What Is Secondary Infertility?
Secondary infertility is the inability to conceive or carry a baby to term after 12 months of unprotected intercourse in a woman who has already had a baby in the past without any fertility treatments.
Secondary infertility occurs at about the same rate as primary infertility (when couples are unable to conceive their first baby). It affects men and women equally, as the cause for a woman’s inability to conceive can be due solely or in part to male factors. About 10% of women of childbearing age have problems getting or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).
Causes for secondary infertility are often the same as they are for primary infertility. Aging, ovulation disorders, low sperm counts and other factors can all play a part.
While secondary infertility can be a surprise to many couples, it can be treated successfully. The earlier patients seek help, the better. As many as 90% of infertility cases are treated with medication or surgery, according to the American Society for Reproductive Medicine (ASRM). This is similar for secondary infertility, with assisted reproductive technologies such as in vitro fertilization (IVF) another option.
What to expect at an appointment for secondary infertility
In order to diagnose the cause of secondary infertility, our physicians will try to uncover what has changed since the last pregnancy. They will:
- Review medical histories and current health.
- Discuss possible tests to help determine the cause of the infertility. Men may undergo a semen analysis. Common tests for women include:
- Blood work to look at hormone levels
- Pelvic exam
- An X-ray of the uterus called a hysterosalpingogram (HSG) to show any scarring or irregularities
- An X-ray of the fallopian tubes
- Transvaginal ultrasound to see if a woman is ovulating and to check her egg supply.
These evaluations can help us arrive at the best treatment options (see below).
Having trouble conceiving after previous success?
Our fertility specialists are experienced at evaluating couples and individuals with secondary infertility. We can get started on effective treatments at the first appointment.
Symptoms of secondary infertility
- If the woman is younger than 35 and has been trying to conceive for at least a year.
- If she’s 35 or older and has been trying for six months.
If a woman or couple experience either of these scenarios, they should make an appointment with a fertility specialist. The earlier we find the cause, the more treatment options we may offer the patient.
Causes of secondary infertility
Many of the causes of secondary infertility are the same as they are for primary infertility. They can be traced to either the man, woman or sometimes to both partners. Often, more than one factor contributes to a couple’s secondary infertility. And sometimes, frustrating as it may be, doctors can find no medical reasons for secondary infertility, which is known as unexplained infertility.
Secondary infertility risk factors for women
A 2018 study showed that couples experiencing secondary infertility were older than those with primary infertility. While healthy couples in their 20s and early 30s have a 25% chance of getting pregnant in a cycle, that number drops precipitously when the woman is older.
At 40 years of age, a woman’s chance of pregnancy success is less than 5% per cycle, according to ASRM. This is primarily due to the fact that the quantity and quality of a woman’s eggs declines with age.
About 1 in 4 women with infertility have ovulation disorders. Women can have problems ovulating for many reasons besides aging, including:
- Breastfeeding women stop ovulating or releasing eggs.
- Thyroid conditions, such as hypothyroidism or Hashimoto’s disease, can affect hormone levels and ovulation.
- Polycystic ovary syndrome (PCOS), a hormonal disorder, is one of the most common causes of infertility in women and can worsen with age.
- Primary ovarian insufficiency (POI) occurs when a woman’s ovaries stop working normally before age 40.
Blocked fallopian tubes, uterine problems & other factors
Blocked fallopian tubes
Blockages can impede the sperm’s ability to meet the egg in the fallopian tubes for fertilization or prevent the fertilized egg’s ability to move to the uterus for pregnancy. Blockages can be caused by pelvic infections or from complications of an ectopic pregnancy or surgery.
Various conditions related to the uterus can impair pregnancy:
- Adhesions or scarring in the uterus can lead to menstruation problems, such as light or missed periods, or can prevent a fertilized egg from implanting. Women who have had a dilation and curettage (D&C) or cesarean delivery may have uterine scarring.
- Uterine fibroids or polyps – benign (noncancerous) growths – can affect the ability to conceive.
Endometriosis is a relatively common condition affecting up to 1 in 10 women. Tissue that normally grows inside the uterus grows elsewhere, such as on the ovaries or bowels. It can cause inflammation and scar tissue on the ovaries, fallopian tubes and other internal organs, leading to issues with egg quality or embryo implantation.
Pelvic inflammatory disease & other infections
Pelvic inflammatory disease (PID) is an infection that can damage the fallopian tubes and uterus. PID can be caused by previous sexually transmitted diseases, such as chlamydia or gonorrhea, or by a past surgery, such as from a C-section. Other infections also can cause a condition called chronic endometritis, an inflammation of the uterine lining that can make it difficult for an embryo to implant in the uterus. Endometritis is hard to diagnose.
The relationship between autoimmune disorders and secondary or primary infertility is a bit murky. Autoimmune disorders cause the body to attack healthy tissues, even reproductive tissues.
Autoimmune disorders such as Hashimoto’s, lupus and rheumatoid arthritis can cause inflammation in the uterus and placenta. Medicines used to treat these disorders may contribute to infertility, too.
Weight or other lifestyle changes
Obesity, excess weight or being underweight can lead to hormonal changes, which could affect menstruation and ovulation. Nutrition, alcohol or drug misuse, or medications also may affect secondary infertility.
Secondary infertility risk factors for men
Men may have a lower sperm count or poor sperm motility (sperm movement) after age 40.
Low testosterone levels
Sperm production relies on testosterone. Testosterone levels can decline due to aging, injury to urinary or genital organs, or certain medical conditions.
About 30% of infertile men have a testicular varicocele, which is an enlargement of veins in the scrotum that can cause low sperm production.
Enlarged prostate & other issues
An enlarged prostate can lower sperm count and make it hard to have a normal ejaculation. Removal of the prostate due to cancer or other conditions can cause semen to flow in reverse and not into the woman.
Some medications can affect sperm count and quality. These drugs include some antibiotics and medications that treat high blood pressure.
Sperm quality also can be affected by treatments for a variety of conditions including cancers, urinary tract infections and others.
Excessive weight gain and lifestyle choices
Weight gain can lower testosterone levels and increase estrogen levels. It also can cause low sperm counts and poor motility.
Smoking, alcohol abuse, moderate marijuana usage and other lifestyle choices also can affect male fertility.
Treatments for secondary infertility
Once our providers identify the cause, they can develop a treatment plan to increase the patient’s odds of conceiving. Treatments vary depending on the cause, how long the couple has been trying to conceive and other factors.
Medications like Clomid
Medications can clear up infections related to infertility. Fertility drugs such as clomiphene (Clomid) and letrozole stimulate hormones that can help women ovulate. They can be taken orally or injected.
Surgery for secondary infertility
Our doctors may recommend surgery to repair structural problems that cause secondary infertility. A minimally invasive procedure called a hysteroscopy is used to treat endometriosis, clear fallopian tube blockages or remove scar tissue, polyps and fibroids from the uterus.
In men, surgery is most commonly used to remove varicoceles. Surgery also can fix blocked or scarred epididymis tubes that store and carry sperm and reverse vasectomies.
Advanced reproductive technology (ART)
Only a small percentage of infertile couples use advanced reproductive technologies – fertility procedures that involve handling eggs, sperm or embryos. The procedures have a 24% success rate, according to 2019 CDC data.
Earlier is better than later with infertility evaluations
The earlier we can examine patients to identify the causes of their secondary infertility, the more treatment options may be available.