Secondary Infertility: What Causes It?

April 9, 2021Bríd Ní Dhonnabháin BSc (hons), MSc

Struggling to conceive might come as a shock if you already have a baby. You might not think of infertility affecting those who already have a family but just because someone has a child doesn’t mean they’re in the safe zone when it comes to having more kids. Secondary infertility is a real concern for many women and couples and we’re here to tell you that you’re not alone. 

Quick WhistleStop Tour

Not everyone has the time to read these lengthy articles, we totally understand! Here’s a quick overview of what we’re going to talk about so you can skip to the bits most relevant to you: 

  • Secondary infertility is defined as women who have had one or more pregnancies but are having trouble conceiving again. 
  • A total of 5% of people are affected by secondary infertility.
  • Some of the causes are age-related fertility decline, hormonal imbalances, weight changes, medical history, or unknown causes. 
  • Medications, surgery, and assisted conception are all options to help you conceive. 
  • Speaking to friends, family, or a partner will help you feel supported. You can also join Secondary Infertility support groups like this one from the Fertility Network UK
  • A Hertility Hormone and Fertility test kit can help get to the bottom of your symptoms and highlight any imbalances.

What is secondary infertility? 

5% of people are affected by secondary infertility and as many as 50% of all infertility cases are secondary infertility (1,2). The World Health Organisation (WHO) defines secondary infertility as people who have had one or more pregnancies in the past, but are having trouble conceiving again. This is different to primary infertility where you struggle to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy term (3,4). Like primary infertility, women are diagnosed with secondary infertility after 12 months of trying to conceive, or 6 months if they’re over 35. 

Why does it happen? 

As with primary infertility, we don’t always know the cause. In many cases the same factors that cause primary infertility in some women, cause secondary infertility in others but the issue might not manifest itself until later in life. If you’re on the hunt for answers, here are a few common causes: 

  • Age related fertility decline catches us all, even those of us who got a headstart on family planning. Your chances of conception are higher before the age of 35 and chances of natural conception after 40 are quite low. There’s a whole relationship between your age and your fertility you can read more about here
  • Hormonal imbalances are a leading cause of infertility (5). Conditions like PCOS or thyroid dysfunctions are the result of hormonal imbalances and can affect ovulation, meaning you might not release an egg every month or the release may be delayed. 

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

  • Weight changes and BMI can affect your fertility. The relationship between hormones and weight is complex but in brief being too underweight or too overweight can prevent ovulation by putting your hormone levels out of whack. 
  • Infections, both viral and bacterial, can affect your fertility. Some infections, particularly STI’s, can have lasting negative effects if left untreated so it’s important to get regular checkups, even if you’re in a relationship. Make sure to register your interest for our Hertility STI kits

Other viral and bacterial infections might temporarily affect fertility. If you’ve had any infections in the last 12 months like mumps, meningitis, or Helicobacter pylori infection this might be worth mentioning to your GP if you’re having trouble conceiving (6). The testis are particularly susceptible to viral infection so if you have a male partner who has been ill in the past 12 months, it might be worth getting a semen analysis test. Evidence is also emerging that Covid-19 might impact the testis (7). 

  • Scar tissue from endometriosis or prior surgeries can block the fallopian tubes, preventing sperm from reaching the egg for fertilisation. It can also make implantation of fertilised eggs into the uterine wall difficult. Prior c-sections can have this effect in a small number of women. It might seem counterintuitive but in cases of severe endometriosis or scar tissue a surgery called a laparoscopy can help get rid of troublesome scars. For others, IVF can help get around the problem. 

What can be done about it? 

There are different treatment options available to you depending on the underlying cause of your secondary infertility. Issues relating to ovulation can often be managed by medications. Surgery can reduce troublesome scarring in women or epididymal blockages in men. Some men can also have sperm surgically removed for ICSI due to blockages or prior vasectomy. Assisted conception like IVF, or egg and sperm donation are all options you can discuss with your GP or fertility specialist to help you grow your family.  

Getting Support 

Infertility and stress are a team no one wants to face but the two always come hand in hand and can negatively impact your mental health. With secondary infertility it can be hard to find support from those who can’t seem to understand that having a family the size you want is as important as having a family at all. If you have a partner, maintaining open and honest communication channels will help develop stronger feelings of support. If you’re a single parent, confiding in close friends or family will help you to realise you’re not going it alone. Remember too to pay attention to children you already have, as kids are very good at picking up on how you’re feeling. 

Many people find comfort speaking to people who have experienced similar journeys with secondary infertility. If you would like to connect with others who are going through or have been through similar infertility encounters, you can connect with others through online forums and support groups, like this group for those experiencing secondary infertility from the Fertility Network UK

Not sure where to start? 

There are lots of little steps that you can take to increase your chances of getting pregnant. You’re probably aware of tracking your ovulation and practicing good preconception care but even after implementing these changes, depending on your age it can take over a year to get a formal secondary infertility diagnosis. 

We believe you shouldn’t have to wait if you feel like something is up. Start by getting a hormone and fertility test kit from Hertility and we’ll take it from there. We don’t believe in giving you the what’s up without the what’s next. Our team of experts include fertility specialists that can help you to create an actionable plan for your fertility future.

  1. https://fertilitynetworkuk.org/trying-to-conceive/other-pathways-to-parenthood/secondary-infertility/
  2. https://www.whattoexpect.com/getting-pregnant/fertility/secondary-infertility/ 
  3. https://www.who.int/teams/sexual-and-reproductive-health-and-research/areas-of-work/fertility-care/infertility-definitions-and-terminology#:~:text=When%20a%20woman%20is%20unable%20to%20bear%20a%20child%2C%20either,classified%20as%20having%20secondary%20infertility.
  4. https://www.nhs.uk/conditions/infertility/ 
  5. Unuane D, Tournaye H, Velkeniers B, Poppe K. Endocrine disorders & female infertility. Best Pract Res Clin Endocrinol Metab. 2011 Dec;25(6):861-73. doi: 10.1016/j.beem.2011.08.001. PMID: 22115162.
  6. Wu W, Tang Q, Gu H, Chen Y, Xia Y, Sha J, Wang X. Infection and Infertility. Genital Infections and Infertility. 2016 Jun 29:23
  7. Li R, Yin T, Fang F, Li Q, Chen J, Wang Y, Hao Y, Wu G, Duan P, Wang Y, Cheng D. Potential risks of SARS-Cov-2 infection on reproductive health. Reproductive biomedicine online. 2020 Apr 30.

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