After conceiving a child naturally, it can come as a surprise when you start trying for a second (or third..) and things don’t happen as quickly as you expected. Though it isn’t talked about as much as it should be, secondary infertility is relatively common — about 12% of women will experience secondary infertility in their lifetime, according to the U.S. Centers for Disease Control and Prevention (CDC) (1). Even those who got pregnant right away with their first (or second, or third) child can find themselves facing fertility issues when they start trying for another baby.
Secondary infertility is an umbrella term used when someone is having trouble getting or staying pregnant after already having at least one child (2). (Primary infertility, on the other hand, refers to infertility in couples who haven’t had children yet.) Read on to dig deeper into the factors that can cause secondary infertility.
What causes infertility after you’ve already had a child?
Like primary infertility, secondary infertility can be caused by a wide range of genetic, lifestyle, and medical factors. One common cause of secondary infertility is age, since there’s no getting around the fact that you’re older than you were when you conceived your first child. Consider this: you're born with all the eggs your ovaries will ever hold, and the number of healthy eggs you have decreases throughout your entire life. However, when you’re around 35 years old, that number starts decreasing even faster, lowering your chances of conceiving in a typical cycle. By your early to mid-40s, your chances of ovulating a healthy egg has reduced significantly (3).
Another potential reason for secondary infertility is the effects of complications from previous pregnancies, such as scarring from an ectopic pregnancy or a cesarean section. This scarring may block fallopian tubes and keep sperm from making it to an egg. Scarring or adhesions in the uterus may lower your chances of getting pregnant by interfering with menstrual cycles or preventing a fertilized egg from implanting in the uterine lining (3).
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Also, if you’ve given birth recently, breastfeeding may drastically lower your chances of getting pregnant again. Fortunately, no matter how long you choose to breastfeed, you should start ovulating again about 6 months after giving birth (4).
Other causes of secondary infertility
In addition to age, fertility can be affected by a variety of factors for both you and your partner, which we talk about below. Doctors may not be able to find a cause for secondary infertility, so you may also be (frustratingly) diagnosed with the unexplained infertility.
Some conditions, such as endometriosis, polycystic ovary syndrome (PCOS), uterine fibroids, thyroid issues, and pelvic inflammatory disease (PID) can make it harder for you to conceive. Endometriosis, uterine fibroids, and PID can cause scarring, adhesions, or growths in the fallopian tubes and uterine lining and prevent fertilization and implantation. PCOS and thyroid conditions, on the other hand, can affect hormone levels, which may impair ovulation and make it harder to get pregnant (3).
Being overweight or underweight can make it harder to conceive and carry a baby. If you’re overweight, the extra pounds can also lead to insulin resistance and elevated testosterone levels, both of which may interfere with your ovulation. Also, carrying too much (or too little) weight may decrease your chances of implantation (2, 5).
Most people know that drinking alcohol while pregnant can harm the developing fetus (6), however, the effects of alcohol on fertility aren’t really given the same public discourse. According to board-certified OB/GYN Dr. Cynthia Austin, in an interview with the Cleveland Clinic, “Moderate to heavy alcohol consumption in women (more than 2 drinks per day or more than 7 drinks per week) increases the time it takes to conceive and reduces your chances of delivering a healthy baby (2).”
We talked earlier about how you’re born with a certain number of healthy eggs, and that that number decreases throughout your lifetime. Smoking cigarettes can actually speed up this process and cause you to reach menopause 1 to 4 years early (7). Infertility rates are about double for smokers than nonsmokers, and the effects of smoking increase with the number of cigarettes you smoke each day. Unfortunately, quitting smoking can’t replace any damaged or lost eggs, but it can help you improve your fertility going forward (8).
Whether you have the same partner or a different partner, it’s worth checking for any male factors that could be affecting your chance of conceiving. Sperm quality and quantity can be affected by age, weight, lifestyle (including smoking and drinking habits), genetics, and medical history. Testosterone supplements and exposing the testes to heat can also decrease sperm production (2).
Even with all that doctors have learned about fertility, there’s not always a clear reason why you and your partner may be having trouble getting pregnant. Fortunately, your doctor will still be able to help you explore your options if you need help conceiving, even if they’re not entirely sure exactly why you haven’t gotten pregnant yet (3).
At what point should I see a doctor for secondary infertility?
When you’re trying to get pregnant, the recommendations for when to see a doctor or fertility specialist are the same, whether you’ve given birth before or not. If you’re younger than 35, you should talk to your healthcare provider if you’ve been having frequent unprotected sex for a year without conceiving. If you’re 35 or older, you should only wait 6 months (9).
Consider seeing a doctor even sooner if you have a history of pelvic inflammatory disease, miscarriages, irregular or painful periods, or if you already know that your partner has a low sperm count (9).
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Depending on what’s causing your infertility, treatments can include lifestyle changes, surgery to remove blockages or scar tissue, fertility medications, or assisted reproductive technology, such as in vitro fertilization or intrauterine insemination (10).
Secondary infertility brings with it a complicated mix of emotions — you’re incredibly thankful for the child(ren) in your family, but you still feel the intense sense of loss that comes with each negative pregnancy test. You may find it helpful to reach out to support groups or mental health professionals, either online or in your area, so that you and your partner receive the support and encouragement you need to get through your infertility journey.
For some people, secondary infertility means that conceiving is going to take longer than planned. For others, it may mean turning to a fertility specialist for help with conception, or exploring other paths, such as adoption or surrogacy. No matter which camp you fall into, a diagnosis of secondary infertility isn’t the end of your family’s story. It’s just the start of your next chapter.