What is Secondary Infertility?

Secondary Infertility

The inability to conceive a child or carry a pregnancy to term after having previously given birth is known as secondary infertility. The previous birth must have occurred without the use of reproductive medicines or therapies, such as in vitro fertilization, to be classified as secondary infertility. Secondary infertility is usually identified after six to a year of unsuccessful attempts to conceive. Recurrent pregnancy loss is a disorder in which individuals and couples are able to conceive but are unable to carry the pregnancy to term.

How common is secondary infertility?

Secondary infertility is just as common as primary infertility.

What are the causes of secondary infertility in a woman or a man?

Secondary infertility can be attributed to one or both couples. About one-third of cases are caused by women, while the other one-third are caused by men. In the remaining one-third of cases, the cause is unknown or a mix of variables. Secondary infertility in women and men can be caused by advancing age, complications from a previous pregnancy or surgery, increased weight, drugs, sexually transmitted illnesses, reduced sperm production, alcohol misuse, and smoking.

Secondary Infertility

What are the causes of secondary infertility in women?

The causes of secondary infertility in women include:

  • Egg supply or quality issues: Women are born with a finite number of eggs and are unable to produce fresh eggs after giving birth. The number of eggs left in a woman’s ovaries decreases as she approaches her 40s and beyond, and the remaining eggs are more likely to have chromosomal issues. Other reasons for a limited number of good quality eggs in women who aren’t concerned about their age include autoimmune or genetic problems, as well as past surgery or radiation.
  • Fallopian tube issues: Pelvic infections like chlamydia or gonorrhea can cause the fallopian tubes, which deliver eggs from the ovaries to the uterus, to become clogged. Pelvic inflammatory disease can be caused by infections, particularly sexually transmitted illnesses. Scarring and occlusion of the fallopian tubes might result as a result of this. Infection with the human papillomavirus (HPV) and its therapies can affect cervical mucus and reduce fertility.
  • Uterine problems: There are a variety of uterine issues that might lead to secondary infertility. During a dilation and curettage (D&C) or Cesarean delivery, scarring can form inside the uterus, causing adhesions that can interfere with future pregnancies. Fibroids or polyps are benign (non-cancerous) growths that can interfere with pregnancy. Infection and uterine damage can result from a retained placenta. It’s possible to get isthmocele, or scarring in the uterus, if you had a cesarean delivery with a previous pregnancy. An isthmocele can cause uterine irritation, which can prevent implantation. According to a case study published in 2019, isthmocele can be successfully treated to promote increased fertility. After a surgical treatment to correct the isthmocele, the woman was able to conceive via in vitro fertilization (IVF).
  • Endometriosis is a condition in which tissue that ordinarily grows inside the uterus grows outside of it, such as on the ovaries or intestinal surfaces. While endometriosis is common, it does not always result in infertility.
  • Polycystic ovarian syndrome (PCOS) is a hormonal disease characterized by menstrual periods that are longer or less frequent than normal. A woman with this ailment has an excess of male hormones in her body, and her ovaries don’t release eggs on a regular basis.
  • Breastfeeding: If a mother just breastfeeds her infant, her body will stop ovulating or releasing eggs for fertilization.
  • Weight gain or other lifestyle changes: In certain patients, weight gain can contribute to ovarian dysfunction. Certain diets may have an impact on fertility. Medications can also have an impact on fertility.
Secondary Infertility

What are the causes of secondary infertility in men?

Causes of secondary infertility in men include:

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Reduced testosterone level.

Testosterone is important for sperm production. Age, injury to the urinary or genital organs, and certain medical diseases can all cause testosterone levels to drop. These are some of the conditions:

  • Infections in the genital area
  • Thyroid problems
  • Diabetes
  • Tuberculosis
  • Mumps
  • Smallpox
  • Blood-related illnesses
  • Tumors that are benign
  • Emotional tension
  • A myocardial infarction is a type of heart attack.
  • Coma
  • Stroke
  • Respiratory failure is a condition in which the body’s ability to breathe is
  • Heart failure due to congestive heart failure
  • Burns
  • Sepsis, which is an infection-related illness that can be fatal,
  • Surgical procedures involving the vaginal tract
  • The presence of mycoplasma, a bacterial species,
  • Anesthesia
Secondary Infertility

Testicular Varicocele

The scrotum, or the sack of skin that encases the testicles, has enlarged veins. This is a prevalent cause of infertility in men due to poor sperm production. Testicular varicocele affects about 30% of infertile men.

Poor-quality Semen.

Semen is the sperm-carrying fluid. Semen quality tends to deteriorate after the age of 40.

Prostate Enlargement.

This can reduce sperm count and make it difficult to ejaculate normally (the discharge of semen from the body).

Prostate removal.

Cancer or other disorders may necessitate the removal of the prostate. The removal of the prostate can cause the flow of sperm to reverse.

Late onset hypogonadism.

This is a condition in which hormone secretion is reduced.

Certain drugs that affect sperm count and quality.

Antibiotics and blood pressure medications are among the pharmaceuticals in this category. Treatments for the following disorders can also alter sperm quality:

Secondary Infertility
  • Prostate cancer is an illness that affects men.
  • Prostate enlargement
  • Infections with fungi
  • Acidity in the stomach
  • Infections of the urinary tract.
  • Ulcerative colitis is a condition in which the intestines become inflamed.
  • Arthritis.
  • Gout.
  • Pain.
  • Cancers.
  • Seizures.
  • Schizophrenia.

Use of certain commercial sexual lubricants that are toxic to sperm.

Peanut, safflower, and vegetable oils; raw egg white; and petroleum jelly are all nontoxic natural lubricants.

Exposure to certain chemicals.

Pesticides, lead, industrial pollutants, and severe heat can all have a negative impact on a man’s fertility.

Excessive weight gain.

This can lead to a drop in testosterone and an increase in estrogen.

What are the possible signs of secondary infertility?

Secondary infertility should be suspected if a man and woman aged 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without becoming pregnant. This is especially true for males with low sperm counts and women over 30 who have had pelvic inflammatory disease, painful periods, irregular menstrual cycles, or miscarriages.

Secondary Infertility

Autoimmune disorders

The link between autoimmune illnesses and infertility isn’t entirely clear. Autoimmune disorders cause the body to target healthy tissues in general. This could also include reproductive tissues.

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By producing inflammation in the uterus and placenta, autoimmune illnesses such as Hashimoto’s, lupus, and rheumatoid arthritis can impact fertility. Medicines used to treat certain illnesses may also play a role.


We understand that this is a sensitive subject, but there is no way to avoid it. According to science, aging does have an impact on fertility. In contrast to primary infertility, age was found to have a statistically significant effect on secondary infertility in this 2018 study. The average age of couples experiencing secondary infertility was greater in the research.

Women’s fertility peaks around the age of 20 and begins to fall around the age of 30—with a major reduction by the age of 40. This isn’t to imply that a successful pregnancy can’t occur at a later stage in a woman’s life. It may simply take longer or be more difficult.

Unexplained reasons

It’s the answer no woman wants to hear, but doctors can’t always (and unfortunately, frequently) uncover a diagnosable cause for secondary infertility. We understand how easy it is to lose hope after a battery of tests, therapies, and “tries.”

However, keep in mind that your health might change, new medical breakthroughs can occur, and the future may contain all you’ve hoped for. As a result, engage with your doctor to ensure that no stone is left unturned in your quest to conceive.

Secondary Infertility

What should a couple do if they suspect secondary infertility?

Schedule an appointment with a women’s health practitioner, a reproductive endocrinologist, or a urologist if you suspect secondary infertility. Don’t wait any longer. Early evaluation is crucial to offer the largest range of therapy options.

If anything has changed since your previous pregnancy, your doctor will evaluate your medical history. The doctor will inquire as to whether you’ve had irregular menstrual cycles and if you’re ovulating and developing eggs normally. A medical history will reveal whether thyroid disease, cancer, or age-related disorders have impacted sperm count or quality in men.

The doctor and the couple will talk about the various tests that could be done. A hystero-salpingogram, or HSG, for example, would identify scarring or abnormalities in the uterus. A semen analysis may also be ordered by the doctor.

What are the treatment options for secondary infertility?

Treatments for infertility, whether primary or secondary, are similar and include:

  • Medications that induce ovulation in women with ovulatory disorders, such as clomiphene (Clomid®) and letrozole,
  • Intrauterine insemination (IUI), which entails surgically implanting sperm into a woman’s uterus in order to improve the chances of conception, IUI can make use of sperm donors.
  • IVF entails daily injections to stimulate the ovaries, a surgical procedure to collect eggs, egg fertilization in a lab to create embryos, embryo growth in the lab, and embryo transfer into the uterus. In IVF, egg or sperm donors can be employed. A gestational surrogate (a woman who is not related to the child) may be used in IVF to carry the pregnancy to term, albeit this is not permitted in all states or countries. Egg freezing can be done before fertilization for women who don’t have a partner or who want to keep their fertility in the future.
Secondary Infertility
  • Surgery to repair uterine-related disorders in women Doctors can treat structural issues in the uterus, such as scar tissue, polyps, and fibroids. Testicular varicocele is repaired with surgery. This is the most surgically correctable cause of infertility in men.
  • Antioxidants and anti-aging vitamins can help men become more fertile. Drug therapy can also help to increase the quality of sperm.
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Tips for coping with secondary infertility

It’s difficult to deal with secondary fertility. There are never-ending doctor’s appointments, tests, treatments, and prescriptions. nights with no sleep. You’re taking time and energy away from your child. Feeling guilty about desiring another pregnancy while so many women are battling to have one. You and your lover are both stressed. When you’re invited to yet another baby shower, you’re sad — and guilty for feeling that way.

The list goes on and on. So, here are a few coping strategies.

  • Don’t put the blame on yourself or your partner. In most circumstances, secondary is unrelated to you or your partner’s actions. Maintain a laser-like focus with your doctor on your current predicament and evidence-based solutions for overcoming it.
  • Maintain an optimistic attitude. Look for success stories; there are a lot of them out there. Look for other women who have had similar infertility experiences in your personal network or support groups. Make contact with them and tell them about your experiences. Discover what they did, which doctors they consulted, and what factors contributed to their successful pregnancy.
  • Make eye contact with your spouse. Even the healthiest relationship can be harmed by the stress of infertility. Take the time to get to know your mate. Discuss your sentiments, express your fears, and come up with a plan to move forward feeling in sync. If you traverse this difficult path side by side, you’ll both be stronger.
  • Concentrate on what you have control over. There are a lot of things you can do to boost your fertility. Self-care is one of them. Take an active role in stress management, living the healthiest lifestyle possible, and looking for new and innovative ways to help you conceive. Bring new thoughts and ideas to your doctor for consideration.
  • Seek out your allies. Every couple dealing with infertility requires a strong support system. If you are experiencing symptoms of clinical depression, such as hopelessness and despair, confide in those you trust and always talk to your doctor.

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