No one wants to struggle with infertility, regardless of its origins. But if you’ve conceived in the past with no apparent difficulty, infertility can be particularly shocking.

What is secondary infertility?

Secondary infertility is when an individual or a couple has difficulty conceiving or carrying a pregnancy to term, despite having prior biological children with no difficulty.

About ten percent of couples who had no trouble conceiving previously will experience secondary infertility. Though it has many of the same causes as primary infertility, this topic doesn’t seem to receive as much attention in the media or in society.

Unfortunately, many couples struggling with secondary infertility find themselves suffering in silence. Well-meaning family and friends try to convince them that they should be content with the family they already have. Coworkers remind them that they already have one or more children and should just focus on that. Your Great Aunt Sue reminds you to “just relax, and it will happen when you least expect it!”

Sadly, there are even medical providers that fail to take your concerns seriously, not giving your case the attention it deserves simply because you have successfully conceived a child before.

But regardless of whether the desired pregnancy is the first child or the sixth, no one should be shamed by others for their desire to grow their family.

What causes secondary infertility?

There are multiple possible causes of secondary infertility. Many of them are the same factors that cause primary infertility. Unexplained infertility is also a common diagnosis. These difficulties in conception can occur at any point in the early pregnancy process: ovulation, sperm production and travel, fertilization, travel of the fertilized egg, or implantation in the uterus. These problems can originate with either a male or a female partner. Though it would be rare for both partners to have developed problems in the time since the conception of the prior child, this is also a possibility.

Here are a few possible causes of secondary infertility, though of course you’ll need to work with your healthcare provider to determine what specific factors are at play in your case.

  • Change in sperm quality and quantity. As a man ages or changes his lifestyle, the quality and number of sperm in each ejaculation can decline. This can be linked to smoking, alcohol intake,  changing testosterone levels and environmental exposures. Sperm morphology and motility can be checked through a semen analysis.
  • Endometriosis. Endometriosis happens when tissue similar to the uterine lining (“endometrium”) grows outside of the uterus, in places like the ovaries or fallopian tubes. This lining can cause scarring in the pelvis and on the fallopian tubes, making it impossible for the sperm to reach the egg or for a fertilized egg to pass through the fallopian tube to the uterus.
  • Uterine fibroids. Fibroids are noncancerous tumors found in the uterus. Some uterine fibroids occur in the uterine cavity and can make implantation difficult.
  • New medical problems. If you have been diagnosed with a new medical condition since your last pregnancy, this could contribute to secondary infertility. Polycystic ovary syndrome, diabetes, autoimmune concerns, uterine polyps, and pelvic inflammatory disorder are examples of conditions that may make conception more difficult than it has been in the past.
  • New medications. Likewise, if you are taking new prescription or over-the-counter drugs, this may affect fertility. Drugs taken for epilepsy, thyroid, pain medications, some steroids, and chemotherapy have been known to impact fertility.
  • Complications from prior pregnancy. Any uterine scarring can cause difficulty with the implantation process. Talk to your physician about your particular prior pregnancy and birth experiences to see if this could be a factor.
  • Complications from prior surgeries. Complications from prior surgeries can lead to scar tissue in the uterus or pelvis that can impact fertility.
  • Age. It goes without saying that both partners are more advanced in age than they were when the prior pregnancies were conceived. Because female fertility tends to decline in the mid-30s, the more a woman ages, the lower her egg quality tends to be.
  • Lifestyle factors. Habits frequently change after one becomes a parent. There are a few lifestyle factors that can possibly contribute to infertility. It’s harder to round up your child and the stroller and get out the door for a walk than it was when you just had to grab your keys and go. Maybe you’ve returned to a smoking habit you picked up in college. Perhaps you find yourself reaching for the wine bottle more often than you did before. It’s easy to slip back into these methods of coping in the busy years of raising small children. Focusing on eating whole, nutritious foods, moving your body more, stopping smoking, and cutting back on heavy alcohol consumption can contribute to a healthy lifestyle that can support fertility.

What is the treatment for secondary infertility?

Just as the causes of secondary infertility are similar to primary infertility, the treatments can be similar as well. After performing a thorough examination and history, your provider can order lab tests to check your hormone levels. A semen analysis is also commonly ordered to check the number and motility of viable sperm.

There are a number of treatments that can be helpful for secondary infertility. These can include medications such as Clomid or letrozole. Intrauterine insemination (IUI) or IVF may be considered as well.

When should I get help for secondary infertility?

If you’ve been having unprotected sex for more than a year, consider seeking medical help. If you are over the age of 35, this time period can be shortened to six months. And if you are over the age of 40 or you have been experiencing irregular menstrual cycles, contact a fertility specialist right away to get the help you need.

Secondary infertility can be a very unwelcome surprise, but The Integrative Fertility M.D. is here for you. Reach out – we’d love to help you with your family planning goals!