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.

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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