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Secondary infertility

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Being unable to conceive when you’ve already given birth to at least one baby is called secondary infertility. If everything was straightforward last time round, it may come as a complete shock to find that it’s taking a while to conceive this time. Often the biggest step in coping with the problem is deciding that you need some help this time around.

When yet another period comes along, you may start to feel dispirited and confused. As the months pass you may be left with a sense of failure and frustration. Why isn’t it happening this time? But first things first – ask yourself whether you really need to start worrying yet. Even for a healthy couple with no reproductive problems it can take time to conceive.

Most couples having regular sex, without contraception, will conceive within one year (84 per cent) and half of the remainder will conceive within two years – resulting in 92 per cent of couples conceiving overall. This is why infertility is defined as the inability to become pregnant during the course of one to two years of regular, unprotected sexual intercourse. Regular sex means making love every two to three days throughout your cycle, which optimists your chances of conceiving.

Many couples will find it hard to wait two years before seeking help. You may prefer to consultation with your doctor after one year of trying, especially if you have a pre-existing medical condition that could be affecting your fertility. Since your chances of conceiving decrease with age, it also makes sense to seek help sooner rather than later – after six months if you are over 35.

If you’re convinced that you have a problem, you’re not alone. About one in seven couples have problems conceiving. The percentage of couples experiencing secondary infertility in particular is not known because some couples do not seek medical help.

When and why does secondary infertility happen?

Secondary infertility may happen at any time and the causes, where they have been pinpointed, are almost identical to those of primary infertility. The problem can lie with the woman’s reproductive system, the man’s reproductive system, or with both partners.

Causes of Secondary Infertility

• low sperm count or another fertility problem in the man (32 per cent )
• an ovulatory problem in the woman (4.9 per cent)
• tubal damage in the woman (16.7 per cent)
• endometriosis or another condition affecting the uterus (3.3 per cent)
• a combination of factors in both the man and the woman (17 per cent).

In just under 19 per cent of cases the cause of infertility is not identified. It can be frustrating to be given the non-diagnosis of “unexplained infertility” when you are desperate to find out why you cannot conceive. However, in cases of unexplained infertility there is still hope. Up to two-thirds of couples with unexplained infertility conceive within three years if they continue trying.

Female reproductive problems

It is possible that you had an underlying health problem when you conceived before, but luckily it did not affect conception on that occasion. These problems include:

• ovulation disorder caused by polycystic ovaries or polycystic ovarian syndrome (PCOS)
• damage to the uterus or fallopian tubes caused by endometriosis
• pelvic inflammatory disease (PID), usually as a result of contracting a sexually transmitted infection (STI), such as chlamydia
• obstruction to fertilisation or implantation caused by fibroids
• damage to fallopian tubes from a previous ectopic pregnancy
• uterine adhesions, possibly caused by previous caesarean section.

Some women develop hormonal disorders that affect ovulation or the ability of a fertilised egg to implant in the lining of the womb, or the mucus around the cervix may be hostile to their partner’s sperm. When a woman is ovulating, “fertile mucus” is usually produced which helps the sperm to swim up through the cervix and the uterus to meet the egg in the fallopian tube. Problems occur when there is not enough cervical mucus to allow the sperm to move easily, or it is too thick and sticky, or it isn’t compatible with your partner’s sperm.

Age is another factor that can affect your chances of conception and so it is inevitably a factor in secondary infertility. Fertility starts to decrease from age 30 and more sharply from age 35 onwards in women. See our article on age and fertility for more information. Early menopause is another possibility to consider.

Male reproductive problems

Sperm may die or be unable to swim in a straight line, making it impossible for them to get near enough to fertilise an egg. Some men have an auto-immune response which means they produce antibodies that kill their sperm, while other men may have erection or ejaculatory problems.

Hormone disorders and tubal blockages also play their part in causing male infertility. Or your partner’s sperm may fail in quantity or quality (motility, shape and normality) as a result of illness, or poor diet or lifestyle.

Men become less fertile as they get older. Some experts suggest that a general decline in fertility starts from about age 35 in men too.

Illnesses and other factors affecting fertility

Serious and chronic illnesses can cause secondary infertility. Diseases associated with mid-life, such as diabetes and raised blood pressure, can also affect fertility. Treatments for cancer – such as chemotherapy and radiotherapy – for either you or your partner, may damage fertility. In such cases, sperm and eggs can be frozen before treatment starts (known as “fertility preservation”) in order to prolong fertility.

Diet and lifestyle can impact on fertility in both men and women. Perhaps you or your partner smoke or drink more, or have put on weight or lost weight since you last tried for a baby? There are steps you can take to improve your fertility through diet and lifestyle.

When you release the number of stages of reproduction when a problem could potentially occur, it seems amazing that any women get pregnant at all. It makes it less surprising that infertility can strike even when you have successfully conceived before. Take a look at our chart detailing the major causes of infertility and find out more about the factors that can affect fertility.

When you need to go to the doctor?

If you‘ve not conceived after a year of regular intercourse, without contraception, then make an appointment to see your GP. Infertility is a joint problem so, ideally, go to see your GP as a couple.

Early diagnosis and treatment of secondary infertility is especially important in older couples, particularly in the case of women over the age of 35, who should make an appointment after six months of trying to get pregnant.

If you have a history of amenorrhoea (no periods), oligomenorrhoea (infrequent periods), pelvic inflammatory disease (PID), or if either you or your partner has had treatment for cancer, you should also seek medical advice sooner rather than later, as you will need to be referred to a specialist.

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