Fertility issues can be frustrating at any stage of life. With secondary infertility, the struggle to conceive a child after previously giving birth brings additional stress to parenthood.
In fact, it is estimated that 8–12% of reproductive-aged couples worldwide suffer from infertility, with secondary infertility ranking as the most common form of female infertility [1].
If you’re experiencing secondary infertility, we recommend consulting your GP who can provide treatment, resources, and specialist referrals if needed.
This article will explore the causes, signs and symptoms of secondary infertility, as well as potential next steps.
What is secondary infertility?
Secondary infertility refers to the situation where individuals or couples who have previously had one or more successful pregnancies then have trouble conceiving or carrying a pregnancy to term.
The diagnosis of infertility is used if you do not fall pregnant after a year of trying, or 6 months for those over the age of 35.
Infertility can affect both men and women and may be due to a range of factors, including age, lifestyle, complications from previous pregnancies, surgeries or medical conditions.
How is it different from primary infertility?
The emotional journey of secondary infertility can be uniquely challenging.
While any form of infertility is heartbreaking, the desire to give your child a sibling adds a sense of urgency to the situation for some parents.
Worries about the age gap between children and being constantly surrounded by reminders of babies can make struggling to conceive the second time around all the more difficult.
Female age is the single most important factor affecting the chance of successful conception, with the risk of infertility for women significantly increasing over the age of 35. For men, the drop in fertility happens around the age of 45 [2].
As the average maternal age continues to rise in Australia, rates of secondary infertility are likely to increase too [3].
Fortunately, treatments like hormones, artificial insemination, and in vitro fertilisation (IVF) are also increasingly available for those who struggle to fall pregnant naturally.
Signs of secondary infertility
Along with the obvious inability to conceive, there are some warning signs of secondary infertility.
If you notice changes in your menstrual cycle or your period is more painful than usual, this can be a sign of ovulation irregularities. Your GP can provide more information about ovulation testing, ovarian reserve testing, and other hormone tests.
For men, any changes in sexual function or low sperm count could indicate an underlying issue. This can be investigated using semen analysis or hormone tests.
Symptoms of hormone fluctuations in all genders, such as skin issues, reduced sex drive, facial hair growth, thinning hair, or weight gain, can also be useful information when diagnosing infertility [4].
Common causes of secondary infertility
Usually, both partners will need to undergo testing to diagnose and treat secondary infertility (this may include screening to rule out chlamydia and other STIs).
For women, common causes of secondary infertility include issues with the ovaries, fallopian tubes, or uterus that have developed since the first pregnancy, along with conditions like endometriosis or polycystic ovary syndrome (PCOS).
In men, secondary infertility often relates to sperm production or movement (also known as motility). Male infertility and low sperm quality or count can happen in men of any age.
Drinking less alcohol and stopping smoking can help increase sperm production [5]. Sometimes the cause of secondary infertility, like primary infertility, remains unexplained, which can be equally difficult to process.
Are there any risk factors?
More research is needed to explore secondary infertility as a separate diagnosis from primary infertility in Australia.
However, age and excessive weight gain are generally considered to be the two biggest risk factors.
A higher body mass index (BMI) appears to affect fertility negatively in both men and women, while consumption of alcohol and tobacco is also linked to higher rates of infertility [6].
STIs or complications from previous surgery or pregnancies can contribute to the risk of secondary infertility.
Much of the available research highlights these issues in developing countries where medical care is less accessible. In these cases, blocked fallopian tubes, which can be treated through surgery or medication, are often the cause of secondary infertility [7].
In Australia, there are a few studies that have focused on the relationship between secondary infertility and mental health and well-being.
A recent article suggested that a holistic approach to mental health and lifestyle factors should be used when treating infertility, as psychological wellness can also play a role in falling pregnant [8].
Can you get pregnant with secondary infertility?
Dealing with secondary infertility for months or even years can be distressing and disheartening, but there are reasons for hope.
Many couples conceive naturally in the second year of trying and IVF success rates are increasing in Australia [9].
Improving the chances of IVF success involves a combination of lifestyle changes, medical strategies, and emotional support. Female age, BMI, psychological factors, hormonal profiles, sperm characteristics, and genetic factors are considered to be predictive factors of IVF success [10].
However, IVF can be a process that requires patience and persistence, as it may take more than one cycle to succeed.
According to a 2009 analysis, only one‐third of women with infertility in Australia used hormonal and/or IVF treatment.
The authors concluded that increased awareness of the risk of age‐related infertility is key for people hoping to have children, especially for those over 30 and in relationships [11].
What to do if you suspect you have secondary infertility
Coming to terms with secondary infertility may involve feelings of grief and guilt. It’s important to allow yourself time to process and assess your options with the help of a doctor.
A fertility specialist can help identify any underlying causes of secondary infertility and discuss treatment options, which may include medications, IVF or surgery.
Infertility often carries stigma and shame, especially in societies that hold traditional views about gender roles.
Even if the cause of secondary infertility lies with only one partner, make sure you approach any obstacles and challenges as a team and communicate openly and honestly about your experiences.
Going through infertility can be an incredibly isolating journey, but when opening up to each other will help you both feel less alone and more understood.
How to overcome secondary infertility
Treatments for secondary infertility are similar to those available for primary infertility. Of course, the best option for you and your partner will depend on the underlying cause of the infertility.
Your GP may recommend lifestyle changes, hormone treatment or further testing for one or both partners to address the root of the issue.
To increase your chances of falling pregnant, it is recommended that a couple have sex every few days during ovulation.
Ovulation typically occurs around day 14 of a 28-day menstrual cycle, counting from the first day of your period. Because sperm can live for several days in the female reproductive system, you can even start trying before ovulation.
Individual cycle lengths can vary, so it’s helpful to track your period using a calendar or an app when trying to conceive.
Once you've begun fertility treatment, your doctor will be able to give you more information about a potential conception timeline.
Lifestyle can also play a role in infertility, so minimising stress, getting enough sleep, and eating a healthy diet are all key factors to keep in mind during this time.
Preparing for pregnancy
If you're lucky enough to successfully address secondary infertility, you'll need to get ready for your little bundle of joy.
Limiting alcohol, nicotine, and caffeine intake is a good idea if you're planning to fall pregnant. There are some vaccinations that people planning to become pregnant should consider too, like hepatitis B and measles [12].
Eating a nutritious diet is essential for mum and any potential baby. Taking a prenatal vitamin is an easy way to get your recommended dose of folic acid in the lead-up to pregnancy, which can help prevent major birth defects [13].
Kin’s Prenatal Vitamin is designed to support pre-conception and pregnancy with highly bioavailable ingredients that are gentle on your digestive system.
Suffering from secondary infertility can have serious effects on women’s reproductive health and emotional well-being.
However, understanding the underlying causes of secondary infertility and getting treatment from a fertility specialist can increase your likelihood of conceiving.
Most importantly, know that you are not alone on your fertility journey and there is support and treatment available.
When it comes to secondary infertility, it is always better to address your concerns with your partner and your doctor sooner rather than later to give yourself the best chance of a successful pregnancy.
Image credit: Getty Images
.svg)