Secondary infertility is the inability to conceive or carry a pregnancy to term after having had at least one successful pregnancy previously. This differs from primary infertility, which involves difficulty conceiving for the first time.
Defining and Understanding Secondary Infertility
Secondary infertility is a common condition, affecting a notable portion of couples trying to expand their families. It is just as common as primary infertility, impacting about 11% of couples in the United States.
This definition applies when the previous birth occurred without the use of fertility medications or treatments like in vitro fertilization (IVF). Secondary infertility can affect either partner or both, with causes often equally split between sexes. Some cases remain unexplained.
Common Factors Contributing to Secondary Infertility
Many factors can contribute to secondary infertility, often reflecting changes in health or lifestyle since a previous successful pregnancy. A primary factor is advancing maternal age, as fertility naturally declines as women get older. The quantity and quality of eggs decrease over time, particularly after age 35, making conception more challenging.
Changes in male fertility also play a role, with issues such as low sperm count, impaired sperm quality, or reduced motility potentially developing over time. Male fertility can be affected by factors like age, new medications, or lifestyle changes. Conditions like testicular varicocele, an enlargement of veins in the scrotum, can also lead to low sperm production.
Complications from previous pregnancies or surgeries can contribute to secondary infertility. For example, scarring within the uterus from a prior C-section or procedures like dilation and curettage (D&C) can hinder successful implantation. Infections, including sexually transmitted infections, can cause pelvic inflammatory disease, potentially leading to blocked or damaged fallopian tubes.
Lifestyle factors, such as weight gain, smoking, or excessive alcohol consumption, can negatively impact fertility in both partners. Weight gain can lead to ovulatory dysfunction in women and affect sperm health in men. Certain medical conditions that may develop or worsen over time, like polycystic ovary syndrome (PCOS), endometriosis, thyroid disorders, or autoimmune conditions, can also impair fertility.
Diagnosis and Available Treatment Paths
When a couple suspects secondary infertility, seeking medical evaluation is an important step. Healthcare providers typically recommend considering evaluation after 12 months of regular, unprotected intercourse if the female partner is under 35, or after six months if she is over 35. The diagnostic process begins with a review of medical histories for both partners to identify any changes since the previous pregnancy.
Common diagnostic tests for women include blood tests to assess hormone levels, such as estrogen and progesterone, and imaging tests like transvaginal ultrasounds to examine reproductive organs. A hysterosalpingogram (HSG), a type of X-ray, can visualize the uterus and fallopian tubes to check for blockages or structural issues. For men, a semen analysis is a standard initial test to evaluate sperm count, motility, and morphology.
Treatment options vary depending on the underlying cause. They can include lifestyle modifications, such as maintaining a healthy weight and avoiding smoking and excessive alcohol. Medical interventions may involve fertility medications, such as clomiphene or letrozole, to induce or enhance ovulation.
If these methods are not sufficient, assisted reproductive technologies (ART) may be considered. Intrauterine insemination (IUI) involves placing sperm directly into the uterus to increase the chance of fertilization. In vitro fertilization (IVF), a more complex procedure, involves fertilizing eggs with sperm in a laboratory setting before transferring the embryo into the uterus. Surgical procedures might also be necessary to address issues like uterine fibroids, polyps, or scar tissue.
Emotional Well-being and Support
Experiencing secondary infertility can bring a complex range of emotions, including sadness, frustration, and guilt. Many individuals may feel confusion, especially since they successfully conceived before. The unique challenge often stems from already having a child, which can lead to feelings of isolation or a sense that their struggle is minimized by others.
It is common for those facing secondary infertility to feel pressure to provide a sibling for their existing child. Well-meaning comments from friends or family, such as “at least you have one,” can be emotionally damaging and induce guilt. This situation can lead to a specific type of grief over the envisioned family size or sibling relationship.
Seeking support is an important step for emotional well-being. Open communication with partners can help navigate the strain secondary infertility might place on relationships. Professional counseling or therapy specializing in infertility can provide coping strategies and a safe space to process feelings. Connecting with others who understand the experience through support groups can also offer validation and shared understanding.