Secondary infertility – when baby #2 (or 3 or 4 …) doesn’t come easily

If you have previously conceived with ease, it can come as a shock when a subsequent pregnancy and baby don’t come as easily. However, this situation is not uncommon.

Secondary infertility, defined as the inability to conceive despite having conceived in the past, affects approximately 10% of women.1 It is different from primary infertility, which is when a woman who has never conceived before struggles to fall pregnant.

Secondary infertility can produce similar heartache to primary infertility, especially if you feel your family is not yet complete, you want to provide your children with a sibling, or you long for the son or daughter you don’t yet have. It’s important to recognise that your feelings and concerns are valid, and shouldn’t be brushed aside simply because you already have one or more children – you are equally deserving of seeking help to achieve a second or subsequent child, as are a woman or couple yet to have any children.

What causes secondary infertility?

There are a number of factors that are commonly associated with secondary infertility. These include:

  • Age: It’s common knowledge that women have a ‘biological clock’ – that is, the age-related decline in a woman’s fertility, due to a decrease in the number and quality of her eggs. This decline accelerates once a woman hits 35. Given that a woman is usually older when planning subsequent pregnancies, her increasing age can be a significant contributing factor to any difficulty she is experiencing second (or third or fourth …) time round. This is particularly true nowadays due to the societal trend towards older age at first pregnancy, meaning women can be well over 35 when they are ready to start trying for another child. For men, there is also a gradual age-related fertility decline from the age of 40, even if their sperm count is reported as normal.
  • Lifestyle: Successful conception requires unprotected sexual intercourse to occur at the right time – around the time of ovulation, when an egg is released from the ovaries. Consequently, unprotected sex every one to two days during this ‘fertile window’ each month provides the best chance of falling pregnant. However, with one or more young children to take care of, maintaining regular sexual intercourse, let alone doing it at the ‘right’ time, can be difficult. Further, you may not be taking care of yourself as well as you usually would, as you put the needs of your little one/s first. A good diet and regular exercise can fall by the wayside for mums of busy toddlers. This, combined with potential weight gain, can also contribute to sub-optimal fertility at this time of life.
  • Complication from a prior pregnancy or delivery: Scar tissue can sometimes form inside the uterus (womb) or cervix. This may be an issue if you have ever had a procedure called a dilatation and curettage (D&C) to remove tissue from the uterus due to a miscarriage or retained placenta after a previous birth. Although uncommon, the presence of scar tissue can prevent a pregnancy. However, it can usually be removed via a simple procedure called a hysteroscopy.

Secondary infertility can also be caused by many of the same factors that cause primary infertility. For women, this includes ‘structural’ disorders that may be affecting the health of your reproductive organs (e.g. endometriosis, fibroids, polyps), as well as hormonal disorders like polycystic ovarian syndrome (PCOS) and thyroid disease. Thus, a full check-up with your gynaecologist is a good first step if your next pregnancy isn’t coming as quickly as you would like or expect.

What should I do if I’m experiencing secondary infertility?

The advice for those experiencing secondary infertility is the same as for those experiencing primary infertility. If you are under 35, seek help after 12 months of trying. If you are over 35, seek help after 6 months of trying. Depending on your circumstances, fertility treatment may be as simple as ovulation tracking and fertility optimisation through lifestyle changes. For advice specific to you, you can make an appointment with one of our fertility specialists by calling Newlife IVF on (03) 8080 8933 or by booking online via our appointments page.

Further reading

Reference


  1.  Mascarenhas et al. PLoS Med. 2012;9(12):e1001356.