Secondary Infertility: Causes, treatment and success rates

If you are reading this, you may be looking for answers and direction on infertility after having a first child. In the United States, the Center for Disease Control and Prevention reports that about 12 % of women have difficulty getting and staying pregnant overall.

trouble getting pregnant
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Infertility would not cross one’s mind after having one or more successful pregnancies. Thus, secondary infertility is a struggle that often catches people with surprise. Secondary infertility often comes with sadness, confusion and frustration as well as guilt and hopelessness. 

If you are having issues with conceiving again or have been diagnosed with secondary infertility, you’ve come to the right page. We’ve put together some information on the symptoms, causes, and treatment for secondary infertility. 

Read on to learn about what you can do in your journey to get pregnant again.

Infertility is classified into two broad categories: primary and secondary. 

Primary infertility occurs when a woman is not able to conceive after one year of frequent, unprotected sexual intercourse. For those who are over 35 years, the duration would be 6 months of trying with no result.

Secondary infertility is the term used to describe those who have trouble getting pregnant after successfully conceiving at least once before. 

Similar to primary infertility, secondary infertility can be caused by problems at any one point in the process of getting pregnant. Both the woman and the man’s fertility can change over time. 

Secondary infertility statistics

The United State’s National Center for Health Statistics (NCHS) reported that more than 3 million women in the US have problems getting pregnant again and/or carrying another baby for a full term. 

According to the news portal Malaysiakini, while Malaysia does not have official statistics on infertility rates, the number of couples who are seeking help to have children is on the rise. The national fertility rate has been on a decline and the total fertility rate in Malaysia is below the replacement rate of 2.1 babies.

How common is secondary infertility?

Secondary infertility is more common than you think. Some have reported that about 30 percent of infertility cases are due to secondary infertility. According to today.com, secondary infertility affects 10 % of all couples.

Many couples do not realize that they are actually experiencing secondary infertility, especially if they conceived easily before. If you are having a hard time getting pregnant again, you might want to visit your doctor to check if you have secondary infertility. 

Secondary infertility symptoms

Secondary infertility symptoms include:

  • Not getting pregnant after 12 months of unprotected sex for men and women under 35.
  • Not getting pregnant after 6 months of unprotected sex for men and women over 35.
  • Painful periods
  • Irregular menstrual cycles
  • Miscarriages
  • Pelvic inflammatory disease
  • Low sperm count for men

Causes of secondary infertility

Secondary infertility shares the same causes as primary infertility. Here are some of the most likely causes related to secondary infertility.

1. Ovulation disorders

Ovulation disorders are one of the main causes of fertility issues in women. Up to 40% of women who suffer from infertility do not ovulate consistently. The following conditions can cause ovulatory problems in women:

  • Polycystic ovary syndrome (PCOS)
  • Primary ovarian insufficiency (POI)
  • Age related decrease in egg production
  • Endocrine disorders such as thyroid problems
  • Being overweight or underweight
  • Alcohol and/or drug misuse

PCOS occurs when too many hormones are produced by the ovaries or adrenal glands. This prevents the ovulation and may cause cysts to form on the ovaries. PCOS is a common issue and with the right treatment, up to 70% of women with PCOS will be able to conceive

2. Issues with the uterus or fallopian tube

Secondary infertility can be caused by a blockage in the fallopian tubes or a structural and tissue problems in the uterus that stops the implantation process. Conditions that affect the uterus and fallopian tubes include:

  • Endometriosis
  • Uterine scarring
  • Uterine fibroids/polyps
  • Abnormal uterus shape

About 10% of women have endometriosis and studies show that 25 to 50 % of women who struggle with infertility suffer from endometriosis. Endometriosis can result from a C-section or uterine surgery thereby causing secondary infertility.

3. Age

A woman’s fertility usually peaks around 20 and starts to decline at 30. There is a significant reduction in fertility by age 40. While it is still possible to conceive naturally at an older age, secondary infertility is more common in couples who are older. 

fertility age of woman
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A 2018 study revealed that age was a statistically significant factor of secondary infertility. The average age of those who experience secondary infertility was higher when compared to those with primary infertility. 

4. C-Section scarring

Scarring in the uterus, which is also known as isthmocele can cause inflammation in the uterus that makes it hard for implantation to happen. This can happen from a cesarean delivery that you had in a previous pregnancy. 

A 2019 case study demonstrated that a successful pregnancy can be attained through in vitro fertilization (IVF) once the isthmocele was treated with surgery.

5. Autoimmune disorders

Autoimmune disorders cause the body to attack its own healthy tissues. This can include attacking healthy reproductive tissues as well. 

A 2012 review found that the increased production of autoantibodies played a role in infertility disorders such as Polycystic ovary syndrome (PCOS), endometriosis and even in unexplained infertility. Autoimmune disorders such as Hashimoto’s and Lupus can cause inflammation in the placenta and uterus.

6. Infections

Infections can lead to pelvic inflammatory disease, which in turn can cause damage to the fallopian tubes. Certain viruses such as the human papillomavirus (HPV) can affect the cervical mucus and negatively affect fertility as well. 

Infections can be treated and when detected and attended to early, will not have a big effect on fertility. 

7. Reduced testosterone levels

For men, testosterone has a major role in sperm production. Testosterone levels may decline due to increasing age, or injury to the genital organs. Certain medical conditions such as thyroid diseases, blood diseases and diabetes, among others, can also reduce testosterone levels. 

8. Low sperm count

Low sperm count, as well as poor sperm quality also contributes to secondary infertility. Besides increasing age, low sperm production can also be caused by testicular varicocele, a condition in which the veins in the scrotum or at the skin encasing the testicles become enlarged. 

9. Unexplained infertility

There are times where there does not seem to be any reason for secondary infertility. Tests may not show any particular problem and treatments may not seem to work. 

Unexplained infertility is not easy to deal with but don’t give up and continue to work with your doctor in your journey to conceive. If you need to, ask your doctor for recommendations for counsellors whom you can speak to. 

Secondary infertility investigations

If you have previously conceived, and suspect secondary infertility, schedule an exam with a fertility doctor as soon as possible. The earlier the problem is diagnosed, the wider the variety of treatment options are available. 

Your doctor will go through your medical history to look for any changes that might have occurred since your last pregnancy. Several tests may also be recommended such as:

  • Blood test to determine hormone levels
  • Ovulation tests
  • X-rays to check fallopian tubes
  • Pelvic exam
  • Transvaginal ultrasound
  • Tests to view your uterus and cervix. 

If your tests do not show any problems, it may be that the infertility issues lie with your partner. Thus, the next step your doctor may take is to run tests for sperm count and sperm quality.

Can you get pregnant with secondary infertility?

The simple answer would be yes. However, depending on your circumstances, you and/or your partner might need treatment at a fertility clinic to help improve your chances of conceiving. 

Secondary infertility can come as a surprise. Coping with it can be very stressful so do speak to your doctor or health care provider on the steps that you can take to overcome it.

Secondary infertility treatment

Once the cause of infertility is determined, your doctor will be able to decide on the best course of action. Here are some common treatments that your doctor may recommend.

Medication

Your doctor may put you on fertility enhancing medication to normalize hormones as well as stimulate ovulation. 

Fertility drugs that are commonly recommended include Clomid, which is taken orally. This drug is effective for women who have issues with ovulation. Gonadotropins, an injectable fertility drug, is another medication that is often prescribed. 

injectable fertility drug
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Medication, antioxidants and anti-ageing supplements can also help increase fertility in men.

Surgery

Surgery may be required if there is uterine fibroids, endometriosis or uterine scarring. These are usually simple, minimally invasive surgeries. 

Your doctor may perform a laparoscopy and a hysteroscopy to diagnose as well as effectively treat conditions such as endometriosis and polyps. While surgery may sound scary, having a surgical solution to infertility is actually good news. 

Advanced Reproductive Technology (ART)

If medication and surgeries cannot be used to treat your condition, ART may be required. Two of the most common ART are intrauterine insemination (IUI) and in vitro fertilization (IVF)

In IUI, the sperms that have been collected from the man will be placed directly in the woman’s uterus during ovulation time. This method is especially suitable when the man has low sperm count or low sperm quality. 

In IVF, the egg is retrieved from the woman via a surgical procedure. It is then fertilized in a lab with sperms from the man. Sometimes donor sperms are used. Once the embryo is formed, it is transferred back into the woman’s uterus.

Secondary infertility treatment success rates

The good news is that there is a high chance of success when it comes to secondary infertility treatment. Because you have been able to conceive before, doctors will be able to look for the exact cause that is creating infertility. 

If you and your partner’s tests return normal, your doctor will probably start with simpler forms of treatment such as timed intercourse, ovulation induction or intrauterine insemination.

How successful are IUI and IVF for secondary infertility?

IVF is considered as one of the simpler ART methods when it comes to treating secondary infertility. IUI is minimally invasive and is often a first-choice treatment for couples who have infertility caused by ovulatory and cervical problems, male factor infertility and unexplained fertility. 

Research shows that with IUI, women who are below 35 have 15 to 20 % chance of success. A 2016 study shows that the chances of pregnancy significantly increased with IUI and that IUI success was higher in couples who had secondary infertility as compared to those who had primary infertility.

Conclusion

Secondary infertility may come as a shock if you have previously conceived easily. However, with early and accurate diagnoses, it can be treated. 

Getting pregnant may take time so don’t give up and consult your fertility doctor for the best course of action. Visit your doctor or a fertility clinic today if you suspect that you have secondary infertility since time is an important factor when you are trying to get pregnant.

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