Infertility is a complicated issue that can impact people in surprising ways. Some couples who had no trouble conceiving and delivering their first child find themselves struggling to expand their families further, for instance.
In fact, survey data from the Centers for Disease Control and Prevention found that about 6% of married women ages 15 to 49 who have previously given birth are unable to get pregnant after one year of trying, and 14% have difficulty getting pregnant or carrying a pregnancy to term.
But why does this happen and what can be done? Below, experts break down what you need to know about “secondary infertility,” the potential causes, steps to take in response, and how to support a loved one dealing with this issue.
What is secondary infertility
“Secondary infertility is the inability to achieve a pregnancy after previously getting pregnant naturally and giving birth,” said Dr. Banafsheh Kashani, an OB-GYN and reproductive endocrinology and infertility specialist. “This occurs if you have been trying to get pregnant for over one year and are under the age of 35 or trying for over 6 months and are over the age of 35.”
This situation is not rare. Many couples struggle to become pregnant despite having previously been able to conceive a child and give birth.
“Secondary infertility is about as common as primary infertility, affecting around 11-12% of couples in the U.S.,” said Rachael Jones, a nurse practitioner and director of clinical client implementations at the family-building benefits company WIN.
“Approximately 50% of the patients we see are seeking support for secondary infertility,” said Dr. John R. Crochet Jr., a fertility specialist at Shady Grove Fertility.
What causes it?
The potential reasons someone might be experiencing secondary infertility are wide ranging.
“Unfortunately, it is also similar to primary infertility in that it can be a number of things,” Jones said. “One of the more prominent causes is age-related decline. If the couple had their first child later in their 30s and therefore then starts even later for their second child, then for the egg producing individual there is usually an age-related decline in quality and quantity of eggs remaining and with that a higher propensity for miscarriage due to genetically abnormal embryos.”
There might be be scar tissue in the uterus due to a difficult cesarean section, or it could be due to a change in sperm count or quality, which might be related to aging as well.
“The causes of secondary infertility can be related to many factors including age, chronic medical conditions, factors surrounding the last pregnancy or delivery, or any interval changes in the health of either partner,” said Dr. Priyanka Ghosh of Columbia University Fertility Center.
Blocked fallopian tubes, endometriosis, damaged uterine lining, weight gain, problems with ovulation and autoimmune issues can also be a cause.
“However, sometimes there is absolutely no explanation, which we then refer to as unexplained infertility,” said Dr. Jonah Bardos, a reproductive endocrinology and infertility specialist and the medical director at CCRM Fertility of Miami.
What can be done?
“For anyone struggling with secondary infertility, definitely seek the advice of a reproductive endocrinologist who can help conduct a full evaluation,” Ghosh said. “Secondary infertility can be a frustrating experience, but the good news is that many individuals are able to achieve success after an evaluation and treatment.”
The sooner you set up a consultation, the sooner you can get an individualized treatment plan and act accordingly.
“Oftentimes, people postpone going to the doctor when they have been able to get pregnant in the past,” Kashani said. “This could be because they are busy with the child they already have, or are convinced that since it was able to happen before, it will happen again. But in women over 35 and particularly women over 40, age is a very important factor in your ability to achieve a successful pregnancy, so it’s best not to delay getting assessed and treated.”
Your consultation will likely involve taking your pregnancy and post-pregnancy history as part of a diagnostic work-up to evaluate anything that’s getting in the way of conceiving.
“Additionally, I will ask if there were any ectopic pregnancies, surgeries, recent illnesses, significant weight gain or loss, changes in lifestyle, new activities, or changes to the menstrual history since the prior pregnancy,” Bardos said. “Typically, the patient and partner will undergo bloodwork, a pelvic ultrasound, possibly a hysterosalpingogram ― an X-ray of the uterus and fallopian tubes ― and a semen analysis.”
You might also want to seek out a supportive community. Crochet noted that Shady Grove Fertility offers a secondary infertility support group. There are also countless online groups that can help you navigate this emotional and challenging experience.
“The most important thing to remember when you are experiencing secondary infertility is that you are not alone,” he said.
What should you do if a loved one is experiencing secondary infertility?
“Secondary infertility can be quite challenging, with some feeling like everything used to work, so what happened?” Bardos said. “Others may feel guilty that they want another child when others haven’t been able to conceive their first. Being present and supporting your loved ones through this process is an important part of the journey. Often people will blame themselves, when in reality it’s not their fault.”
He suggested giving them fertility affirmation cards like the ones sold by Glitter Enthusiast. Acknowledge how difficult this situation can be and reach out periodically to check in. And in general, try to be mindful of the comments you make to people.
“You may feel that a comment is a cute rib, but it can actually be hurtful when you don’t know what’s happening,” Bardos explained. “A few common ― and not so harmless ― comments include: ‘So when are you going to have another one? When are you going to make so-and-so a big brother or sister? You don’t want to spoil your child by being an only child!’”
You don’t have to know the exact, perfect thing to say. Offering a shoulder to cry on is helpful in itself.
“Many who experience secondary infertility can feel surprised, alone and unclear how to share their feelings with their friends and family,” Crochet said. “They may experience unwelcome reactions from friends and family who may not understand why they’re so upset. It can be very difficult to make sense of these challenges and to stop feeling so distant from everyone around them.”
Remember, if your loved one is confiding in you about their secondary infertility struggles, that means they feel comfortable opening up with you.
“My advice is simply to be a good listener,” Crochet added. “And resist the urge to insert your opinions ― simply stick with phrases like, ‘I am here for you,’ or ‘Thank you for trusting me as a friend/family member to share what’s been going on.’”