What is Secondary Infertility? Causes, Treatment, and More

Struggling to conceive after your first pregnancy? It could be secondary infertility.

As mamas, we all have different ideas about what the perfect family looks like.

For some of us, it’s just one chick in the nest and for others, it’s a whole brood!

But what about when the nest doesn’t seem to be filling up as you’d hoped?

If you’ve been trying for a second baby for a while and things aren’t working out, it could be that you’re experiencing secondary infertility.

We know that struggling to conceive can be a really tough and isolating experience, and it can seem all the more confusing when you’ve already had one or more children before.

That’s why we spoke with embryologist and fertility expert, Navya Muralidhar, to get the key facts about secondary infertility here, to help you navigate this difficult time.

We’re here for you, always.

In this article: 📝

What does primary and secondary infertility mean?

Secondary infertility means that you’re unable to conceive or carry a baby to full-term (the point when they’re fully grown and ready to be born), even though you’ve had at least one little peanut in the past.

Usually, you’ll have been trying for a baby for a year – or six months if you’re over 35 years old – before secondary infertility is diagnosed.

In contrast, primary infertility is where you haven’t been able to conceive or carry a full-term baby at all, after trying for at least six months.

Both primary and secondary infertility are painful experiences to go through for many women and their partners.

However, it can be especially hard to get support when you’re experiencing secondary infertility and the condition is often misunderstood.

Unsympathetic responses like “But you already have a child…” just aren’t helpful.

How common is secondary infertility?

A lot of the data on infertility doesn’t have separate primary and secondary infertility statistics.

For example, the CDC reports that 12% of women in the US struggle to conceive or carry a pregnancy to term.

It’s also estimated that at least 50 million couples across the world go through infertility.

However, a 2010 study that took into account multiple national health surveys from different countries suggests that secondary infertility is actually more common than primary infertility.

The researchers found that, globally, 10.5% of women experienced secondary infertility while only 2% experienced primary infertility.

What are secondary infertility symptoms?

We can’t really define secondary infertility symptoms, since the definition is being unable to conceive after having a successful pregnancy.

It is also possible to experience secondary infertility after miscarriage, according to Dr. Meredith Snook, of the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Pittsburgh.

How does secondary infertility feel?

Our mamas on Peanut who are experiencing secondary infertility have shared that it feels like a mix of conflicting emotions.

While they’re feeling so much love for the child they have, they still pine for the baby they’re struggling to conceive.

Secondary infertility can be hard, which is why it’s important to talk about it.

What is the main cause of secondary infertility?

Secondary infertility shares many of the same causes as primary infertility.

Conception – the process of the egg and the sperm meeting in just the right way to make a baby – has different stages, and a problem at any of those stages can result in infertility.

So, what are some of the causes of secondary infertility in women and men?

What are causes of secondary infertility in women?

Secondary infertility in women is often linked to a problem in one of three key areas: ovulation, the fertilized egg’s journey down one of the fallopian tubes, and the attachment of the fertilized egg to the wall of the uterus.

Let’s break down the potential causes of secondary infertility in women:

Ovulation

Ovulation is the release of an egg from the ovaries, so, naturally, it’s a key part of whether you think you might have secondary infertility.

One of the most common reasons behind women’s secondary infertility is PCOS (polycystic ovary syndrome), where the body’s hormone production is modified and this gets in the way of the ovaries releasing their eggs.

Other conditions that can cause ovulation problems include POI (primary ovarian insufficiency), thyroid disorders, and reduced ovulation related to age.

Fallopian tubes

For conception to be successful, the egg has to meet the sperm in one of the fallopian tubes, get fertilized, and then travel down to the uterus.

If the tubes become blocked (for example, with scar tissue following pelvic inflammatory disease or severe endometriosis) then the egg may not be fertilized or may not be able to reach the uterus, resulting in secondary infertility.

Uterus

Sometimes the shape of the uterus or the state of the tissue that lines it can make it more difficult for an embryo to implant and grow into a baby.

Other times the presence of a polyp or fibroids in the uterus can pose as a barrier.

Scarring from a previous c-section (also called isthmocele) can also cause problems.

What are causes of secondary infertility in men?

Secondary infertility in males can be linked to:

Issues with sperm

If a man isn’t producing enough semen with a high enough sperm count, or there’s a problem with the sperm’s shape or movement, that could be a cause of secondary infertility.

This can reduce the chances of a healthy sperm cell meeting the egg to fertilize it.

Medical conditions

Conditions such as varicocele (swollen veins around the testicles) or low testosterone production can also cause secondary infertility in men.

Medical treatments or drugs

For example, chemotherapy as a cancer treatment, calcium channel blockers for high blood pressure, or recreational drugs.

Other causes of secondary infertility in men and women

For both women and men, lifestyle factors can sometimes play a part in secondary infertility, such as:

• Your diet
  
• Smoking habits
  
• Occupational hazards
  
• Genetics
  
• How much alcohol you consume
  
• How much you exercise
  
• Your stress levels
  
• Your age

The good news is that getting support for lifestyle changes could minimize your changes of secondary infertility.

How is secondary infertility treated?

If you think you’re experiencing secondary infertility, the next step is to visit your doctor.

They’ll be able to test you and your partner, and find out where the issue lies.

For you, this could involve blood tests, a pelvic exam, ovulation tests, and an X-ray of your fallopian tubes.

Once the problem has been spotted, your doctor will then be able to discuss possible secondary infertility treatments.

These could include:

Medication for secondary infertility

For example, PCOS can be effectively treated with medication to bring about ovulation (sometimes in combination with lifestyle changes).

This medication can allow up to 70% of women with the condition to have successful pregnancies after secondary infertility.

Surgery for secondary infertility

Surgical procedures may be used to treat scarring in the uterus (for example, from a previous C-section) or to remove large uterine fibroids (non-cancerous growths that can, in rare cases, stop a fertilized egg from attaching to the wall of the uterus).

If you think you might have scarring in your uterus or uterine fibroids, speak with your doctor to see what the next best steps are for you.

ART (Advanced reproductive technology) for secondary infertility

Fertility treatments can also boost your chances of conceiving, including IUI, IVF, and ICSI.

IUI for secondary infertility

IUI is intrauterine insemination ‒ with IUI, sperm is inserted directly into your uterus around the time that you’re ovulating.

Success rates for IUI for secondary infertility can range from 11.7% to 38.1%.

IVF for secondary infertility

With IVF, your eggs and your partner’s (or a donor’s) sperm are collected and used to make embryos in a lab, which are then implanted in your uterus.

While it’s hard to predict secondary infertility IVF success rates and how they might relate to you, it can be useful to see whether you think IVF is right for you and your family.

IVF success rates for secondary infertility range, but the average is about 21%.

Intra Cytoplasmic Sperm Injection (ICSI) for secondary infertility

This is only done in cases of severe male infertility.

With ICSI, your eggs and your partner’s sperm are collected, but a specific sperm with optimal motility and morphology is chosen under a microscope with high magnification.

This sperm is then selected and injected into the egg within a culture dish.

Post-fertilization and further growth, the embryo may be transferred to the uterus.

How do you beat secondary infertility?

An estimated 15–30% of couples are diagnosed with “unexplained infertility” (where the doctors just can’t figure out what’s wrong), but many do still go on to conceive eventually, without treatment.

So even if you have unexplained secondary infertility, there’s still a chance you could have a successful pregnancy.

Can you get pregnant with secondary infertility?

Yes, it is possible.

But it can help to find out why you’re experiencing secondary infertility ‒ it might be that one of the treatments we’ve listed could help.

Our advice? Check with your doctor and keep trying.

How do you overcome secondary infertility?

There’s no denying that the experience of secondary infertility is challenging: conflicting emotions, tiring doctor’s appointments, and (sometimes) intrusive treatment.

But the key, if possible, is to stay hopeful and be kind to yourself.

You could even seek out secondary infertility success stories on Peanut for a little inspiration.

If you’re sharing your secondary infertility journey with a partner, remember to connect with them and make sure you listen to each other on the road.

On the other hand, if you’re going it alone, look for support from family, friends, and other women.