Secondary Infertility: Coping with infertility, again?
Written by Valicia France. Reviewed by Dr. Phoebe Howells.
Infertility is one of the most difficult and painful experiences for those trying to bring a baby home. But what happens when someone who has had a successful pregnancy is having difficulties getting pregnant a second time?
In this article, our team will talk you through what it means to experience the condition of secondary infertility, how it is diagnosed and what your treatment options are based on your age and family plans.
What is Secondary Infertility?
When we think of the term “infertility”, many only consider “primary infertility," which describes not having a successful pregnancy after 12 months or more of trying (note you should see a specialist sooner than this for investigation if you are aged 36 or over). Secondary infertility, on the other hand, refers to infertility in individuals who have had a child prior. The main signs of primary and secondary infertility are almost the same, with the one distinction being a previous successful birth with the latter.
“You may have faced difficulty conceiving the first time around, or perhaps the journey was straightforward – nonetheless, secondary infertility can be a tough, surprising, and emotionally challenging experience for those trying to bring a baby home.”
~ Dr. Phoebe Howells, Co-Chief Medical Officer at OVUM
Data suggests that secondary infertility is as common as (or even more than) primary infertility, which affects 12.5% of women.
Causes and risk factors of Secondary Infertility
In addition to all the same factors that contribute to primary infertility (ranging from genetic to environmental factors), continued breastfeeding, sexually transmitted infections (STIs), and complications from a prior C-section can increase the risk of secondary infertility. Whether primary or secondary infertility, the causes are varied:
Age and hormonal imbalances
Age and hormonal imbalances are common causes of secondary infertility, especially as there is a sharp decline in fertility after age 35 in women, mainly due to decreased ovarian reserve (amount and quality of eggs). The very fact that you’re now older than when you conceived your first child means conceiving will be more difficult.
With men, advanced age leads to a decrease in the number and quality of sperm available for fertilising eggs. Diseases characterised by, or that can cause, hormone imbalances — such as polycystic ovary syndrome (PCOS), hyperprolactinemia, thyroid disease, diabetes, and certain autoimmune disorders — may also contribute to infertility.
Structural issues and blockages
Various reproductive blockages and other anomalies can hinder fertility. These may occur due to congenital defects, such as having half or two uteri in women, or swollen veins in the scrotum, which holds the testicles in men. Issues may also be caused due to past surgeries (such as C-sections, vasectomies, abortions), injury to reproductive organs, or inherited conditions (endometriosis, fibroids), or STIs (chlamydia, gonorrhoea, pelvic inflammatory disease).
BMI, lifestyle factors and medications
Having a higher body mass index (BMI), smoking, heavy alcohol use, and certain medications (such as antidepressants and immunosuppressants) have also been shown to impact fertility.
Diagnosing Secondary Infertility
Diagnosing secondary infertility is a similar process as for primary infertility. Your GP will consider your medical history, including risk factors and possible signs for infertility. Evaluations may also include blood tests to evaluate for certain hormones (such as oestrogen, testosterone, follicle-stimulating hormone, or thyroid hormones), sperm tests in males, and ultrasound imaging to evaluate for structural concerns or abnormalities.
Treatment options for secondary infertility
Various treatments may be recommended to you. These will depend on your age, current fertility health, any identified cause of your secondary infertility and future family planning and will range from fertility treatment (IVF or IUI), to medications to stimulate ovulation or lifestyle changes.
ART and medication
Fertility medications, such as clomiphene citrate (Clomid) and metformin, may be recommended for individuals who have hormonal problems, irregular ovulation cycles, inflammatory diseases, or to simply help stimulate ovulation. Fertility treatment may be recommended, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), together often referred to as Assisted Reproductive Technology (ART) procedures.
Recommended lifestyle changes may include eliminating smoking and alcohol use, weight loss programs, and improved timing and/or frequency of intercourse. Changes in diet and the use of supplements to support fertility may also be recommended to improve reproductive and overall health.
How to decide on fertility treatment
Ovulation medication and ART are proven therapies, and IVF alone sees more than 500,000 babies being born worldwide. A few things to consider may be financial costs and risks, such as side effects due to medication, surgical complications and inflexible timelines and adverse pregnancy and birth outcomes with IVF. However, these treatments have been shown to be safe and effective for many people, and recent improvements to patient protocols and patient management have seen a much decreased risk of IVF-related complications like ovarian hyperstimulation syndrome (OHSS).
For many, lifestyle changes will not only improve reproductive health but help also to support overall health. Difficulties in this approach may lie in eliminating bad habits. In addition, relying on methods or products based on junk science may actually hinder fertility health. For example, many fertility supplements contain L-arginine, which data tells us is potentially harmful for our eggs, or ingredients not backed by scientific evidence — unlike our Ovum supplement, which is created based on the latest available research. Whether it is lifestyle changes or fertility treatments, it is critical to implement proven methods backed by high-quality science to help increase your chances of conceiving.
Always be sure to consult with your GP or fertility specialist for treatment guidance and to consider evidence-based methods and products to support your fertility health.
Common questions about secondary infertility
- How common is secondary infertility? Secondary infertility is as common as (or even more than) primary infertility, which affects 1 in 5 women.
- What causes secondary infertility in women? In addition to the common factors for primary infertility, secondary infertility may be caused by surgical procedures after a prior pregnancy, STIs, or continued breastfeeding.
- Do I have secondary infertility? If you’ve had a successful pregnancy, but have been recently unable to conceive for 12 months or more (or 6 months if 35 years old or over), it may be a sign of secondary infertility.
- Can secondary infertility be treated? Treatments may include IVF, IUI, medication, or lifestyle changes (such as eliminating smoking, maintaining a healthy weight, limiting stress and using proven supplements). Between 15 to 20% of people are able to conceive after treatment for secondary infertility.
- When to see a provider about secondary infertility? You should see your GP if you have been trying to conceive for one year or more to be evaluated for secondary infertility or other causes. Those aged 36 or over should be referred sooner for specialist treatment and we recommend visiting your GP after trying to conceive for six months.
Coping with Secondary Infertility
While secondary infertility is common, many women find it even more difficult to discuss than primary infertility. We know that women suffering from secondary infertility are less likely to talk about it with their peers:
“We talk a lot about infertility, but the topic of secondary infertility doesn't get as much focus. It can feel like perhaps your feelings aren't as valid as you already have a child, I myself have secondary infertility and these are feelings I definitely struggle with. We know that in one study it was determined that twice as many women with secondary infertility do not discuss their diagnosis with others, compared to women experiencing infertility for the first time. ”
~Jenny, CEO / Founder at Ovum.
If you are concerned about secondary infertility, reach out to your GP or fertility specialist for help and to plan next steps. Treatment for secondary infertility can be successful, with between 15 to 20% of women conceiving afterward, and it is important to speak with a trusted medical professional about your options and to put practices in place to support your overall health and wellbeing.
Seeking mental health support may be an especially important part of the entire process to help you manage negative emotions and challenging experiences on your journey. As with primary infertility, stigma and feelings of shame or embarrassment may affect individuals facing secondary infertility. These feelings may be amplified with secondary infertility as many may feel like they should feel “lucky” to have been able to have prior children. Taking care of your mental health may be especially important at this time.
Here at OVUM, we believe it is important to recognise and acknowledge the challenges experienced by all women coping with infertility, regardless of whether or not they have children. The ability to have a child does not define your worth, but it doesn’t mean your feelings are any less valid or important. Secondary infertility is more common than many realise and there is help available to support you in improving your chances of conceiving and ability to cope. If you’re worried that you may be experiencing secondary infertility, contact your doctor and support network for help.
Take Aways from Secondary Infertility
- Secondary infertility refers to the inability to conceive after 1 year of trying for individuals who previously experienced a successful pregnancy.
- Rates of secondary fertility are similar to that of primary infertility, which affects one in 6 people globally.
- Factors increasing the risk of secondary infertility include age, BMI, certain medication, hormonal disorders, damage or blockage of reproductive organs, smoking, and alcohol consumption.
- Healthcare providers will assess your medical history and conduct various exams, from labs to imaging tests, to diagnose secondary infertility.
- Secondary infertility is common and is often successfully treated with options such as fertility medications, ART, or surgery to correct structural issues.
- Working closely with your healthcare provider and relying on a support network will be helpful for those experiencing secondary infertility.