9th July 2019
For many people, the term “secondary infertility” is completely unknown, and of those who have heard of it, many still won’t even understand it. You may think that if you have one child, you can surely have another one, right? Not necessarily.
This misconception results in a lack of information, advice, and support for all those suffering the consequences of secondary infertility.
NBC meteorologist Dylan Dreyer recently opened up about her issues with secondary infertility and miscarriage:
We need more voices like Dreyer’s. On our fertility blog, we have already written about the main causes of female infertility; we did the same for the common causes of male infertility; now, we shine a light in an increasing problem that is often not discussed enough.
What is the difference between primary and secondary infertility?
When a woman does not get pregnant, after a year of unprotected sex, we talk about primary infertility. The NHS defines secondary infertility as: “where someone has had 1 or more pregnancies in the past but is having difficulty conceiving again.” This affects women as well as men.
There is also the case in which a woman or a man already has a child from a previous partner and experiences infertility with a new partner. This is also considered secondary infertility.
How common is secondary infertility?
Secondary infertility happens more often than we may think. It is common for couples who don’t have a child to have a consultation, but not as common for those who have been trying for the second one for more than a year without success. These couples experience feelings of guilt, denial, anger, depression, and frustration. That is why we believe it is very important to talk about the causes of secondary infertility.
Certain changes in life habits that occur after having the first child, can compromise the quality of the sperm or egg to the point of preventing fertilization, and, therefore, the start of a new pregnancy. If so, then there will be a need to deepen the personalized study to determine the cause of this situation that is affecting one or both members of the couple.
The causes follow the rule of thirds, as described by Gynaecologist José Luis Gómez Palomares member of the Spanish Society of Fertility. In a third, the cause is only male; in another, only female; and in a third, mixed.
Main causes of secondary infertility
Age: With the passage of time, fertility decreases naturally, in women and men. After 38 years, the ovarian reserve and the quality of the eggs decreases. Recent studies have shown that the quality of the sperm also decreases with age.
Consequences of a previous pregnancy: A previous pregnancy may have caused pelvic infection, uterine adhesion, or blockage of the fallopian tubes.
Weight gain or decrease: Fertility is affected by weight. Being overweight or underweight can cause ovulation problems in women. Weight also affects sperm health in men.
You can learn more about sperm health and how to increase sperm count in our recent blog.
New health problem: Having cancer or developing a tumour can also cause infertility, especially if chemotherapy or radiotherapy has been received. Diabetes or hypertension, among other diseases, can lead to fertility problems.
New partner: It could be that the new couple has an undiagnosed fertility problem. It is also possible that a fertility problem has developed over time.
For men there can be multiple causes
The reasons that could lead to infertility in men can be genetic, physiological or surgical. Low morphology, absence of sperms or low sperm count can cause infertility in men. Others may include:
- Retrograde ejaculation.
- Hormonal disorders.
- Infectious processes in the genitals.
- Consumption of certain medications.
- Toxic habits such as smoking or alcohol.
- Diseases like diabetes.
- Professional exposure to substances toxic to the testicles (lead, cadmium or manganese), etc.
In women, some of the leading causes of sub-fertility include:
- Ovulation problems (e.g. PCOS, endometriosis, hypothalamic/pituitary disorders).
- Tubal problems.
Treatment of secondary infertility
The tests performed to diagnose secondary infertility are the same as for primary infertility. The tests should be performed on both men and women, even if either of them have proven to be fertile before. Having previous children does not mean that you cannot experience infertility now. Treatments may include:
- Fertility drugs and gonadotropins, often starting with the most commonly prescribed fertility drug Clomid
- IVF which could be combined with other assisted reproductive options.
- IUI, a fertility treatment where sperm is placed inside a woman’s uterus to facilitate fertilization. The goal is to increase the number of sperm that reach the fallopian tubes and therefore increase the chance of fertilization.
- Surgery, usually laparoscopic, to remove fibroids, endometriosis deposits or repair blocked fallopian tubes.
Some women who have conceived later have turned to preservation of fertility through methods like egg or embryo freezing as an option. Freezing of the eggs or embryo stops the aging process, giving the couple the same chances of gestation that they had when with the pregnancy of the first child.
In our blog, you can read Emily’s egg freezing journey where the influencer shared her experience with the Adia Health community.
As you search for a solution to your fertility problems, you may have friends and family asking you to relax and telling you that it will simply happen again because you had a child before. Remember that you need the same treatment as someone with a primary infertility and the first step is the evaluation by a fertility specialist.
Will having a healthy lifestyle and changing my diet help?
It may help, and it certainly can’t hurt, to maintain a healthy lifestyle. Stop smoking, lose any excess weight, exercise regularly, and eat a healthy diet. Certainly, stay away from drugs and avoid drinking too much alcohol.
You can read about our fertility diet plan and find further information in the Adia app to learn the importance of eating healthy not only for fertility, but your general health. For general recommendations about your quality of life we also wrote the blog “What is a healthy lifestyle” to inspire you the path to follow.
Eating healthy and getting plenty of exercise is a really good way to start your journey.
Secondary infertility statistics
While infertility has slowly gained recognition as a common emotionally taxing condition, secondary infertility remains largely unspoken.
The reality is that there are no hard and fast secondary infertility statistics to share aside from survey based reviews and estimates like the one from the National Center of Health Statistics for the USA that estimates than 3 million women who have one biological child have difficulty getting pregnant or carrying another to term. Roughly 800,000 married women with one child are unable to get pregnant again after one year of having unprotected sex, month after month.
In the UK one in six couples who already have a child fail to become pregnant with another child after one year of unprotected sex. Around 3.5 million people in the UK have difficulty conceiving. That is 1 in 7 couples with difficulties trying to conceive – so you’re definitely not alone.
In Ireland it is estimated that secondary infertility accounts for 60 percent of fertility cases.
Previous studies in developing countries also reflect a growing increase in numbers for secondary infertility. This multinational study also found that most infertile couples around the world suffer from primary infertility. Sub-Saharan Africa is a striking exception to this pattern where 52% suffered from secondary infertility. Latin America also has a relatively high rate of secondary infertility: 40%. In contrast, only 23% percent of infertile couples in Asia and 16% percent in North Africa suffered from secondary infertility.
More recent studies and statistics are needed to bring some light to a growing problem.
When should we seek help for secondary infertility?
With secondary infertility you should seek help in the same way as if you were conceiving your first baby.
The NHS recommends that after trying and failing to get pregnant for a year, you should see your doctor. if you are over 35 years of age and have been trying for 6 months you should consider consulting a fertility specialist.
Also be aware, your GP is unlikely to offer you any treatment or test for secondary infertility unless you have been trying to get pregnant for at least a year.
If you suspect that you or your partner may have a condition that makes it harder to conceive, make an appointment with your GP and go with your partner since infertility affects both men and women equally.
From a psychological point of view, how to deal with secondary infertility depression?
Being involved in fertility MOT tests, treatments and struggling to conceive can have a significant impact in the way you feel emotionally and with your relationships. It is important to seek help and support if you are struggling. It is not uncommon to experience depression and anxiety. In our blog you can read about the connection between fertility and mental health and how best to cope with these challenges and learn what makes a good relationship.
The Seleni Institute wrote an interesting blog talking about what makes secondary infertility different.
As they mention, many women have a vision of what their family is going to look like, and when that does not happen that leads to all sorts of conflicting emotions tied to this loss of control, especially if they got pregnant easily the first time.
Even in the infertility community you will find a lot of people that tell you that you should be grateful about the baby you have and stop complaining. The comparison game here becomes unfair.
As they conclude, there is a stigma attached to secondary infertility where there is more criticism and judgement, and less empathy toward the couple suffering the issue.
Acceptance as an opportunity
On the other hand, infertility support groups, forums, and blogs can be very useful. Reading the experiences of other patients who have already gone through the pain and frustration that few other people understand can be helpful.
In most cases, with all the treatments that couples have at their disposal today, it is rare that pregnancy does not occur. Although it is true that, given how hard it is to go through a process of assisted reproduction – or several, in a large number of cases, many women decide not to continue.
How to get further help?
As we previously mentioned, infertility support groups, forums, and blogs can be very useful. You can read Akiko’s story dealing with secondary infertility, the story of our founder, Lina, and her difficult road to motherhood, and our other founder Tyler’s story of male infertility, along with others sent by our community members, in our blog.
We also invite you to join Adia, a platform that we created to empower women with the needed knowledge and tools to succeed in their fertility journey. Our key features include:
- Free access to fertility experts. Ask your questions and get a response within 48 hours.
- Free guided meditations for fertility.
- Free fertility and nutrition education programs.
- Personalised fertility profile based on hormone test results.
- An easy at home fertility test now available for only £99.