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secondary-infertility

Secondary infertility comes with a unique set of challenges.

Women and couples who already have at least one child and are trying to get pregnant again often hear "don't worry, it will happen just like last time" from family, friends and sometimes even physicians.

Then, if they're having trouble getting pregnant, they'll hear: "You should feel blessed you have at least one," or "just keep trying, it'll happen."

Sound familiar? If so, then welcome to the world of secondary infertility.

While primary infertility (the inability to have a live birth after one year of conception attempts) is often the more focused on version infertility, secondary infertility has a significant impact and should not be ignored.

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When you have one child but are having difficulty conceiving another, this is called secondary infertility—the inability to conceive after six months of attempts and no risk factors.

An estimated three million women in the U.S. struggle with secondary infertility, according to the National Center for Health Statistics.

Actor Anne Hathaway, who recently announced she is pregnant with her second child, said in an Associated Press interview that pregnancy has not come easily. Today Show host Dylan Dreyer has talked candidly about having secondary infertility—she also recently announced she is pregnant with her second child.

Causes of secondary infertility

Secondary infertility is usually due to changes since your prior conception. Reasons might include:

Advancing age

Usually, the age of the woman is most significant, but more evidence is accumulating on the impacts of the male partner or sperm donor's age. There is simply no escaping the male or female biological clock. With age, fertility declines and miscarriages increase (mostly due to chromosomal abnormalities of the aging egg).

Female or male significant weight gain

It's not uncommon for people to gain weight after a baby enters their lives, and weight gain can impact male and female fertility.

Pelvic or uterine scarring

If your first birth was a C-section, if you've had others forms of surgery, or perhaps experienced uterine scarring following D&C for miscarriage, you may be at a higher risk for secondary infertility.

When to see a specialist about secondary infertility

Since you already have a child, your doctor may delay in referring you to a fertility specialist because they presume you will readily conceive again.

However, when you feel there is a problem, we as fertility specialists need to address those concerns to reduce your stress, shatter myths, and direct you quickly toward evidence-based treatment.

With secondary infertility, you should see a fertility specialist if you are:

  • under the age of 35 and have been trying to conceive for six months to a year
  • age 35 to 39 and have been trying to conceive for three to six months
  • over the age of 39 and unable to conceive no longer than three months
  • sooner for all scenarios if you are without regular periods or if there are risk factors.

The evaluation for secondary infertility is the same as for primary infertility: blood work, a pelvic exam and an ultrasound will likely be the first steps. Reproductive specialists should not assume just because all was normal prior to the first baby that all will remain normal.

Secondary infertility treatment

As with primary infertility, if the woman has at least one open fallopian tube, is ovulating monthly, and the sperm (partner's or donor) is adequate, treatment begins with fertility medication combined with intrauterine insemination (IUI). If she does not ovulate, IUI may not be necessary. Following three to six unsuccessful cycles of IUI, IVF would be the next step.

Check out Motherly's guide to assisted reproductive technologies

Lifestyle changes can make a big difference. As I mentioned, weight gain is a common change that occurs after having a child. The problems resulting from an increased body mass index include reduced fertility and ovulation disturbances, as well as reduced sperm counts in men. Studies have also found that high BMI can increase the risk of miscarriage.

Tobacco use, either directly or second hand can reduce egg and sperm function.

Other factors of importance for the man and the woman are level of exercise and nutrition.

Check out Motherly's guides to these concerns here:

Staying positive and focused during secondary infertility

Women and couples experiencing secondary infertility feel the same disappointment, frustration and void as those struggling to have their first child. However, they often receive much less social support.

One of the most difficult aspects of infertility is acceptance. Whether the reason is known or unexplained, I find that many people struggle with accepting that they may need treatment. Unique to infertility, many consider treatment a personal failure rather than a possible road to success.

Add this feeling of inadequacy to the unintentionally hurtful and insensitive comments of others, and those struggling with secondary infertility can feel alone and lost. Whether dealing with primary or secondary infertility, the psychological impact can be significant. Therapy and support groups can make a big difference.

Please hear me when I say that infertility is in no way a failure. Your emotions here are completely valid. Many find comfort by knowing they aren't alone and that treatments continue to advance.

While it's hard to pinpoint statistics around success rates of secondary infertility treatment, many families do go on to grow their families. I highly encourage you to meet with a fertility specialist to discuss your specific scenario.

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I quizzed my own mom and the friends who ventured into motherhood before I did. I absorbed parenting books and articles like a sponge. I signed up for classes on childbirth, breastfeeding and even baby-led weaning. My philosophy? The more I knew, the better.

Yet, despite my best efforts, I didn't know it all. Not by a long shot. Instead, my firstborn, my husband and I had to figure it out together—day by day, challenge by challenge, triumph by triumph.

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The funny thing is that although I wanted to know it all, the surprises—those moments that were unique to us—were what made that first year so beautiful.

Of course, my research provided a helpful outline as I graduated from never having changed a diaper to conquering the newborn haze, my return to work, the milestones and the challenges. But while I did need much of that tactical knowledge, I also learned the value of following my baby's lead and trusting my gut.

I realized the importance of advice from fellow mamas, too. I vividly remember a conversation with a friend who had her first child shortly before I welcomed mine. My friend, who had already returned to work after maternity leave, encouraged me to be patient when introducing a bottle and to help my son get comfortable with taking that bottle from someone else.

Yes, from a logistical standpoint, that's great advice for any working mama. But I also took an incredibly important point from this conversation: This was less about the act of bottle-feeding itself, and more about what it represented for my peace of mind when I was away from my son.

This fellow mama encouraged me to honor my emotions and give myself permission to do what was best for my family—and that really set the tone for my whole approach to parenting. Because honestly, that was just the first of many big transitions during that first year, and each of them came with their own set of mixed emotions.

I felt proud and also strangely nostalgic as my baby seamlessly graduated to a sippy bottle.

I felt my baby's teething pain along with him and also felt confident that we could get through it with the right tools.

I felt relieved as my baby learned to self-soothe by finding his own pacifier and also sad to realize how quickly he was becoming his own person.



As I look back on everything now, some four years and two more kids later, I can't remember the exact day my son crawled, the project I tackled on my first day back at work, or even what his first word was. (It's written somewhere in a baby book!)

But I do remember how I felt with each milestone: the joy, the overwhelming love, the anxiety, the exhaustion and the sense of wonder. That truly was the greatest gift of the first year… and nothing could have prepared me for all those feelings.

This article was sponsored by Dr. Brown's. Thank you for supporting the brands that support Motherly and mamas.

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In just over three weeks, we will become parents. From then on, our hearts will live outside of our bodies. We will finally understand what everyone tells you about bringing a child into the world.

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I don't mean thinking and planning about the lack of sleep, feeding schedule, or just the overall changes a new baby is going to bring. I'm talking about how we're going to handle excited family members and friends who've waited just as long as we have to meet our child. That sentence sounds so bizarre, right? How we're going to handle family and friends? That sentence shouldn't even have to exist.

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