What is secondary infertility?

Think of the word “infertility,” and you might picture a couple without children struggling to get pregnant or stay pregnant. But there is another set of people — those who have successfully conceived and given birth to one or more children — who struggle with infertility, too. Called secondary infertility, the condition often carries an extra burden: Those affected by it might feel guilty over wanting another child; those close to them may be unsympathetic because they are already a parent; or frustrated because getting pregnant the first (or second) time was relatively easy. Those feelings can come on top of the sadness, loneliness and shame that infertility often triggers. 

But infertility is common — more than 6 million women in the United States have trouble getting and staying pregnant — and if you suspect you might be experiencing secondary infertility, there are treatment options that can help you with achieving your goals for your family. 

Read on to learn more about secondary infertility causes and when to talk to your doctor about testing and treatment. 

Primary infertility is a condition in which a successful pregnancy has never been achieved by a person trying to conceive. Secondary infertility is when at least one successful pregnancy has occurred, but someone is now struggling to get pregnant and give birth again.

In the United States, about 19 percent of women — or 1 in 5 — who have never given birth are unable to get pregnant after a year of trying to conceive according to the Centers for Disease Control and Prevention (CDC). This percentage is smaller in women who have had one or more prior births: About 6 percent of women in that group have trouble getting pregnant after one year of trying.

Both men and women can experience health issues that lead to secondary infertility, and sometimes the cause is unknown or unexplained. Some factors that might contribute to difficulty conceiving include:

• Age

• Weight gain

• A low quantity of eggs or low-quality eggs

• Low sperm count or poor-quality sperm

• Low testosterone

• Blockages in the fallopian tubes or uterus 

• Problems with ovulation 

• Polycystic ovary syndrome (PCOS)

• Endometriosis

• Use of certain medications

• Environmental factors, such as exposure to certain chemicals

If you have been having regular unprotected sex for one year and have not conceived and you are younger than age 35, talk to your doctor. If you’re 35 or older, your doctor might want to see you after six months of regular unprotected sex.

“An evaluation in patients with secondary infertility is quite important because we need to determine what the problem is — and sometimes it can be multifactorial,” says Valerie Ratts, MD, a Washington University fertility specialist at Barnes-Jewish Hospital. “Once we know where the problem lies, then we know how to treat it.”

If you’ve been struggling to conceive, schedule an appointment with your health care provider. They will go over your medical history, ask about your menstrual cycles to make sure you’re ovulating and rule out any conditions or medications that might be making it difficult to get pregnant. If your doctor determines more testing is needed, they might recommend getting bloodwork done to check hormone levels, performing a semen analysis or doing a transvaginal ultrasound or other imaging to look at your uterus and fallopian tubes.

Treatment for secondary infertility might include surgery to fix issues in the uterus or testicles, drugs to induce ovulation for those who aren’t ovulating regularly, intrauterine insemination or in vitro fertilization. 

Generally, yes, says Kenan Omurtag, MD, a Washington University fertility specialist at Barnes-Jewish Hospital. “Patients with prior live births experiencing secondary infertility generally have a more favorable prognosis with fertility treatment than those with primary infertility,” he says.

The Fertility & Reproductive Medicine Center at Barnes-Jewish Hospital and Washington University School of Medicine offers a range of fertility testing and services. Call 314-286-2400 to make an appointment. Specialists also see patients for consultations and labs at Missouri Baptist Medical Center and Memorial Hospital Shiloh.