If you’re here, you may be searching for answers, support, hope, and direction on how to move forward with infertility after conceiving once before. The truth is, you’re not alone — far from it.
Looking at infertility overall, an estimated 12 percent of women in the United States have difficulty conceiving or staying pregnant. And secondary infertility — when this difficulty occurs after one or more successful pregnancies — often catches people off guard.
We understand that secondary infertility can bring a range of challenging emotions such as sadness, hopelessness, confusion, frustration, and even guilt — among others. Whether you’ve been formally diagnosed with secondary infertility, or are navigating early troubles with getting pregnant again, this is a safe place to learn more about it.
There are two types of infertility: primary and secondary. Primary infertility describes not being able to get pregnant, usually after 1 year of trying — or 6 months, if age 35 or over.
Those who experience secondary infertility, on the other hand, have trouble conceiving after successfully becoming pregnant at least once before.
Just like primary infertility, secondary infertility can occur due to an issue at any point in the natural — and somewhat complicated — process required to become pregnant. Your fertility can change even after the birth of a child. (And your partner’s can change with time as well — more on that in a second.)
A problem may occur with one or several of the following steps:
Now, there’s a long list of diseases and conditions — as well as the frustrating “unexplained infertility” catchall — that can cause issues. But before we discuss them, it’s important to know that both women and men can contribute to infertility.
This article focuses on women, but there’s both a female and male factor in 35 percent of couples experiencing infertility. And in 8 percent of cases, it’s a male factor alone.
Primary and secondary infertility often share the same causes. The most important thing to know is that, in the vast majority of cases, infertility is not your fault. We know this doesn’t make it easier to cope with, but it can help you feel more empowered to find evidence-based solutions that may help you successfully conceive.
Here are some of the most common causes of infertility in general, which usually relate to secondary infertility, too.
Most female infertility is due to ovulation disorders. In fact, 40 percent of women with infertility don’t consistently ovulate. Problems with ovulating can be caused by several conditions and factors, such as:
One of the most common causes of female infertility is PCOS, which makes the ovaries or adrenal glands produce too many hormones that prevent the ovaries from releasing eggs. It can also cause cysts to develop on the ovaries that may further interfere with ovulation.
The good news is that there are effective treatments for PCOS. In fact, treatment with medications (more on this below) may result in successful pregnancies in up to 70 percent of women with PCOS.
Structural problems can affect your ability to get pregnant. For example, if there is a blockage in the fallopian tubes, sperm and egg may not be able to meet. The uterus may also have a structural or tissue defect that prevents implantation.
Here are some specific conditions that affect the fallopian tubes or uterus.
Endometriosis is important to call out, because it affects up to 10 percent of women.
Plus, this 2010 review of endometriosis and infertility shares a compelling relationship — 25 to 50 percent of women with infertility have endometriosis.
Secondary infertility because of endometriosis can result after a cesarean section or uterine surgery, when uterine cells can get misplaced and symptoms begin or increase.
If you had a cesarean delivery with a previous pregnancy, it’s possible to have scarring in the uterus, called isthmocele. An isthmocele can lead to inflammation in the uterus that affects implantation.
A 2019 case study outlines how isthmocele can be successfully treated to promote enhanced fertility. In this case, the woman successfully conceived via in vitro fertilization (IVF) after the isthmocele was resolved with a surgical procedure.
Infections — including sexually transmitted infections — can cause pelvic inflammatory disease. This can lead to scarring and blockage of the fallopian tubes. A human papillomavirus (HPV) infection (and its treatments) may also affect cervical mucus and decrease fertility as well.
The good news: The sooner the infection is treated, the less fertility will be affected.
The relationship between autoimmune disorders and infertility isn’t fully understood. In general, autoimmune disorders cause the body to attack healthy tissues. This could involve reproductive tissues, too.
Autoimmune disorders such as Hashimoto’s, lupus, and rheumatoid arthritis may affect fertility by causing inflammation in the uterus and placenta. And, medicines that treat these disorders may contribute as well.
We know this is a touchy subject, but unfortunately, there’s no way around it. Science says that age does play a role in fertility. This 2018 study correlated age as a statistically significant factor in secondary infertility compared to primary infertility. In the study, the average age of couples was higher among those experiencing secondary infertility.
Biologically, fertility peaks around age 20 for women and begins to decline at age 30 — with a significant reduction by age 40. This isn’t to say that a successful pregnancy can’t happen at more advanced maternal ages. It just might take longer or be more challenging.
It’s the answer no woman wants to hear, but sometimes (and sadly commonly) doctors can’t find a diagnosable reason for secondary infertility. After batteries of tests, treatments and so many “tries,” we know it can be easy to lose hope.
But please keep in mind that your body can change, new medical insights can emerge, and the future may hold everything that you’ve been hoping for. So work with your doctor to leave no stone unturned along your journey to conceive.
If you previously conceived easily, this all may feel very scary and unfamiliar — and complicated. But treatment for infertility first starts with identifying its cause. So, your doctor may recommend some tests. These tests might involve:
If your tests come back without any red flags, your doctor may suggest looking into tests for male infertility. (Sorry, ladies: It’s a fact of life that we’re put under the microscope first.)
Once you know the cause, your doctor can develop a treatment plan to increase your odds of conceiving. Here are some common treatments for infertility in women.
Medications are often used to normalize hormones. Other times, fertility-enhancing medications are recommended to help stimulate ovulation.
Because PCOS is such a common cause of infertility, it’s worth mentioning that treatment may involve medications to help stimulate ovulation in addition to lifestyle interventions, such as getting to a healthy weight if your doctor decides weight is a factor.
In some cases, you may need surgery. There are several effective surgical procedures that may treat issues such as uterine fibroids, uterine scarring, or advanced endometriosis. Many of these procedures are performed minimally invasively.
Hysteroscopy is used to diagnose and treat abnormalities of the uterus, such as polyps and endometriosis. Laparoscopy is a method to help diagnose infertility when other measures have been unsuccessful and can be used with hysteroscopy as effective treatment.
Surgery sounds scary, but being told there’s a surgical solution to your infertility is actually pretty encouraging news.
A successful pregnancy might involve ART. Two of the most common are intrauterine insemination (IUI) and IVF.
With IUI, sperm is collected and then inserted into the uterus at the time of ovulation. In IVF, a woman’s eggs are collected as well as the sperm. In a lab, the egg is fertilized with the sperm where they develop into embryos. Then, an embryo (or more than one) is implanted into a woman’s uterus.
These methods can be promising. The CDC’s 2017 Fertility Clinic Success Rates Report showed that 284,385 ART cycles performed in the United States in 2017 resulted in 68,908 live births and 78,052 babies born (yes, that means lots of multiples!). That’s a 24 percent success rate.
Coping with secondary fertility can be tough. Endless doctor appointments, tests, procedures, and medications. Sleepless nights. Time and energy away from your little one. Guilt over wanting another pregnancy when many women are struggling to have just that. Stress between you and your partner. Sadness when you get invited to yet another baby shower — and guilt for even feeling that way.
The list is never-ending. So here are a few tips to help you cope.
Secondary infertility can take a physical and emotional toll on anyone, including you, your partner, and loved ones. It’s important to talk to your doctor about all of your concerns, struggles, and goals.
This way, you can be guided to the right resources that can help you along your journey to conceive again. Stay strong (it’s OK to cry, too), lean on your support networks, look for inspiring success stories, and never lose hope.
Last medically reviewed on January 13, 2020
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