Why Can’t I Get Pregnant Again? It May be Secondary Infertility

couple with secondary infertility

Many women can have their first child without any issues but may experience trouble getting pregnant with a second child. If you are having trouble getting pregnant after successfully having a child (or children) in the past you may be experiencing secondary infertility.

A woman’s fertility declines with age, sometimes it can be harder to get pregnant with a second child than it was with the first. When a woman has trouble getting pregnant on her own after a previously successful natural conception and birth, fertility doctors refer to this as secondary infertility. Secondary fertility can often be treated with fertility treatment.

Our reproductive endocrinologists, Dr. Scott Morin, and Dr. Jonathan Kort have experience diagnosing and treating a range of infertility causes, including secondary infertility.

They answer the most common questions asked about secondary infertility below.

 

Why would a woman experience secondary infertility?

Dr. Morin: A woman is born with all the eggs she’ll ever have, and that supply slowly decreases as she releases eggs every month during her menstrual cycle. So as a woman ages, she has fewer eggs, and fewer good quality eggs – both factors that reduce her chances of getting pregnant naturally.

Generally, a woman is most fertile in her mid- to late-20s, after which point her fertility begins to decline slowly until age 35 when the decline accelerates. That said, every woman is different, and that decline can begin earlier or later. Because fertility declines with age, it’s possible – and even common – for women who had no trouble getting pregnant with their first child to struggle to conceive the second time around, when they are older and less fertile.

What is the difference between Primary Infertility and Secondary Infertility?

Primary infertility is more commonly referred to as simply, infertility. Primary infertility is diagnosed when a couple fails to become pregnant after 6-12 months of trying. Secondary infertility is when a couple fails to become pregnant after successfully giving birth in the past.

 

But if I still have eggs left, why am I not getting pregnant?

Dr. Kort: While women over the age of 35 still have eggs left, it becomes more difficult to get pregnant because the eggs are of lower quality. Research performed by doctors at RMA showed that a woman’s age impacts the viability of the embryos created from her eggs. Namely, the older a woman, the more likely it is that her eggs have a chromosomal error which will, in turn, result in embryos being aneuploid, or chromosomally abnormal.

For example, in her mid-to-late 20s, the rate of aneuploidy in a woman’s eggs is a little more than 20 percent, rises to the mid-30s by age 35, is about 50 percent by age 40 and is nearly 90 percent by age 42 and 43. This means that while about 20 percent of the embryos a woman creates may be abnormal in her late 20s, almost 90 percent could be abnormal by her early 40s. That is a significant change in a little over a decade.

 

What does aneuploidy have to do with a successful pregnancy?

Dr. Morin: A lot. The opposite of aneuploid is euploid, which means an embryo is chromosomally normal, or that it has the normal amount of chromosomes and has a good chance of implanting inside the uterus and leading to a successful pregnancy.

Aneuploid embryos, on the other hand, have too few or too many chromosomes, and often fail to implant inside the uterus. In the chance they do implant, they often lead to miscarriage or an affected child. So the older the woman, the higher her chances of producing aneuploid embryos that fail to implant, leading to infertility.

Aneuploidy embryo chart

How can I tell if I have secondary infertility?

Dr. Kort: If you were able to get pregnant naturally and gave birth without issue in the past but are having trouble conceiving on your own for the second or third time, you may have secondary infertility.

However, it is also possible that there is another cause for your infertility, and doing the necessary fertility testing will help you determine the cause so you can move forward with the appropriate treatment. All patients at RMA undergo diagnostic testing to get a complete picture of their fertility before moving onto treatment; this includes fertility bloodwork to learn more about a patient’s egg count, which can help determine whether or not she is experiencing secondary infertility.

 

What type of treatment is available for women with secondary infertility?

Dr. Morin: Secondary infertility is treatable, and many women diagnosed with it go on to have successful subsequent pregnancies. There are various treatment options based on the woman’s specific fertility profile, including Intrauterine Insemination (IUI), where sperm is inserted into a woman’s uterus at the time of ovulation, and In Vitro Fertilization (IVF), where sperm and egg are fertilized outside the woman’s body and a resulting embryo is transferred back into the woman’s uterus in hopes of implantation.

IVF infographic
No matter which treatment path you pursue, you should have hope that we are here for you and you can overcome secondary infertility with just a little bit of help.

 

Secondary Infertility Support Groups

Struggling with infertility can be very hard to deal with alone. It is important to know that there are support groups out there dedicated specifically to men and women dealing with infertility. Resolve: The National Infertility Association offers support groups all across the US. Use their helpful Infertility Support Group Finder to find a meeting closest to you.

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