Secondary Infertility: How Common Is It, Causes, Diagnosis, and Treatment Options

It’s confusing to have an infertility diagnosis when you have previously given birth naturally and are now facing difficulty getting pregnant again. It’s called secondary infertility. It may not be as commonly discussed a topic as primary infertility, but secondary infertility can and does affect many couples.

This post will walk you through all you must know about secondary infertility, the causes, treatment, and whether natural pregnancy is possible after secondary infertility. Let’s get started.

What Is Secondary Infertility?

Secondary infertility refers to the inability to get pregnant after having achieved pregnancy naturally before. It’s when you have become pregnant once, no matter whether that pregnancy led to a live birth or not, but experience fertility issues when trying again. Primary infertility is when a couple has never experienced pregnancy and is struggling to conceive. 

The condition is more prevalent than people assume. According to Cleveland Clinic, around 11% of couples in America struggle with secondary infertility. 

What Causes Secondary Infertility?

Finding the cause of secondary infertility may seem difficult, as the couples have already achieved a pregnancy before. This is why your fertility expert will run a thorough investigation, which includes a physical examination, ultrasounds, semen analysis, and more advanced tests if needed. 

Note that secondary infertility can be due to problems in the female reproductive function, male’s semen issues, and combined factors. Let’s explore common secondary causes of infertility in men and women.

Female Causes

Advanced Maternal Age: Age-related decline in the female’s egg quality and count becomes more prominent in the late 30s and 40s. That’s the most common reason why you may have conceived your first baby easily, but are facing difficulty getting pregnant the second time.

Low Ovarian Reserve: An important part of fertility testing is checking the Anti-Mullerian Hormone and Antral-Follicle Count. These are used to assess the number of eggs left in your ovaries.  While women with a reduced ovarian reserve may have lower chances of pregnancy, it doesn’t make conception impossible. 

Ovulation Disorders: You may not have ovulation disorders earlier, but with advancing age, ovulation patterns might change. If you experience irregular periods, absent periods, or have known ovulation disorder, it could be the cause of secondary infertility.

Endometriosis: Endometriosis can cause tissue similar to your endometrium to develop in unusual places, including the ovaries and near the fallopian tubes. The inflammation, pelvic adhesions, and scars from endometriosis can distort the pelvic anatomy, causing secondary infertility in women.

Fibroids: Fibroids, specifically, submucosal or large intramural fibroids, can distort the uterine cavity and affect blood flow to the uterus, which in turn makes conception and implantation difficult. However, not every fibroid affects your fertility. Only the ones located inside the uterine cavity or significantly larger fibroids that distort the uterus can affect fertility.

Tubal Blockage: Fallopian tubes are where eggs and sperm meet to create an embryo. An obstruction in these tubes will simply not let the sperm enter or reach the egg that’s descended from the ovaries. This makes pregnancy impossible, especially if both fallopian tubes are entirely blocked.

Hormonal Disorders: Several reproductive hormones produced by your ovaries work with your thyroid and pituitary gland to support ovulation. So, significant disruption in these hormones, such as elevated prolactin or imbalances in estrogen and progesterone, can cause infertility after first pregnancy. 

Male Infertility Causes

Reduced Sperm Count: Over time, sperm count in men can change. If there’s a significant reduction in sperm production or transportation, a man’s fertility can be affected. 

Poor Sperm Motility: For the egg to be fertilized, the sperm must swim through the female reproductive tract fast and in a direct direction. Poor sperm motility is when a large proportion of the sperm cells swim slowly or do not swim at all, making it difficult for enough sperm cells to reach the egg. 

Abnormal Morphology: A large volume of sperm cells with abnormal shape or structure can make conception difficult. For fertilization, it’s important that at least 4% of the sperm cells have a proper shape, i.e., an oval-shaped head, a slender midpiece, and a single, long tail.

Varicocele: Another cause of secondary infertility in men is varicocele, i.e., enlargement of the veins around the testes. Although it may not always affect a man’s fertility, it can sometimes interfere with sperm production and quality.

Hormonal Disorders: Hormonal changes in men can affect their fertility, as male hormones are responsible for producing sperm. Low testosterone, for example, can affect the testicles’ ability to produce adequate sperm. This declines the number of sperm cells available to fertilize an egg.

Lifestyle Changes: Excessive alcohol consumption, smoking, recreational drug use, exposure to heat, and certain industrial chemicals can affect a man’s fertility. 

Increasing paternal age is also linked to changes in men’s reproductive function, but their fertility does not usually decline the way it does in women.

Symptoms of Secondary Infertility

Sadly, there are no specific secondary infertility symptoms either partner experiences. A woman may experience periods regularly and still have infertility linked to other causes, such as hormonal imbalance, fibroids, or scar tissue from previous surgery. 

Likewise, a man might feel completely healthy but have an extremely low sperm count. Still, certain reproductive issues can produce symptoms that do not necessarily indicate infertility but can be early signs of underlying reproductive health issues that can contribute to secondary infertility.

• Irregular periods in women, with shorter or longer menstrual cycles than usual
• Absent periods
• Painful and heavy periods
• Pelvic pain 

In men

• Erectile dysfunction
• Reduced libido

The most obvious sign of infertility is difficulty getting pregnant after trying sexual intercourse regularly for more than 12 months, and 6 months if you are above 35 years. That’s also when experts recommend you see a fertility specialist. 

If you can’t get pregnant despite trying regularly, book a consultation with a fertility doctor at Australian Concept. It’s advisable to take action sooner, as the more advanced the maternal age is, the more the success rates of fertility treatments drop.

How Secondary Infertility Is Diagnosed

Proper evaluation of the reproductive health of each partner allows the doctor to find out the root cause of infertility and tailor the treatment plan to the couple. 

Female Evaluation

Medical History: A fertility expert will collect details of your previous pregnancy, delivery method, any complications that occurred following the pregnancy, history of miscarriages, pelvic pain, irregular menstrual cycles, any medication you are currently on, and your age.

Ultrasound: An ultrasound is a non-invasive diagnostic test for identifying the cause of female infertility. It gives a clear picture of the woman’s uterus, ovaries, and the surrounding structures, thus identifying fibroids, polyps, endometriomas, ovarian cysts, and other uterine anomalies.

Hormonal Tests: Blood tests to detect AMH, LH, FSH, estradiol, and other key reproductive hormones are the next step in secondary infertility diagnosis. Depending on your thyroid history or current symptoms, a thyroid test may also be needed.

HSG: HSG tests your tubes’ function and whether they are open or blocked. A special dye is injected and passed through the tubes to rule out tubal blockage.

Hysteroscopy: Although not required for all secondary infertility cases, if a doctor suspects polyps, fibroids, or other abnormal growths in the reproductive organs, this minimally invasive procedure can be helpful. Not only is it used for diagnosis, but it can also be used to remove fibroids or other growths.

Male Evaluation

Semen Analysis: A semen analysis shows details of semen parameters, including sperm count, sperm motility, morphology, semen concentration, etc. If an abnormality is found, a repeat test may be needed, or further investigation might be required.

Hormone Testing: Hormone tests are recommended when a man has erectile dysfunction or abnormalities in sperm production, low libido, and other symptoms that indicate hormonal imbalance.

Ultrasound: A scrotal ultrasound may be needed to rule out varicocele or other structural issues.

In selected cases, a DNA fragmentation test may be needed to identify the volume of sperm cells with damaged DNA material.

Treatment Options for Secondary Infertility

Treatment for secondary infertility is decided once the cause of the infertility is clear. Treatment usually differs depending on whether you have male-factor, female-factor, or unexplained infertility. Common secondary infertility treatment options include:

Lifestyle Changes

Infertility associated with modifiable lifestyle factors may not require any invasive fertility treatment. For example, if either partner smokes heavily, drinks excessive alcohol, or uses recreational drugs, stopping them can make a difference. 

Likewise, if the female partner is significantly overweight or underweight, managing weight can be an important step in regulating your hormones and restoring ovulation. However, these steps cannot reverse existing medical conditions that deserve gynecologic attention.

Ovulation Induction

If irregular or absent ovulation is the cause of infertility, ovarian stimulation medication may be used to regulate your ovulation cycles. Letrozole is most commonly used to increase production of follicle-stimulating hormone, which supports egg development. Clomiphene Citrate may be administered in some cases. Gonadotropins are stronger stimulation drugs used when the above medications fail. However, since they are associated with the risk of ovarian hyperstimulation syndrome and multiple pregnancies, they require proper administration and regular monitoring.

Surgical Treatments

If there’s a known structural issue that’s causing infertility, surgical treatment might be advised. For example, if there’s a mild tubal blockage, a surgical reconstruction may be attempted to unblock the tubes and improve your chances of natural conception. Likewise, if fibroids, endometriomas, or polyps are believed to be interfering with implantation, these growths can be removed through minimally invasive surgical procedures. 

That said, surgery is still a major procedure and may not be automatically an ideal treatment option for all structural issues. Several other factors, such as your age, surgical history, whether you are on any medication, or whether you have an existing medical condition, are all considered before a surgery is advised.

Intrauterine Insemination (IUI)

A less-invasive fertility treatment can be tried if you have mild male-factor infertility, thick cervical mucus, unexplained infertility, or other underlying issues that prevent sperm from reaching the eggs. 

Intrauterine Insemination (IUI) involves placing specially prepared sperm cells into your uterus, allowing them a chance to reach and penetrate the egg. For severe male factor infertility, blocked fallopian tubes, or severe pelvic infections, IUI might not be advised.

IVF

IVF is an advanced fertility treatment in which sperm and eggs are placed together in a special dish in a controlled lab setting. The fertilization takes place outside the womb, so it’s usually considered a practical treatment option if you have blocked fallopian tubes or severe male-factor infertility. IVF for secondary infertility can work if you have:

• Low ovarian reserve
• Advanced maternal age
• Blocked fallopian tubes
• Low or no sperm found in the ejaculate
• IUI and other fertility treatments have failed
• Unexplained infertility

IVF isn’t always the first-line fertility treatment for every couple that experiences secondary infertility. However, delaying IVF just because you may want to try conservative treatment first isn’t appropriate either, as increasing age is linked to a higher risk of failed fertility treatments. Your fertility expert may determine an age-appropriate fertility treatment that may offer you the best chance at getting pregnant.

Can You Get Pregnant Naturally with Secondary Infertility?

Yes, many couples with secondary infertility conceive naturally or with fertility treatments. However, whether or not you can conceive after first pregnancy depends on many factors, such as your age, reproductive health, your partner’s semen parameters, and the underlying cause of infertility. 

Some couples conceive after changing lifestyle factors that may be contributing to their infertility, while others find ovulation stimulation medication effective. In selected cases, more advanced fertility solutions, such as IUI, Micro-TESE, IVF, ICSI, and PGT, may be required to improve your chances of conceiving naturally.

Conclusion

Secondary fertility can feel overwhelming, not just because you are facing difficulty conceiving naturally, but because you know you have been pregnant once, so what could be making it difficult to get pregnant again? It’s important to understand that a woman’s and a man’s reproductive health changes with age. 

Sometimes, lifestyle factors contribute to these changes. In other cases, surgical procedures, current medication, weight changes, or a medical condition can make pregnancy challenging, even if you have conceived before. The best step is to see a fertility expert. Early diagnosis can help your doctor explain the most relevant treatment options based on your diagnosis.

FAQs 

What is secondary infertility?

Secondary infertility is difficulty conceiving after achieving pregnancy before.

How is secondary infertility different from primary infertility?

The biggest difference is that couples with primary infertility have never become pregnant, while those facing secondary infertility have been pregnant before.

Can secondary infertility happen after a normal first pregnancy?

Yes, you can have a normal first pregnancy and experience problems conceiving in subsequent pregnancy attempts.

What is the most common cause of secondary infertility?

Maternal age, low ovarian reserve, sperm issues, endometriosis, and sometimes tubal blockage are the common causes of secondary infertility.

Can men develop secondary infertility?

Yes, men too can develop secondary infertility. 

Is age a major factor in secondary infertility?

Yes, advanced maternal age is linked to reduced ovarian reserve. Besides, if a woman tries for a second pregnancy after several years since her first pregnancy, i.e., in her 40s, she may already be near perimenopause. This can make conception difficult.

Can secondary infertility be treated without IVF?

Yes, many infertility treatments can help you conceive. Ovulation stimulation medication, IUI, and sometimes lifestyle changes can help you get pregnant.

How is secondary infertility diagnosed?

It can be diagnosed with physical examination, ultrasounds, semen analysis, hysteroscopy, and HSG.

How long should I try before seeing a fertility specialist?

The sooner, the better. The recommended duration is 12 months of having unprotected sexual intercourse for women below 35 and 6 months for those above 35.

Can I get pregnant naturally after secondary infertility?

Some couples get pregnant naturally after secondary infertility, but it depends on the underlying cause.