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Once you have had your first child, you’d think that having a second child would be plain sailing. However, many couples struggle to conceive more children. In this article, we’ll have a look at this phenomenon, also known as secondary infertility, the possible causes behind it, as well as the available treatments.

What is secondary infertility?
Secondary infertility is the inability to either conceive a child or to carry a baby to term after already giving birth to one or more babiesThis type of infertility may have similar causes as primary infertility.

Secondary infertility is diagnosed if:

  • The previous child was conceived without the use of fertility treatments
  • The couple has been trying to conceive naturally for 12 months (if under 35) or for 6 months (if older than 35) and have not yet become pregnant.

A related condition is when couples manage to conceive but are unable to carry the baby to term.

What are the causes of secondary infertility?
There are various reasons why a couple or individual may struggle with secondary infertility and the problem may lie with the woman, the man or both. The reason for secondary infertility may even be unknown.

Causes of secondary infertility in women may include:

  • Problems with the quality and quantity of eggs – as women age, they not only have fewer eggs available, but the eggs may also not be viable anymore. This is especially true of women over 40.
  • Problems with her fallopian tubes – including them being blocked.
  • Problems with the uterus – including scarring due to previous Caesarean sections, fibroids, or polyps. (These fibroids and polyps are benign and not cancerous.)
  • Endometriosis – although not all cases of endometriosis lead to infertility, there are some cases that may.
  • Polycystic Ovary Syndrome (PCOS) – women suffering from PCOS release eggs less often and they may also have longer or infrequent periods.
  • Breastfeeding – when a woman feeds her child only through breastfeeding, her body stops releasing eggs for the time being.
  • Weight gain or lifestyle changes – weight gain may lead to ovary dysfunction. Certain medications and diets may also play a role.

Causes of secondary infertility in men may include:

  • A reduced testosterone level – testosterone is vital in sperm production. A decrease in this hormone may be because of ageing, injury to the genital or urinary organs, as well as certain medical conditions.
  • Testicular varicocele – this is the enlargement of veins in the scrotum, which may lead to low sperm production and infertility.
  • Poor quality semen – with ageing, the quality of semen declines, especially after 40.
  • Prostate enlargement – this can lower the sperm count as well as hinder ejaculation.
  • Prostate removal – after being removed due to cancer or another condition, semen may flow backward.
  • Late onset hypogonadism – with hypogonadism, there is a decline in the release of certain hormones.
  • Taking medication that affects sperm count and quality – especially medication for high blood pressure, antibiotics, cancer, schizophrenia, seizures and arthritis
  • Using a commercial sexual lubricant that is toxic to sperm.
  • Exposure to certain chemicals – these chemicals include pesticides, lead, and industrial chemicals. Excessive heat may also affect fertility.
  • Excessive weight gain – this decreases testosterone while increasing estrogen.

Even though many of these reasons for secondary infertility are the same as that of primary infertility, there are also cases where the cause of infertility cannot be determined even though tests are done. We’ll look at this type of infertility next.

What is unexplained secondary infertility?
Much like unexplained (primary) infertility, unexplained secondary infertility is diagnosed after tests and screening haven’t shown a definitive reason for a couple or individual not being able to conceive.

To be able to make a diagnosis of unexplained secondary infertility, the doctor will review the couple’s medical history, find out whether the woman has irregular menstrual cycles, and find out if there is a history of thyroid disease, cancer or age-related conditions in either the man or the woman. The other tests mentioned here and in this article about unexplained fertility are also required.

The medical treatment for unexplained secondary fertility is the same as that for unexplained (primary) infertility and much the same as the treatments used for secondary infertility.

Which tests are done to confirm a secondary infertility diagnosis?
The various tests that are done to confirm the reason for secondary infertility, includes:

  • An x-ray of the uterus – usually referred to as “HSG” (hysterosalpingogram) – to ensure that there is no scarring that can interfere with conception and that the fallopian tubes are open.
  • Semen analysis – a sample of semen is studied to make sure that there are an adequate number of sperm and that their motility is normal.
  • Blood tests to make sure all hormone levels are normal. If not, hormones can usually be given to the couple or individual to increase their chances of conception.
  • A pelvic exam and tests to view the uterus and the cervix.

Depending on these outcomes, unexplained secondary fertility can also be diagnosed.

How long should you wait before seeking help?
Although you should be patient when trying to conceive, you shouldn’t wait for longer than 12 months if you’re under 35 and are trying to conceive, and no longer than 6 months if you’re older than 35.

In the meantime you can make use of a system like Eveline to help you find out when you are ovulating and are at your most fertile.

Which treatments are available for secondary infertility?
Most of the treatments that are available for primary infertility are also available for secondary infertility. These treatments include:

  • Medication and supplements – can induce ovulation where an ovulatory disorder is present in women or improve semen quality and improve fertility in men. A device like Eveline can again be of great use as it can tell you when you have ovulated.
  • Intrauterine insemination (IUI) – during this procedure, sperm is surgically placed within the uterus to increase the chances of fertilization.
  • In-vitro fertilization (IVF) – this procedure has multiple steps; daily injections are given to the woman to stimulate the ovaries. The mature eggs are then harvested and fertilized in the laboratory. The embryo is grown in the laboratory and surgically placed within the uterus. A woman’s eggs can also be frozen and then the procedure can be done at a later stage.
  • Surgery – removes scar tissue, polyps, or fibroids from the uterus and can also be used to repair testicular varicocele in men.

As you can see, being diagnosed with secondary infertility doesn’t necessarily mean that you can never have a child again. Seeking medical treatment if you struggle to conceive is always important and even just test results can be a great help to find out which steps you need to take to make it easier for you to conceive.


This article is for informational purposes only and is not meant to offer medical advice.


Photo by Benjamin Manley on Unsplash