What is Secondary Infertility?

For some, it may seem like a given that you won’t have any trouble getting pregnant again after having successfully given birth.  However, for many women, this is not the case. Secondary infertility is the inability to conceive or carry a baby to term after previously having given birth, and it accounts for six out of ten infertility cases in the US. Receiving a secondary infertility diagnosis might feel like a major setback, but assisted reproductive technology like in vitro fertilization can help you grow your family. 

What is secondary infertility?  

Secondary infertility is defined as the inability to conceive or carry a pregnancy to term after previously successfully giving birth. Primary infertility occurs when the woman has never been able to successfully achieve pregnancy. For both conditions, they can be unexplained, however secondary infertility remaining unexplained only occurs in about 1 in every 5 cases. There are often medical reasons explaining the cause for secondary infertility in women that can thankfully be solved using infertility treatments such as IVF treatment.

What causes secondary infertility?  

There can be a range of factors causing secondary infertility in women, most of which can be addressed with the use of in vitro fertilization. Some of the most common factors leading to secondary infertility are endometriosis, polycystic ovary syndrome (PCOS), reduced ovarian reserves and complications from previous surgeries or pregnancies, to name a few. Below are some of the conditions that can lead to secondary infertility.  

Reduced ovarian reserves  

Women are born with all the eggs they will ever produce. As women approach their 40s, their egg stores start to deplete, and the risk of your remaining eggs having underlying health problems such as chromosomal abnormalities increases. Low egg count or poor egg quality could also be caused by autoimmune or genetic conditions.  

Freezing your eggs in your younger years and then undergoing a frozen embryo transplant (FET) is a great way to combat the loss of eggs in as you age, or donor eggs can also be used. However, female infertility testing can also be conducted to evaluate your ovarian reserve. This is why it can be important to think about freezing your eggs before your 40s, if the option is available. 

Complications from a prior pregnancy or surgery  

A range of complications can occur from previous surgeries or pregnancies that unfortunately lead to secondary infertility. Scarring from certain procedures such as C-section deliveries and dilation & curettage (D&C) can affect your ability to conceive another child. If you are struggling to conceive, it is important to visit your fertility doctor to conduct female infertility testing to determine if there is any scarring or blockages in or around your uterus and to see what can be done moving forward. 

Polycystic ovary syndrome (PCOS) 

Polycystic ovary syndrome, also referred to as PCOS, is a common hormonal condition. It can cause irregular or infrequent ovulation that can be quite painful depending on the person. This irregular ovulation can cause secondary infertility as it makes it harder to conceive with infrequent or irregular windows of implantation (WOIs). Thankfully, with assisted reproductive technology like IVF treatment, there exists solutions that can allow you to successfully conceive. 

Endometriosis  

Endometriosis is a common condition where tissue that is supposed to grow inside your uterus begins growing elsewhere in your abdominal cavity, most commonly on or around the ovaries. While not all cases of endometriosis can result in primary or secondary infertility, some unfortunately do cause difficulty conceiving. This occurs most frequently after a c-section or uterine surgery misplaces uterine cells, and symptoms of endometriosis begin or become more severe. It is also important in this case to visit your doctor and fertility specialist to see what your fertility treatment options are. 

Sexually transmitted infections (STIs)  

Certain sexually transmitted infections (STIs) can cause damage to your fallopian tubes or uterus. Notably, infections such as chlamydia and gonorrhea can lead to pelvic inflammatory disease (PID), which can cause primary or secondary infertility by creating blockages or scarring in the fallopian tubes. These infections can often be treated with medicine prior to turning into pelvic inflammatory disease if they are caught in time, making it important to regularly schedule STI screening. 

Weight gain or other lifestyle changes 

Weight gain can cause ovarian problems for some women. A significant weight gain can put undue stress on the body, which may contribute to secondary infertility. Likewise, if you are experiencing prolonged, high levels of stress, this can reduce your fertility. 

If you have other underlying health conditions, some medications or treatments can also cause infertility, so this is important to discuss with your infertility doctor before looking into in vitro fertilization or other infertility treatments. Lifestyle habits such as smoking or drinking in excess can also have a profound impact on your fertility. 

Who is at risk for secondary infertility? 

Secondary infertility can be caused by a number of factors. Some conditions (such as endometriosis) do not necessarily cause secondary infertility in everyone affected, so it is important to follow-up with an infertility doctor if you suspect you might have it. Factors such as advanced age, weight gain, or previous health conditions are the most common causes of secondary infertility. Thankfully, even with a diagnosis of secondary infertility, there are a range of fertility treatment options, such as IVF treatment, that can help you grow your family.  

How is secondary infertility diagnosed?  

Fertility testing for women involves several different tests to evaluate your hormone levels, quantity of your ovarian reserve, and your overall uterine health. Specifically, female fertility testing involves blood tests, hysterosalpingography, ultrasounds, and a uterine cavity exam. These tests will reveal if you have any blockages caused by polyps, cysts, or scar tissue; any uterine abnormalities; or any hormonal issues that may be interfering with your ability to conceive. Your doctor will also evaluate your medical history in case any pre-existing conditions may be contributing to your difficulties getting pregnant. 

What are the treatment options for secondary infertility?  

Depending on what the specific causes for your secondary infertility are, there exists a range of possible solutions, IVF treatment being among them. The treatment depends on the causes behind it, your age, personal preferences, and how long you’ve been dealing with infertility. Your fertility specialist will work with you to create a personalized treatment protocol based on your female fertility test results and medical history. 

Hormone medications  

Hormone medications are a very common part of fertility support. These hormone medications can stimulate ovarian production, ovulation, as well as support endometrial receptivity in those who have secondary infertility. Your fertility specialist will be able to determine the kind of fertility support you need based on your fertility test results.  

Intrauterine insemination (IUI)  

Intrauterine insemination (IUI) refers to the procedure in which sperm is inserted into the uterus in order to increase your chances of conceiving. This can either be done with your partner’s sperm or using donor sperm depending on your situation. The procedure involves placing the sperm directly within reach of your eggs so that when a healthy egg is released it can easily fertilize the egg and is a slightly less invasive procedure than in vitro fertilization. 

In vitro fertilization (IVF)  

In vitro fertilization (IVF) has become one of the most common assisted reproduction procedures used today. The treatment involves retrieving eggs from your ovaries and  combining them with sperm in a lab setting. As opposed to simply injecting the sperm directly into the uterus as is done with IUI, IVF goes one step further and fertilizes the egg in order to maximize your chances at successfully conceiving.  

Corrective surgery  

Corrective surgeries can sometimes be used as fertility treatment options. This often occurs in cases where there is a polyp, scar tissue, or other blockages in your uterus or fallopian tubes that need to be removed in order for egg fertilization and development to occur. Thankfully these blockages can often be easily removed and after some recovery time, you should be able to conceive unaided as long as there are no other pre-existing conditions found.  

When should you speak to your doctor?  

If you have been trying to conceive for six months to a year with no success, it’s recommended you speak to your doctor about undergoing infertility testing. If you are diagnosed with infertility, be sure to check out our Guide to Coping with Female Infertility.  With all the advances being made in reproductive medicine, it is important to keep in mind that this diagnosis doesn’t mean that you won’t be able to conceive again. There are many possible infertility treatments that exist and could allow you to overcome barriers regarding your fertility.