Infertility is a deeply personal journey, often shrouded in silence and heartbreak. As medical director and co-founder of Reproductive Medicine Associates of Houston, my team and I regularly help women navigate this journey with compassion and expertise.
For many women, the road to motherhood begins with joy, with the first child coming easily and filling their lives with love and happiness. However, when it comes time to expand their family, they face an unexpected and often devastating obstacle: secondary infertility. This condition, where a woman who has given birth before has difficulty conceiving again, can be a surprising reproductive challenge that captivates parents.
The joy and fulfillment of having a child is contrasted with the pain and frustration of not being able to have another, leading to a deep sense of sadness and confusion. It’s a common misconception that once a woman has a child, subsequent pregnancies should come easily, but the rate of secondary infertility is common, affecting about 11 percent of couples in the United States—about the same rate as primary infertility. According to the Centers for Disease Control, about six percent of women who have had a previous child have trouble getting pregnant after a year of trying.
Understanding Secondary Infertility
As I explain to my patients, if a woman has given birth before and is under 35 and has not been able to conceive in one year of continuous trying, or is over 35 and has been unable to conceive in six months of continuous trying, she is experiencing secondary infertility and should seek medical attention. This schedule exists because time is an important factor in fertility and women should not wait too long, especially if they are older. This schedule also assumes normal menstrual cycles. If a woman experiences irregular cycles, defined as less than 21 or more than 35 days, she does not need to wait to see a fertility specialist.
A woman with secondary infertility is different from a woman who experiences more than one miscarriage. This is characterized as recurrent pregnancy loss and has its own unique diagnostic and treatment issues.
The emotional cost of secondary infertility
Secondary infertility is not only a physical struggle but also an emotional one. I hear a range of emotions from patients dealing with secondary infertility. Many feel guilty because they already have a child and think they should be content. Others struggle with intense grief because they know the joy of parenthood and long to experience it again.
One of my patients with two children felt guilty about wanting a third. I assured her that there is no guilt or shame in wanting to build the family she desires—and I mean it. Whether it’s two children or five, seeking help to fulfill that dream is perfectly valid.
Possible health reasons for secondary infertility
Understanding the possible health reasons behind secondary infertility is important for those affected. Common medical factors that can contribute to this condition include:
Age plays a key role in secondary infertility, as a woman’s fertility naturally declines over time. This is a function of decreasing egg quantity and quality. As a woman ages, there is an increased chance of chromosomal abnormalities in her eggs, which reduces the chance of implantation and continued pregnancy.
Hormonal imbalances such as hypothyroidism or hyperthyroidism and elevated prolactin can cause secondary infertility. PCOS is a common hormonal disorder that can affect fertility. PCOS includes three diagnostic criteria: irregular cycles, elevated androgens (such as testosterone), and polycystic ovaries. PCOS is a lifelong condition, but its severity can increase over time, affecting fertility.
Anatomical problems can also develop after the first pregnancy, leading to secondary infertility. Tubal factor infertility, where the fallopian tubes become blocked, is one such issue. The tubes may be blocked due to pelvic infections, endometriosis, or other inflammatory conditions.
Complications during childbirth, such as caesarean section, infection, significant bleeding, and prolonged products of conception can lead to the development of scar tissue in the uterus, which can affect a woman’s ability to conceive later.
- Changes in sperm parameters
Sperm parameters may decrease over time, leading to difficulty in conception. Sperm quantity can be particularly affected by decreased testosterone levels, anatomical abnormalities that form over time, such as varicocele, and worsening chronic medical conditions such as diabetes.
- Menstrual cycle changes as a red flag
One of the indicators to seek treatment more quickly is a change in the length of the menstrual cycle. As women age, their cycle frequency may decrease before lengthening again, signaling the onset of the perimenopausal transition. If a woman notices that her cycles are becoming shorter, from every 28 days to every 21 days, for example, it may be a sign of reduced egg quantity and quality.
When to seek treatment
The general age/time rules for primary infertility apply to secondary infertility. As noted, women should consider seeking medical support for infertility if they have been unable to conceive after one year of regular, unprotected intercourse if they are younger than 35, or after six months if they are 35 and above. And, if a woman is 40 or older, she should consider getting evaluated after a few months of trying.
However, there are specific situations where women should seek help sooner. For example, if they or their partner have a serious medical condition, have irregular cycles, are having trouble conceiving their first child, or have symptoms of a hormonal disorder (eg fatigue, hair loss), they should not wait for the full period. recommended for typical infertility.
To seek treatment, most women do not need a referral to see a fertility specialist and can call a clinic directly for an appointment. However, talking to an OBGYN can be helpful for reliable referrals, as can recommendations from friends or family who have had positive experiences with fertility centers.
What to expect on a date
When entering treatment for secondary infertility, expect a thorough review of the medical history of the pregnancy for both partners. It is always better when a couple comes together on the date to enhance efficiency and understanding. It’s a common misconception that infertility is solely a female problem, but there are three key ingredients to making a baby: egg, sperm, and uterus. Optimizing everything is crucial.
Discussion will focus on previous deliveries and mode of delivery (vaginal vs C-section), miscarriages, complications and any subsequent treatments such as D&C.
After the consultation, a transvaginal ultrasound will be performed to assess the woman’s anatomy, focusing on the uterus and ovaries. Further imaging may be indicated, depending on the history and results of the baseline ultrasound. Blood work is often done, including infectious disease screening, hormone testing, and ovarian reserve testing. Semen analysis is often recommended to assess the quality of the male partner’s sperm.
Treatment and success rates
Fertility treatment success rates depend on each woman’s individual prognosis. While doctors cannot change a woman’s biology or ovarian reserve, they can optimize her existing biology to support pregnancy. Severely diminished ovarian reserve or advanced maternal age can make treatment more difficult, but reproductive endocrinologists often find success with women of all ages. Over 50 percent of women who seek IVF treatment for secondary infertility successfully conceive.
Each treatment plan is individualized. Some women prefer more aggressive interventions, while others choose lighter treatments. It’s about finding the right balance and making a clear plan with her care team. Whether a woman is just gathering information or ready to proceed with treatment, the goal is to communicate all of her goals to her doctor so that he can offer a clear plan and execute it effectively.
No shame in seeking help
Secondary infertility is a complex condition affected by several factors. Understanding the underlying causes and seeking early evaluation can help manage and treat this condition. There should be no guilt or shame in a woman who wants to build the family she desires, and there are treatment options available to help achieve that dream.
