What is Secondary Infertility?

It’s difficult to imagine having trouble conceiving when you’ve already done it once.

However, it is a possibility—and it’s more common than you think. 

Secondary infertility is the inability to conceive after successfully giving birth a previous time. It affects people at nearly the same rate as first-time infertility, with 12% of people being unable to have another child after their first.¹

If you’re having trouble conceiving after more than 12 months (six months for those 35 and over), your doctor may diagnose you with secondary infertility. 

Secondary infertility can affect both men and women.

Primary and Secondary Infertility

While a secondary infertility diagnosis necessitates a successful pregnancy in the past, primary infertility simply means an inability to conceive at all.

If you can’t seem to get pregnant after twelve months and you’ve never gotten pregnant in the past, your healthcare provider may diagnose you with primary infertility.

Both primary infertility and secondary infertility can be caused by similar conditions and co-morbidities.

However, secondary infertility may sometimes occur after problems experienced during the first or previous pregnancy or if the mother or father is affected by a different condition between childbirth and their next attempt at pregnancy.

Causes of Secondary Infertility

There are several causes of secondary infertility in both men and women.

Secondary infertility in women can be caused or exacerbated by:

• Endometriosis - This is when lining that resembles uterine lining (the endometrium) grows outside of the uterus, causing inflammatory, sometimes life-impacting pain, irregular periods, and infertility.
• Uterine fibroids - Noncancerous growths (also called myomas or leiomyomas) that develop in uterine tissue muscles that often go undiagnosed. They’re not always painful and are sometimes discovered accidentally. They can be an issue when trying to conceive because they can block the fallopian tubes, change the size and lining of the uterus and make pregnancy more difficult, or even alter blood flow to the uterine cavity.
• Polycystic Ovary Syndrome - PCOS is a hormonal disorder where the ovaries overproduce androgen, sometimes even causing small cysts to grow. This causes problems when it comes time for the ovaries to release eggs, causing missed/irregular periods, pain, and infertility.
• Damage to the reproductive system after previous pregnancy - Any unprecedented damage caused to the reproductive system (such as uterine scarring, blocked fallopian tubes, etc.) can permanently alter the possibility of a subsequent pregnancy
• Excessive weight gain or loss - Weight affects hormone production, and excessive fluctuations can make it more difficult to conceive.
• Different health problem - Can come in the form of genital infections, STIs, and other comorbidities that make it difficult to conceive.
• Age - Fertility in women starts to decline between 35-40.

Secondary infertility in men can be caused or exacerbated by:

• Sperm count - Whether low or absent altogether, impaired sperm production will affect your chances of conceiving. Low sperm count means that the odds of fertilizing an egg are lower because there are fewer sperm when ejaculating.
• Enlarged or absent prostate - An enlarged prostate can affect ejaculation and erection, making it more difficult to conceive.
• Hypogonadism - This is when the male sex glands underproduce or even don’t produce any hormones at all. This can lower sex drive and cause problems with maintaining an erection.
• Excessive weight gain or loss - Weight affects hormone production, and excessive fluctuations can make it more difficult to conceive.
• Different health problem - Can come in the form of genital infections, STIs, and other comorbidities that make it difficult to conceive.
• Age - Fertility in men starts to decline between 35-40.

Testing for Secondary Infertility

If you’re still having trouble conceiving after 12 months, your doctor may start testing you.

This all depends on whether or not you have any other known conditions that can affect fertility. If you’ve previously been diagnosed with any hormonal disorders or diseases that directly affect your reproductive system, it may be easier to get to the root of the problem.

If not, your doctor will begin testing you for any hormonal imbalances, look into your family history for PCOS or other genetic causes, and may even do some procedures to eliminate other possibilities.

Diagnosing underlying causes of infertility will better help them treat you and increase your chances of getting pregnant.

Your fertility doctor, OB-GYN, or medical counselor may ask you to undergo a fertility test just to be sure. They’ll do various assessments, whether it’s checking your reproductive anatomy or even testing for semen quality through a semen analysis.

Some procedures that may be done are: 

• History and standard physical exam
• Semen analysis
• Ovulation assessment
• Imaging of ovaries and fallopian tubes
• Pelvic ultrasound
• Hysterosalpingogram test to check if the fallopian tubes are unblocked
• Hormone level assessment
• Bloodwork

Can I Still Get Pregnant Even with Secondary Infertility?

Yes. It may take more unconventional means, but there are still ways to get pregnant. While you may have difficulty conceiving through penetration alone, medical therapies can help you carry to term.

What Treatment is Available for People with Secondary Infertility?

While secondary infertility can feel hopeless, it can be treatable—depending on the underlying cause. 

In fact, 85-90% of infertility cases are treated successfully through conventional fertility medical procedures and therapies.²

Your healthcare provider may start putting you on fertility medications, ask you to go specifically to a fertility clinic, and even recommend uterine surgery if necessary.

Some treatment options are: 

• Medication 
• In vitro fertilization
• Intrauterine insemination
• Fertility treatment and drugs