What You Should Know About Secondary Infertility

Infertility is a deeply personal issue, yet more people have come forward to share their stories of pain and hope in recent years. Though many choose to keep their struggle private, infertility is not rare, affecting millions worldwide. According to the World Health Organization, infertility affects 48 million couples and 186 million individuals across the globe.

Though some think that getting pregnant should happen right away once you stop birth control, infertility is diagnosed after one full year of having unprotected sex and trying to get pregnant with no success, as per the CDC.  The timeline changes to six months for women ages 35 and older, so time is of the essence.

There are also different types of infertility. Primary infertility is diagnosed when you've never been pregnant before, and secondary infertility occurs when you've already conceived in the past but are unable to get pregnant again.

Causes of secondary infertility

The causes of secondary infertility are similar to primary infertility. One major cause is ovulation problems, either irregularly or not ovulating at all, as per Mayo Clinic.

Another cause of secondary infertility is blocked fallopian tubes. Often the tubes become blocked or damaged, which keeps sperm from meeting the egg. Even when sperm does manage to fertilize the egg, blocked tubes can keep the egg from reaching and implanting in the uterus.

Endometriosis, the painful condition where endometrial tissue grows outside of the uterus, is another big reason for secondary infertility (via Verywell Family). Difficulties stemming from previous surgery or pregnancy can also contribute.

Other conditions that can lead to secondary infertility include fibroids, polycystic ovary syndrome (PCOS), uterine scarring, and immunological problems in which anti-sperm antibodies are present, as well as having hostile cervical mucus that can prevent fertilization. Like primary infertility, sometimes secondary is unexplained, and no one cause is found.

Men play a role in secondary infertility

Low testosterone levels are a significant cause of male infertility. According to the Cleveland Clinic, levels decrease with weight gain, injury, and medical conditions, including diabetes, sexually transmitted infections, and even stress.

Other causes of secondary infertility in men include testicular varicocele, where veins in the scrotum are enlarged, poor quality sperm, and hormonal problems. Medications can also cause poor sperm quality, such as those used to treat high blood pressure, gout, and stomach acid.

As men age, changes take place that can also contribute to decreased fertility, as per the National Library of Medicine. Sperm motility, movement, and sperm morphology, the shape of sperm, change after age 40. These changes result in lower-quality sperm and fewer sperm, which can lead to secondary male infertility.

In addition, prostate issues can inhibit male fertility, as per WebMD. An enlarged prostate or a prostate removal can cause a reduced sperm count and a reverse in sperm flow.

Being diagnosed with secondary infertility

Diagnosing secondary infertility is a multi-step process. Both men and women need to be tested. First, a complete medical history will be taken to discuss previous illnesses, surgeries, sexually transmitted infections, and current medications (via MedicalNews Today).

In women, a history of their cycle, past pregnancies, and pregnancy loss will be recorded. In men, doctors will inquire about injury or issues with testes.

Both men and women will have a physical exam, bloodwork, and possibly an ultrasound to check reproductive organs. Men will undergo a sperm analysis.

Once diagnosed with secondary infertility, it's essential to seek out support. Secondary infertility can leave you feeling lonely and disconnected because there is often less understanding among the infertility community because the couple/person already has a child (via Resolve). However, that does not diminish the pain of infertility or the need for support. Counselors who specialize in reproductive challenges can help you through the process.

How secondary infertility is treated

Like primary infertility, there are a few different ways to treat secondary infertility. The first line of defense for both men and women is treating any medical conditions contributing to infertility. Next, women may be given fertility medication, usually oral or injectable hormones, to foster increased egg production, as per Penn Medicine.

Sometimes minimally invasive surgery in the form of laparoscopy or hysteroscopy is done to address fibroids, uterine scarring, endometriosis, or polyps (via Healthline). This helps prime the uterus for implantation.

Advanced reproductive technology (ART) is also helpful in treating secondary infertility. One commonly used treatment is intrauterine insemination (IUI), where a sperm sample is taken. Doctors insert sperm directly into the uterus when a woman is ovulating to increase pregnancy chances. Another form of ART is in-vitro insemination (IVF), where a sperm sample is taken to fertilize an egg in a lab to form embryos which are then implanted directly into the uterus.

When to see a doctor

When a couple already has a child, they tend to think they will eventually have another. "There's a little bit of denial," says Dr. Stephanie Beall, a fertility specialist at Shady Grove Fertility (via Today). "Couples who are struggling with secondary infertility tend to have more guilt, feel as if they are selfish, and feel they should be happy with the children they have."

Though it takes one year of trying to get pregnant to be diagnosed with secondary infertility or six months if the woman is 35 or older, you can check in with your doctor before those timelines. "If it's been three months and you're concerned, it's not too early to get evaluated, even though it may be premature to treat," says Dr. Jamie Grifo, program director of the New York University Fertility Center, tells Parents. "Waiting a year to find out there's an issue with sperm count or egg supply can lead to a lot of heartache."

When trying to conceive, seeing your doctor early on to discuss your plans and their recommendations is always a good idea.