What is Secondary Infertility?
Secondary infertility can take couples by surprise. Secondary infertility is the inability to get pregnant or carry a baby to full term after having previously been pregnant and given birth without the need for fertility treatment or assistance. Most people with secondary infertility had a relatively easy time conceiving before and now are struggling to get pregnant. This scenario is more common than most people realize, and if you’re experiencing secondary infertility, you’re certainly not alone.
Secondary infertility is estimated to be nearly as common as primary infertility, affecting 10 to 12 percent of women in the United States. If you have been trying to get pregnant and have not been successful, you may be experiencing infertility. Women under the age of thirty-five are recommended to meet with their doctor after twelve months of trying or after six months of trying for those over thirty-five. People with known medical conditions which may influence fertility and those over forty should contact their doctor immediately to review their options. These recommendations hold true for both primary and secondary infertility.
Though primary and secondary infertility are very similar, they are not the same. Secondary infertility can arise for different reasons than primary infertility and often has a different emotional impact.
A couple’s struggles may be obvious and easy to diagnose through a review of the medical history or fertility testing; However, at times, the reasons may be less clear and more challenging to diagnose. Regardless, infertility can occur at any point in the reproductive cycle.
For a natural conception to occur, the following must happen:
- Ovulation (the release of the egg from the ovary)
- Fertilization (the sperm and egg coming together)
- The embryo travels to the uterus
- Implantation of the embryo in the uterus
Though these steps all take place in the body of the person carrying the pregnancy, it’s important to remember that either partner could play a role in infertility.
The inability to conceive or stay pregnant after a previous successful pregnancy and birth can be frustrating, isolating, and confusing. Aside from a healthy baby, what you want most are answers. While we can’t provide you with all of them, we hope this article helps you learn more about secondary infertility and your options for building your family.
Secondary Infertility Causes
There can be many identifiable and unidentifiable causes for both primary and secondary infertility, making it difficult to explain why you’re having trouble conceiving. The diagnosis is often the dreaded “unexplained secondary infertility” because current diagnostic testing is not adequate to determine the cause of infertility. Infertility can be scary if you’ve previously had ease conceiving a child; however, understanding the potential reasons behind secondary infertility can empower you on your journey to conceive.
Issues with the Ovaries, Fallopian Tubes, or Uterus
Most fertility issues for women result from the ovaries, where the eggs are. These issues can be related to either ovulatory dysfunction (which is the failure to consistently ovulate or release an egg) or egg quality/quantity issues. Certain conditions can result in an egg not being released regularly; these include:
- PCOS – polycystic ovary syndrome
- POI – primary ovarian insufficiency
- Lifestyle factors (age, weight, nutrition)
- Endocrine disorders affecting hormone regulation
PCOS is a common factor in infertility. The hormone fluctuations it causes can result in an egg not being released (anovulation) and, at times, can also influence the quality of the eggs.
POI is a condition when a woman runs out of eggs and enters menopause before age 40. If there are none or very few eggs remaining in the ovary, then there is no egg to ovulate. POI may be caused by medications (certain chemotherapeutic medications), an autoimmune condition, unknown causes, or a genetic source.
Lifestyle factors can impact egg health and ovulation. These are easy to evaluate and improve upon, such as weight loss or weight gain, improving diet, monitoring the amount of exercise, etc. Your physician would be able to advise you about this.
Endocrine disorders, hypothyroidism or hyperthyroidism, or hyperprolactinemia interfere with the brain’s signaling to the ovary to help develop the egg and to ovulate. Simple blood tests can determine if this is the cause of anovulation, and medications can correct this issue to help resume ovulation.
The term ‘ovarian reserve’ is used to describe egg quality, egg quantity, and overall reproductive potential compared to other women your age. Women are born with all the eggs they will ever have. Over time, the number of eggs diminishes until menopause, when there are essentially no eggs left. Additionally, eggs do not age well and have an increased amount of functional abnormalities over time. A transvaginal ultrasound as well bloodwork can help better determine ovarian reserve. Based on the results, specific treatments may be recommended.
Anatomic or structural issues with the fallopian tube(s) and uterus can also hinder a couple’s ability to get pregnant. A blocked fallopian tube will prevent the ability of the sperm and egg from meeting. Causes of blocked fallopian tubes may include infection, abdominal surgery, and endometriosis.
The uterus, which is the site of implantation and development of the fetus, can develop polyps or fibroids over time. There are benign growths inside the uterus that may prevent an embryo from implanting. Scar tissue may develop inside the uterus as well, most commonly after a D+C procedure, and can also result in preventing an embryo from implanting. Additionally, some individuals are born with an abnormally shaped uterus, which can impact both implantation and pregnancy. An abnormally shaped uterus may not be apparent or diagnosed with the first pregnancy and only become evident when difficulties to conceive a subsequent pregnancy arise.
Reviewing your medical history helps your doctor determine the possible cause behind your difficulty in conceiving. Since your last pregnancy, you or your partner may have started taking a medication that can affect fertility. Weight gain is typical when a new baby arrives but, in some cases, may decrease fertility. Both lifestyle factors, health conditions, surgeries, and changes in healthy habits can impact a couple’s ability to conceive.
Remember, it takes egg and sperm to make a baby; and men aren’t immune to fertility issues. At least 30% of infertility is attributed to the male partner. Secondary infertility factors related to sperm include:
- Low sperm count
- Azoospermia (no viable sperm)
- Sperm abnormalities
- Prostate removal
- Taking medications or conditions that affect hormone production
- Varicocele (a varicose vein affecting the scrotum)
- Anti-sperm antibodies
A semen analysis is a simple test to determine sperm count, motility, and morphology. These numbers can change over time, especially if the individual had significant changes in medical history. If you or your partner are concerned about this issue, it is a good idea to seek support and guidance from a fertility specialist.
The Emotional and Mental Impacts of Secondary Infertility
Infertility is devastating no matter when it occurs. However, the emotional response to secondary infertility can be different from that experienced by individuals struggling with primary infertility.
Confusion is a common response, especially considering you were able to conceive and carry a pregnancy before. Other common emotions include sadness, anger, guilt, and loneliness.
The anxiety and emotional distress associated with secondary infertility can affect both partners. The feelings are similar to those going through primary infertility but usually with less social support available to the couple. Insensitive comments from family and friends such as “Be grateful, you have a child!” do not ease the pain of not being able to continue to grow your family.
Unfortunately, sometimes health care providers who do not specialize in fertility medicine may also lack empathy and be reticent to discuss treatment options, citing the couple’s ability to conceive before. It’s important to advocate for your fertility. Reproductive Endocrinologists (“fertility specialists”) would never turn a patient away for “not trying long enough.” A visit to a fertility specialist can provide insight and education about secondary infertility and a plan moving forward to help you conceive.
It is imperative to remember that you are not alone. Secondary infertility in no way represents inadequacy or failure. Modern treatments continue to improve, allowing more couples to realize their dream of conceiving.
If you’re coping with secondary infertility, these tips may help:
- Find your support system. Talk to people you can trust. Discuss your concerns with your doctor. Find an infertility support group.
- Connect with your partner. Avoid blaming each other (and yourself). Acknowledge your feelings of loss and take time to discuss your feelings. Secondary infertility can challenge even the strongest relationships. Feeling that you are both working for the same goal (another baby) can lessen the emotional burden.
- Focus on what you can control. Educating yourself about the causes of secondary infertility, the availability of diagnostic testing, and potential treatment options can empower you to decide how to move forward. A healthy diet, lifestyle choices, vitamins, etc., are within your control.
Paths to Building a Family
There is little research regarding secondary infertility. Fertility treatment outcomes and statistics often do not acknowledge secondary infertility as the cause, implying that this is a highly uncommon occurrence. However, many couples do overcome secondary infertility and achieve subsequent pregnancies with the help of a fertility specialist. Often, the treatment for secondary infertility is the same as prescribed for people with primary infertility.
The couple’s age, the cause(s) of secondary infertility, and how many additional children the couple desires will influence the recommendation regarding treatment options.
Initial interventions include using oral medication for the female partner or intrauterine insemination (IUI). An IUI is a procedure when a doctor inserts sperm (via a small catheter) directly into the uterus at or near ovulation. Combining IUI with fertility medication can help to increase the number of eggs ovulated in a regular cycle and the number of sperm ready to meet the egg.
Another fertility treatment option is, In Vitro Fertilization (IVF). This treatment includes daily injections for about 8 to 12 days to stimulate the ovaries to grow all of the potential eggs in that menstrual cycle (as opposed to the one egg that would develop on its own in a natural menstrual cycle). This is one of the reasons IVF is more successful than simpler interventions – because there are many more eggs produced to increase the chance of finding the healthiest egg to make a baby. Once the eggs have reached an appropriate size, your doctor will perform a surgical procedure called an egg retrieval to collect the eggs. The eggs are evaluated in a specialized lab (the embryology lab) and then fertilized with sperm to create embryos. The embryos are closely monitored while they grow over the next 3 to 6 days.
At this time, your doctor may transfer an embryo back into your uterus and freeze the remaining viable embryos for future children or future attempts to conceive if this first try is not successful.
Alternatively, you may elect to have your embryos tested for chromosome abnormalities to identify those embryos that will give the highest chance of successfully implanting and avoid those embryos that would result in a miscarriage. This is called Preimplantation Genetic Testing.
Sometimes, the recommended treatment for having another child may include using donor eggs, donor sperm, or surrogacy.
These terms, acronyms, and procedures can seem overwhelming and may be options you had not previously considered, making it essential to have open and honest conversations with your doctor about the best path to continue building your family.
Can I Get Pregnant with Secondary Infertility?
Yes, many individuals and couples that have struggled with secondary infertility have successfully continued to build their families. Early evaluation by a medical professional is key to finding the best treatment option for you and your partner. Your doctor will likely review changes in your medical history since your last pregnancy. They may include ordering tests, such as an X-ray of the uterus or semen analysis (as described above). Couples going through secondary infertility may be reluctant to reach out to others. However, you don’t have to face this uncertain and challenging time alone. Talking with your doctor can help you better understand infertility and your options for growing your family.