulation.

Uterine Conditions Such as Uterine Fibroids or Adenomyosis

These conditions can distort the uterine cavity, impairing implantation and development of the embryo, causing blocked fallopian tubes, leading to hormonal imbalance, and increasing your risk of miscarriage.

Polycystic Ovarian Syndrome (PCOS) 

Women and people assigned female at birth might experience irregular ovulation, anovulation, hormonal imbalance, and ovarian cysts as a result of polycystic ovary syndrome — all of which can lead to trouble conceiving.

Endometrial Scarring

Endometrial scarring can damage the normal lining of your uterus, making it an unfit environment for implantation and development.

Sexually Transmitted Infections (STIs)

Like other conditions, STIs have the potential to damage your reproductive organs and cause lasting inflammation, both of which reduce fertility and increase the risk of complications during pregnancy.

Problems with Ovulation 

Ovulation is central to successful conception, so when mature eggs aren’t regularly released for fertilization, chances of conception are reduced.

Impaired Egg Quality or Quantity 

Problems with the quality or quantity of eggs can hinder successful fertilization and implantation.

Fallopian Tube Damage 

Eggs and sperm travel through the fallopian tubes in order to reach one another, so any damage to the fallopian tube that makes it more difficult to pass through can inhibit fertilization.

Identifying the exact cause or causes of infertility is an important first step so that an effective treatment plan can be identified and implemented.

For Men

Sometimes, secondary infertility is the result of male infertility, or changes in reproductive health for the male partner. For men and people assigned male at birth (AMAB), causes include:

Low Sperm Count 

Low sperm count, caused by genetic abnormalities, excessive heat exposure, hormonal imbalance, smoking, alcohol consumption, and certain health conditions, reduces the likelihood of conception.

Impaired Sperm

Impaired sperm have abnormalities in their mobility, structure, or composition, reducing their ability to reach or fertilize an egg.

Low Testosterone 

Low testosterone levels can decrease both sperm production and quality, ultimately leading to fertility issues.

Certain Medications 

Certain medications prescribed to men are known to contribute to secondary infertility cases, like some chemotherapy drugs and testosterone replacement therapy.

Weight Gain 

When men and people assigned male at birth gain weight, hormonal balance can shift, causing reduced sperm production, motility, and fertility.

Age 

Testosterone levels and the quality and motility of sperm decline with age, contributing to both primary infertility and secondary infertility.

There is also the possibility that the doctor cannot diagnose the cause of your secondary infertility. Approximately one in five cases of secondary infertility are unexplained. Even when the cause is unknown, treatment focuses on improving the chances of conception and implantation through lifestyle changes, ovulation tracking, IUI or IVF, assisted reproductive technology, and/or ovarian stimulation.

Risk Factors for Secondary Infertility

There are several conditions that can increase your risk of developing secondary infertility, including:

• Hormonal imbalances
• Irregular menstrual cycles
• Previous miscarriages
• PCOS
• Endometriosis
• Pelvic inflammatory disease (PID)
• Sexually transmitted infections (STIs)

Can You Get Pregnant With Secondary Infertility?

Yes. Secondary fertility is common and usually results in pregnancy with treatment. Your doctor will develop your treatment plan based on your diagnosis and goals.

When Should I See a Doctor For Secondary Infertility?

If you’re concerned you may be experiencing secondary infertility, you should speak with your doctor.

If you experience any of the following health symptoms alongside your inability to conceive, you should consult a medical professional as soon as possible.

For women and AFAB:

• Irregular menstruation or no menstruation
• Extremely painful periods
• Endometriosis
• History of miscarriages
• History of PID
• Known or suspected uterine or tubal disease
• Previous chemotherapy or radiation

For men and AMAB:

• Sexual dysfunction
• History of infertility with another partner
• Previous chemotherapy or radiation
• Previous hernia surgery
• History of testicular trauma

If you are under 35 and have tried to conceive for at least 12 months, you should schedule an appointment with your healthcare provider, a reproductive endocrinologist, fertility specialist, or urologist.

If you are over 35 and have tried to conceive for six months, you should schedule an appointment with your healthcare provider, a reproductive endocrinologist, fertility specialist, or urologist.

If you have experienced two consecutive miscarriages, you should make an appointment with a reproductive endocrinologist.

Receiving an early evaluation helps to keep as many treatment options open as possible.

How Does a Doctor Diagnose Secondary Infertility?

The doctor can conduct certain tests to pinpoint the causes of your secondary infertility, including:

• Semen analysis to examine the quality, quantity, and motility of sperm in a semen sample to identify any abnormalities and determine next steps.
• Transvaginal ultrasound to help identify problems like uterine fibroids, polyps, ovarian cysts, or tubal blockages, all of which can be secondary infertility causes.
• Blood tests for hormone levels help diagnose male and female infertility by assessing the various levels of hormones involved in reproduction that, when imbalanced, might contribute to difficulty with conception.
• Hysterosalpingogram is an X-ray that shows your medical provider your uterus and fallopian tubes to check for abnormalities, scar tissue, and blockages that might be contributing to infertility.

Treatment of Secondary Infertility

There are several avenues of treatment for secondary infertility that can lead to successful pregnancies. 

Some treatments include:

• Medications that induce ovulation, such as letrozole (Femara) and clomiphene (Clomid). These medications can help treat secondary infertility by stimulating the release of eggs, increasing your chances of successful fertilization and addressing ovulation-related issues that might be contributing to difficulties in conceiving a second child.
• Intrauterine insemination (IUI). IUI can help overcome secondary infertility by bypassing potential issues with cervical mucus or sperm quality and increasing the chance of fertilization by placing prepared sperm directly into the uterus at the right time during your cycle.

• In vitro fertilization (IVF). IVF works by overcoming a wide variety of fertility challenges like poor egg quality, damaged fallopian tubes, or male infertility by retrieving eggs from the female partner, fertilizing them with sperm in a laboratory, and then transferring the resulting embryos back into the uterus.
• Surgery. Surgery can correct uterine complications, such as removing fibroids, scar tissue, or polyps. Additionally, if the secondary infertility is caused by testicular issues, such as testicular varicocele, this can be surgically corrected. Testicular varicocele is responsible for approximately 30 percent of all male and AMAB infertility.

Your provider will determine the appropriate treatment based on your diagnosis.

We Can Help You Try Again

Whether you’re partnering with a physician for the first time or looking for a second opinion, the team at Tidewater Physicians for Women is here to help diagnose and treat your secondary infertility today. Take the next step toward growing your family by calling 757-461-3890 now.