Secondary infertility is when a couple is having trouble getting pregnant after successfully having a child (or children) in the past. Many women who don’t experience any issues getting pregnant with their first child may find it more difficult to get pregnant the second time around.

Reproductive Endocrinologists, Dr. Scott Morin and Dr. Jonathan Kort explain exactly why this happens and how to have a successful pregnancy if you are experiencing difficulties achieving pregnancy after your first child.

 

What is 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.

 

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.

The causes of primary and secondary infertility are nearly identical, but the emotional impact can be very different from each other. Fortunately, fertility treatments for primary and secondary infertility are the same and both have high success rates.

How common is secondary infertility?

Secondary infertility is as common as primary infertility. Infertility affects 1 in 8 couples trying to conceive or about 12.5 percent.

Out of all infertility causes, secondary infertility makes up about 50 percent of all cases.

Causes of Secondary Infertility

Secondary infertility can be caused by issues with the female or male partner.

  • About 33% of all infertility cases stem from issues with the female partner.
  • Another 33% of cases stem from the male partner.
  • The remaining 33% are a combination of issues from both the male and female partner

Causes of secondary infertility in women

  • Egg quality or quantity: 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.
  • Damaged or blocked fallopian tubes: Issues with the fallopian tubes can hinder the egg from traveling to the ovaries successfully.
  • Issues with the uterus: Scaring from a C-section or fibroids may also cause infertility.
  • Endometriosis: Endometriosis is a very common cause of infertility. It is a condition where tissue that typically grows inside the uterus grows in places like the ovaries.
  • Polycystic Ovary Syndrome (PCOS): A hormonal disorder that causes women to have infrequent or prolonged periods. PCOS patients may also have excess androgen levels (male hormones). Patients with PCOS often develop small collections of fluid around their ovaries which inhibit eggs from releasing.
  • Lifestyle: An increase in BMI and/or certain medications may also lead to ovary dysfunction and affect your fertility.

Causes of secondary infertility in men

Male infertility is mainly caused by issues with their sperm, hormonal imbalances, or problems related to their reproductive anatomy.

  • Low sperm count: Low testosterone levels, a blocked duct, and even certain medications can cause low sperm count.
  • Sperm abnormalities: Sperm may be abnormal in shape or may not be able to swim to the egg well enough for fertilization to occur.
  • Azoospermia: Azoospermia is when a man has no viable sperm. This means that his body produces abnormal sperm.
  • Varicocele: Think of a varicocele as a varicose vein in the scrotum. This may raise the temperature in the testes to higher-than-normal levels which can alter sperm production.
  • Anti-sperm antibodies: Some men and women have anti-sperm antibodies that make it difficult for them to achieve a pregnancy.

Can a C-Section cause secondary infertility?

Roughly 20% of women who gave birth via cesarean section reported difficulties getting pregnant with a second child.

A C-section causes scarring and sometimes this scarring can cause inflammation or obstructions that can make becoming pregnant more difficult.

Scar tissue can also grow and form large masses and cause endometriosis.

Secondary Infertility, Dr. Lange | RMA of Philadelphia, Fertility Clinic

When should I see a doctor for secondary fertility?

The guidelines on when you should see a fertility doctor for secondary infertility are exactly the same as for any woman trying to get pregnant.

You should seek the assistance of a reproductive endocrinologist if you are under 35 years old and trying to conceive for 12 months.

It is recommended that you seek help after just 6 months of trying if you are 35 years old or older.

Can you get pregnant with secondary infertility?

The short answer is yes, you can get pregnant with secondary infertility, but you may need to seek out the assistance of a fertility doctor, and here’s why.

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?

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?

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?

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.

In Vitro Fertilization (IVF) is another option, 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.

Is IVF more successful in secondary fertility?

IVF is not necessarily more successful for patients with secondary infertility, but it is often the only or most successful fertility treatment option.

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.