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If you and your partner are struggling to conceive after an already successful pregnancy, it can be a confusing, surprising, and anxiety-inducing experience. You may be wondering why this is happening now and if it’s normal to have fertility problems after having one or more successful pregnancies.
First, know that if you are dealing with secondary infertility you are far from alone. Roughly 1 in 10 couples worldwide will experience some form of infertility; and by some estimates, secondary infertility—which affects both men and women—makes up more than 40% of all infertility cases (Deshpande, 2021).
Here’s everything you need to know about this condition, including why it happens and how it’s treated.
What is secondary infertility?
Fertility specialists usually define infertility as an inability to become pregnant after 12 months of regular, unprotected sex, and it can be categorized as either primary or secondary infertility (ACOG, 2020; Walker, 2021).
Primary infertility refers to situations in which a person has never experienced a successful pregnancy. Secondary infertility refers to cases of infertility among those who have had a successful pregnancy in the past (Raque-Bogdan, 2015).
What causes secondary infertility in women?
As with primary infertility, age can be a big factor in secondary female infertility. In general, a woman’s fertility declines with age. One study showed that in married women who are 34 or younger, rates of primary infertility range from 7% to 9%. This jumps to 25% among women aged 35 to 39 (Chandra, 2013). Another study has found that women with secondary infertility are, on average, more than three years older than women with primary infertility (Benksim, 2018).
There are many additional factors that may cause or contribute to secondary infertility. Again, these closely overlap with the causes of primary infertility. These include (Benksim, 2018):
- Ovulatory or fallopian tube dysfunction
- A history of endometriosis or uterine fibroids
- Past pelvic adhesions or polycystic ovary syndrome (PCOS)
- Tubal blockages
- Other tubal/uterine abnormalities
- Hormone disorders
- A past STD or infection
Pregnancy-related complications, like scarring after cesarean section, can also cause or contribute to secondary infertility (Bakavičiūtė, 2016).
What causes secondary infertility in men?
The causes of secondary infertility in men often overlap with those of primary male infertility. Many of these affect a man’s sperm’s health or viability or cause low sperm count.
Some factors that may cause or contribute to secondary infertility in men are (Agarwal, 2020):
- Past genital or urinary tract infections, including STDs
- Scrotal cysts, varicoceles, blockages, or other abnormalities of the genitals
- Chemotherapy or radiation
- Past testicular trauma (injury)
- Obesity or metabolic syndrome (Ventimiglia, 2017)
- Lifestyle factors, such as a history of smoking or heavy alcohol use
- Some medications, including opioids
However, up to 20% of infertility cases in men—whether primary or secondary—are termed “idiopathic.” This means that it cannot be explained (referred to as unexplained infertility) and has no identifiable cause (Winters, 2014).
Signs of secondary infertility
Apart from an inability to become pregnant, there aren’t many hard-and-fast signs of secondary infertility. However, women who experience irregular, absent, or painful menstrual cycles may be at increased risk for infertility (Filip, 2020; Walker, 2021).
Among men, sexual dysfunction—which includes conditions like erectile dysfunction and premature ejaculation—has been linked to infertility. It’s possible that men who experience these issues may have underlying health conditions that could also affect their fertility (Leslie, 2021).
While none of these are true signs—they’re more like risk factors—men or women who have experienced (or are still dealing with) one of the medical conditions listed above may have a more difficult time conceiving (Walker, 2021; Agarwal, 2020).
Treatments for secondary infertility
Just as the causes of secondary infertility often mirror those of primary infertility, many of the treatments for these two conditions are the same (Raque-Bogdan, 2015).
In vitro fertilization, or IVF, is one option for couples experiencing secondary infertility. During IVF, fertility doctors collect mature eggs from a woman’s ovaries and fertilize them in a fertility clinic or medical facility using a man’s sperm.. The fertilized egg or eggs are then implanted in a woman’s uterus. This helps bypass many of the problems that may be preventing a successful pregnancy (Choe, 2021).
Another fertility treatment is intrauterine insemination (IUI). During IUI, a reproductive specialist collects and washes a male’s sperm (washing optimizes the chances of successful fertilization), and artificially inseminates them into a partner’s uterus. This can raise the odds of successful egg fertilization (Starosta, 2020).
There are many other treatment options depending on the specific causes of a couple’s infertility. These include (Raque-Bogdan, 2015; Leslie, 2021)
- Endometrial surgery
- Surgery to repair irregularities in the female or male reproductive systems
- Surgery to remove cysts or blockages
- Surgery to repair C-section scar tissue
- Use of donor eggs, sperm, or uterus
- Use of medications, such as those that promote ovulation
- Healthy lifestyle changes, such as cutting down on alcohol and tobacco, getting more exercise, or reducing weight. These sorts of lifestyle changes may be particularly helpful in improving the health of a man’s sperm.
While many treatment options exist, many couples eventually have success even without treatment. Studies have found that 23% of infertile couples who do not undergo treatment will have a successful pregnancy within two years. The success rates further increase if couples keep trying for four years (Leslie, 2021).
Living with secondary infertility
Whether you’re dealing with primary or secondary infertility, the experience can cause emotional distress, as well as feelings of guilt, loneliness, and frustration.
In fact, some researchers have found that many of these negative feelings are just as commonplace and severe among people who are dealing with secondary infertility, compared to those who are experiencing primary infertility (Raque-Bogdan, 2015).
Women with secondary infertility can feel isolated or disconnected from their peers. They may feel as though other people can’t understand the pain that comes from wanting another child and not being able to conceive.
Men may also experience some of these negative emotions. But research shows that women are more likely than men to assume responsibility for fertility issues, so a woman’s burden may be greater.
Practicing self-compassion through mindfulness-based cognitive therapy or compassion training has been shown to protect women from the negative emotions related to secondary infertility. This means treating yourself with kindness, rather than judgment, and recognizing that millions of people around the world experience difficulties conceiving (Raque-Bogdan, 2015; Frostadottir, 2019).
If you are struggling to get pregnant after already having a child, reach out to your healthcare provider. They can work with you to get to the bottom of why you may be dealing with secondary infertility and can provide you with some treatment options that may help you conceive.
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Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.