Secondary Infertility

What Is Secondary Infertility?

When a couple experiences a healthy pregnancy and delivery, they may presume their next pregnancy will be the same. Sometimes, however, a woman may be unable to conceive or carry a baby to term after a year of unprotected intercourse, even if they've already had a child without any fertility care. This is known as secondary infertility.

Secondary infertility occurs at about the same rate as primary infertility, and it affects men and women equally. According to the Centers for Disease Control and Prevention (CDC), about 10% of women of childbearing age have problems getting or staying pregnant. Causes of secondary infertility include aging, ovulation disorders, low sperm counts, and other factors.

While secondary infertility can be surprising and frustrating for many couples, it can be treated successfully. The earlier patients seek help, the better. As many as 90% of infertility cases are treated with medication or surgery, including assisted reproductive technologies like in vitro fertilization (IVF).

What to expect at an appointment for secondary infertility

To diagnose secondary infertility,  the expert physicians at the Reproductive Science Center of New Jersey (RSCNJ) will try to uncover what has changed since the last pregnancy. They’ll review medical histories and current health, as well as discuss possible testing, like a semen analysis for men. Common tests for women include:

• Blood work to look at hormone levels

• Pelvic exams

• An X-ray of the uterus called a hysterosalpingogram (HSG) to show any scarring or irregularities

• An X-ray of the fallopian tubes

• Transvaginal ultrasound to check ovulation and egg supply

These evaluations can help us determine the best treatment options.

Symptoms of secondary infertility

RSCNJ physicians will diagnose secondary fertility if a woman younger than 35 has been trying to conceive for at least a year without success or six months if older than 35.

If a woman or couple experiences either of these scenarios after previously having a successful pregnancy, they should make an appointment with one of our fertility specialists. The earlier we find the cause, the more treatment options we may offer the patient.

Causes of secondary infertility

Many of the causes of secondary infertility are the same as they are for primary infertility. They can be traced to either the man, woman, or sometimes to both partners. Often, more than one factor contributes to a couple’s secondary infertility. In some cases, frustrating as it may be, doctors may find no medical reasons for secondary infertility. This is called  unexplained infertility.

Secondary infertility risk factors for women

Various factors can increase a woman’s risk of experiencing secondary infertility, such as:

Aging

A 2018 study showed that couples experiencing secondary infertility were older than those with primary infertility. While healthy couples in their 20s and early 30s have a 25% chance of getting pregnant in a cycle, that number drops significantly as the woman ages.

By 40 years of age, a woman’s chance of pregnancy success is less than 5% per cycle, as the quantity and quality of their eggs decline.

Ovulation disorders

About 1 in 4 women with infertility have ovulation disorders. Women can have problems ovulating for many reasons besides aging, including:

• Breastfeeding women stop ovulating or releasing eggs.

• Thyroid conditions, such as hypothyroidism or Hashimoto’s disease, can affect hormone levels and ovulation.

• Polycystic ovary syndrome (PCOS), a hormonal disorder, is one of the most common causes of infertility in women and can worsen with age.

• Primary ovarian insufficiency (POI) occurs when a woman’s ovaries stop working normally before age 40.

Blocked fallopian tubes, uterine problems, and other factors

Structural issues and other conditions that impact the uterus and surrounding areas can also impact fertility.

Blocked fallopian tubes

Blockages can impede the sperm’s ability to meet the egg in the fallopian tubes for fertilization or prevent the fertilized egg’s ability to move to the uterus for pregnancy. Blockages can be caused by pelvic infections or from complications of an ectopic pregnancy or surgery.

Uterine problems

Various conditions related to the uterus can impair pregnancy. Adhesions or scarring in the uterus can lead to menstruation problems, such as light or missed periods, or can prevent a fertilized egg from implanting. Women who have had a dilation and curettage (D&C) or cesarean delivery may have uterine scarring. Additionally, uterine fibroids or polyps – benign (noncancerous) growths – can affect conception.

Endometriosis

Endometriosis is a relatively common condition affecting up to 1 in 10 women. In a patient with endometriosis, tissue that normally grows inside the uterus grows elsewhere, such as on the ovaries or bowels. This can cause inflammation and scar tissue on the ovaries, fallopian tubes, and other internal organs, leading to issues with egg quality or embryo implantation.

Pelvic inflammatory disease, and other infections

Pelvic inflammatory disease (PID) is an infection that can damage the fallopian tubes and uterus. PID can be caused by previous sexually transmitted diseases, such as chlamydia or gonorrhea, or by a past surgery, such as a C-section. Other infections also can cause a condition called chronic endometritis, an inflammation of the uterine lining that can make it difficult for an embryo to implant in the uterus. 

Autoimmune disorders

The relationship between autoimmune disorders and secondary or primary infertility is a bit murky. Autoimmune disorders cause the body to attack healthy tissues, including reproductive tissues.

Autoimmune disorders such as Hashimoto’s, lupus, and rheumatoid arthritis can cause inflammation in the uterus and placenta. Medicines used to treat these disorders may contribute to infertility, too.

Weight or other lifestyle changes

Having excess weight or being underweight may lead to hormonal changes, which can affect menstruation and ovulation. Nutrition, alcohol or drug misuse, or medications may also affect infertility.

Secondary infertility risk factors for men

There are various factors that can impact the male partner as well, leading to secondary infertility, including:

Aging

Men may have a lower sperm count or poor sperm motility (sperm movement) after age 40.

Low testosterone levels

Sperm production relies on testosterone. Testosterone levels can decline due to aging, injury to urinary or genital organs, or certain medical conditions.

Testicular varicocele

About 30% of infertile men have a testicular varicocele, which is an enlargement of veins in the scrotum that can cause low sperm production.

Enlarged prostate and other issues

An enlarged prostate can lower sperm count and make it difficult to have a normal ejaculation. Removal of the prostate due to cancer or other conditions can cause semen to flow in reverse, impacting fertilization.

Medications

Some medications can affect sperm count and quality, including some antibiotics and medications that treat high blood pressure. Cancer, urinary tract infections, and other conditions can also impact sperm quality.

Excessive weight gain and lifestyle choices

Weight gain can lower testosterone levels and increase estrogen levels. It can also cause low sperm counts and poor motility. Smoking, alcohol abuse, moderate marijuana usage, and other lifestyle choices may also affect male fertility.