Is it harder to conceive with your second child? It can be but it’s different for everyone. Unfortunately, infertility affects 1 in 6 people, so if you are struggling, you’re not alone. This article will share everything you need to know about what secondary fertility is, what causes it, and the treatment options available to you.

Quick facts:

• Secondary infertility is the inability to conceive after having already conceived naturally and given birth. 
• It can be common and lots of people struggle with it when trying for another baby. 
• There area number of lifestyle and medical treatments available for secondary infertility. 
• If you’re struggling to conceive again, speaking to a fertility specialist can help.

What is secondary infertility?

Secondary infertility is when you are having difficulty conceiving after previously conceiving and giving birth. To be defined as secondary infertility, the previous birth must have occurred without help from fertility treatments or medications like IVF (in-vitro fertilisation).

The definition of primary infertility, in comparison, is when someone who’s never conceived a child has difficulty conceiving.

So, how common is secondary infertility? Struggling to conceive might come as a shock if you’ve already had a baby. Secondary infertility, however, is a challenge faced by lots of individuals and couples who are trying for more children. 

A World Health Organization (WHO) report suggests that around 1 in 6 (17.5%) people are affected by infertility (primary and secondary infertility) worldwide.

Secondary infertility: definition and signs

You can be diagnosed with secondary infertility by a healthcare professional when:

• you’ve experienced a pregnancy to full-term in the past.
• Have been trying to conceive without falling pregnant for 12 months or more.
• Or six months or more if you’re over 35.

The main sign of secondary infertility is being unable to get pregnant when you’re having regular, unprotected sex for up to six months or a year depending on your age. It could also include several failed artificial insemination (IUI) attempts. 

If you’re worried about your fertility, discuss it with your GP or a healthcare professional.

Common causes of secondary infertility

The causes of secondary infertility are the same as the causes of primary infertility.

For women and those assigned female-at-birth (AFAB), these include age-related fertility decline, hormonal imbalances, blockages in your reproductive environment (uterus, fallopian tubes or ovaries) and lifestyle choices such as your weight, nutrition, sleep, stress, and smoking and alcohol.

For males and those assigned male-at-birth (AMAB), the causes of secondary infertility are similar. These include age-related fertility decline, lifestyle choices, and hormone imbalances. However, specific concerns for males and those AMAB are testicular damage, genital infections, or problems with ejaculation or sperm.

Age-related causes of secondary infertility

Age-related fertility decline could be a cause of secondary fertility. For women and those AFAB, it’s natural for the quantity (ovarian reserve) and quality of eggs to diminish, leading to a decline in fertility.

In your 20s, your fertility peaks. Then, fertility gradually declines in your 30s, particularly after age 35.he chances of getting pregnant each month during your 30s are about 20%. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again. 

By age 40, the chance is less than 5% per cycle, so fewer than five out of every 100 women are expected to be successful each month.

Advanced maternal age is associated with increased risks of infertility and complications during pregnancy. Factors like decreased ovarian reserve and higher rates of chromosomal abnormalities can contribute to challenges in conception.

Hormonal imbalances affecting secondary infertility

Hormonal imbalances are a leading cause of primary and secondary infertility. Hormones regulate your menstrual cycle—consider them the orchestrators of your fertility.

Hormonal imbalances can indicate conditions like polycystic ovary syndrome (PCOS) or thyroid issues and can affect ovulation, meaning you might not release an egg every month or the release may be delayed. If an egg isn’t released, pregnancy can’t occur.

Hormonal changes can also negatively affect male fertility, reducing sperm production, mobility and motility. 

Infections and STIs affecting secondary infertility

Infections, both viral and bacterial, can affect your fertility. Some infections, particularly Sexually transmitted infections (STIs), can have lasting negative effects on your fertility if left untreated so it’s important to get regular checkups.

Other viral and bacterial infections might temporarily affect fertility. For male secondary infertility, the testis are particularly susceptible to viral infection. Evidence is also emerging that Covid-19 might impact the testis.

A common cause of secondary infertility in males or those AMAB, is poor semen quality, including a low sperm count, and low motility. This means sperm that isn’t moving properly or abnormally-shaped sperm which makes it harder for them to move and fertilise an egg.

There’s a male fertility misconception that the type of underwear someone wears can affect fertility. Although there seems to be a link between increased temperature of the scrotum and reduced semen quality, there’s no evidence to suggest that the type of underwear worn by men and those AMAB can affect infertility.

If you’ve had any infections, surgeries or medical diagnoses in the last 12 months, it might be worth mentioning to your GP if you’re having trouble conceiving or with secondary infertility.

Medical diagnoses and treatments affecting secondary infertility

Unfortunately, cancer treatments like radiation and chemotherapy, surgery, or a medical diagnosis can affect secondary infertility.

If you’ve recently undergone cancer treatment or are about to, you might want to check your fertility with a hormone and fertility test and consider fertility preservation treatments like egg freezing, IVF (in-vitro fertilisation), and donor eggs or embryos.

Lifestyle considerations for secondary infertility

Lifestyle choices can affect secondary infertility. Things like being underweight or overweight, smoking, using drugs and drinking alcohol. These can all increase the risk of secondary infertility by disrupting your hormone balance and impacting your overall health and well-being.

Poor nutrition can negatively impact fertility

Poor nutrition like eating lots of trans fats and saturated fats found in ultra-processed foods, and having a high-sugar diet have been shown to negatively impact fertility.

Regular exercise to support fertility

Although regular physical exercise is considered healthy and will support weight management and optimise fertility, excessive exercise can negatively affect ovulation and fertility in women and those AFAB.

Getting enough sleep to support fertility

Studies suggest that sleep disturbances correlate with adverse reproductive health outcomes like menstrual irregularities, increased time to and reduced rates of conception, and increased miscarriages. Women with diminished ovarian reserve were found to be 30 times more likely to have disturbed sleep.

Reduce stress to optimise fertility

The connection between infertility and stress is a complicated one. Women and those AFAB report elevated levels of stress and low mood so it’s clear that infertility causes stress. It’s less clear whether stress causes infertility however research suggests that psychological interventions to lower stress have been associated with increased pregnancy rates. With this in mind, take care of your mind as well as your body to optimise fertility.

Treatment for secondary infertility

Depending on the cause of your secondary infertility, there are different treatment options available to you. Secondary infertility relating to ovulation and hormonal imbalances can often be managed with medication and making healthy lifestyle choices. For issues with your reproductive environment, surgery and fertility treatments could support your fertility journey.

Lifestyle adjustments for secondary infertility

To optimise your hormones and fertility, it’s recommended to eat a well-balanced diet (that contains lots of whole grains, protein, fibre, fruit and vegetables), get regular exercise, get enough sleep (7-10 hours each night) and manage stress with relaxation techniques such as breathwork, yoga, meditation and mindfulness—anything that helps you feel more zen!

The Mediterranean diet, which is considered anti-inflammatory, has been shown to optimise fertility. You can also optimise your fertility by tracking your menstrual cycle, so you know exactly when your optimal fertile window is (usually five days before ovulation, the day of ovulation and the following day).

Medical treatments and interventions for secondary infertility

For those with endometriosis, fibroids, scarring or any other blockages in your reproductive environment—uterus, fallopian tubes and ovaries for women and those AFAB, and sperm and genital tracts in men and those AMAB—surgery can help to reduce or remove scarring and blockages to clear a pathway for the egg and sperm to meet and the egg become fertilised.

If you’re experiencing secondary infertility, fertility treatments and assisted conception like IVF (in-vitro fertilisation), donor eggs or embryos and sperm donors are all options you can discuss with your GP or fertility specialist to help you grow your family.

Going through fertility treatments can be difficult and it can negatively impact your mental health, but there is support available. If you’re struggling with your mental health, contact your GP or chat to a fertility counsellor who can give you specialised emotional support, and reach out to family, and friends if you can.

There are also online support groups for secondary infertility like the Fertility Network UK’s Facebook group that could help you to feel less alone.

Unexplained secondary infertility

Unfortunately, in the UK, 1 in 4 cases of infertility are unexplained. This is when no cause of infertility can be identified in either partner. If a cause for your secondary infertility hasn’t been found, talk to a healthcare professional about your next steps.

The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained fertility who have not conceived after two years of trying should be offered IVF treatment.

Structural infertility FAQs

What is secondary infertility?

Secondary infertility is difficulty conceiving after previously giving birth and becoming pregnant naturally or via IUI. To be defined as secondary infertility, the previous birth must have occurred without help from fertility treatments or medications like IVF (in-vitro fertilisation).

Is secondary infertility common?

Although there aren’t any reliable statistics for secondary infertility, infertility (primary and secondary) sadly affects 1 in 4 people. It’s thought that secondary infertility is as common as primary infertility. If you’re worried about your fertility, discuss it with your GP or a healthcare professional.

Can secondary infertility be treated?

Depending on the cause of your secondary infertility will depend on what treatments are available to you. Secondary infertility relating to ovulation and hormonal imbalances can often be managed with medication and making healthy lifestyle choices. For issues with your reproductive environment, surgery and fertility treatments could support your fertility journey.

Can PCOS (polycystic ovary syndrome) cause secondary infertility?

PCOS can cause secondary infertility because it can affect ovulation. For a pregnancy to occur, the first biological step that needs to happen is for the most mature egg to be released by the follicles in your ovaries. However, if you have polycystic ovary syndrome (PCOS), the follicles don’t develop and mature properly so there’s no ovulation (release of an egg).

When to worry about secondary infertility?

Secondary infertility is challenging for anyone at any stage, and it’s normal to worry. If you’re under 35, you can be diagnosed with secondary infertility if you’ve been trying to conceive for 12 months or more. If you’re over 35, you can be diagnosed if you’ve been trying for six months or more. 

If you’re worried about your fertility at any stage, discuss it with your GP or a healthcare professional. You can also get a hormone and fertility test to check your fertility.

It’s important to remember that there are lots of treatments available for secondary infertility, and a healthcare professional can discuss these with you.

Secondary infertility: When to stop trying?

If you’ve been struggling with secondary fertility for a while, you might be wondering when to stop trying to get pregnant or how to move past secondary infertility.

Your fertility journey is unique to you, and only you can decide on your next steps and what’s best for you. But there are lots of support and secondary fertility treatment options available to you whatever you decide.

If you have a partner, maintaining open and honest communication channels will help develop stronger feelings of support. Also speaking to your family, friends or a healthcare professional that specialises in fertility can support you.

You might feel more comfortable expressing your emotions and thoughts with people who are going through the same thing as you. There are also online support groups for secondary infertility like the Fertility Network UK’s Facebook group that could help you to feel less alone.

What’s the difference between primary infertility and secondary infertility?

Secondary infertility is difficulty conceiving after previously giving birth. To be defined as secondary infertility, the previous birth must have occurred without help from fertility treatments or medications like IVF (in-vitro fertilisation). The definition of primary infertility in comparison is when someone who’s never conceived a child has difficulty conceiving.