Secondary Infertility: Causes, Symptoms, Treatment & More

Reproduction is incredibly complex. Innumerable systems and physical functions come together to create new life, and every individual body is different. So, it’s understandable that 30% of parents face obstacles on their path toward having a successful pregnancy with a second child. In fact, it’s completely normal.

Hopeful parents may deal with secondary infertility for biological reasons (like age) or clinical ones (like testicular dysfunction). While these roadblocks can be frustrating to go through, they do not mean you won’t be able to grow your family.

Struggling with fertility issues can be a challenge—particularly if you had an easy time conceiving the first. Here are some causes of secondary infertility and coping mechanisms that you can use.

What is secondary infertility?

Secondary infertility occurs when a mother who has already given birth to one child is struggling to conceive and carry a second to term. Of all reproductive-aged women (often those between 14 and 49 years old), some 6% will struggle to get pregnant a second time. Going through secondary infertility can be an indicator of:

• Changes your body is going through
• Reaching a transitional period in your reproductive journey

Secondary Infertility Signs and Symptoms

Physicians use the following signs as official indicators of secondary infertility cases:

1. A woman 35 years old or younger who is unable to conceive after having unprotected intercourse for a minimum of 1 year.
2. A woman 30 years old or older who has a history of pelvic inflammatory disease, irregular or painful menses, or miscarriage.
3. A man who has a history of low sperm counts or poor sperm quality.

Secondary infertility is regarded as a circumstance of general reproductive health—not a disorder in and of itself. In some cases, the inability to get pregnant after you’ve already had a baby indicates a related underlying condition or a shift in physical health. In others, secondary infertility may just signify a normal transition in your reproductive journey.

What causes secondary infertility?

Secondary infertility can occur as a result of conditions related to one parent or both.

Possible Causes of Secondary Infertility in Men

Secondary infertility is caused by the male partner in 33% of cases. Testicular dysfunction is the leading cause of infertility in men, and some other common fertility problem causes include:

• Low sperm count – To produce sufficient amounts of sperm, a man’s body must produce an adequate supply of testosterone. There are myriad reasons why testosterone production may decline over time, from natural causes (like aging), physical conditions (like diabetes), or stress.
• Poor semen quality – Sperm are the reproductive cells responsible for fertilizing an egg, while semen is the fluid that both includes and encases them. Semen holds a host of necessary proteins, sugars, and other nutrients that help sperm stay healthy and nourished.

Experts are still trying to understand the causes of sub-par semen, but research suggests endocrine dysfunction or exposure to chemicals is linked with semen quality decline around the world.

• Anatomical abnormalities – Men with irregular reproductive anatomy may have depressed fertility. These are often related to an enlarged or removed prostate, or a condition called varicocele, which affects 40% of men struggling with unexplained infertility.

Infertility in men may also result from taking drugs to treat existing medical conditions. These could include:

• Antibiotics
• Hypertension medications
• Stomach acid medications
• Pain management medications
• Seizure medications
• Psychotropic drugs (e.g. drugs used to treat schizophrenia)

Possible Causes of Secondary Infertility in Women

Female infertility causes about one-third of reported secondary infertility cases. In the remaining one-third, the cause of secondary infertility may be unclear or result from several interrelated factors.

For women, the most common reproductive difficulties that can directly affect the average time to get pregnant with a second child are:

• Diminished ovarian reserve – A woman’s ovarian reserve (the cache of eggs she’s born with) declines in both quantity and quality with age. This ovulation decline will accelerate between 37 and 38 years of age, when many women may begin to experience fertility challenges. Research suggests that healthy lifestyle habits (avoiding tobacco, reducing pollution exposure, etc.) correlate with a higher likelihood of maintaining high-quality eggs.
• Reproductive conditions – Women who struggle with reproductive conditions affecting the fallopian tubes, uterus, or ovaries may also encounter difficulties in their second pregnancy. Some of these are fairly common, like endometriosis (affecting some 10% of reproductive-age women) and PCOS (estimated to affect 5 million women in the US alone). Additionally, some women who deliver their first baby via cesarean develop uterine scarring, which can make future pregnancies more difficult.
• Interpregnancy adjustments – The period of time between your most recent birth and next conception is called interpregnancy. Almost all women experience a decline in fertility preservation during interpregnancy, since breastfeeding pauses your reproductive cycles while your body recovers, and you take care of (and breastfeed!) your new baby. This period lasts for approximately 45 to 94 days.

Can you have a baby with secondary infertility?

Every case of secondary infertility is unique. Some women can conceive and successfully deliver their second baby after a year or more of difficulty getting pregnant.

In other cases, women may choose to use alternative treatments and solutions. This could look like:

• Assisted Reproductive Technology (ART) – Many parents can achieve a healthy, happy second pregnancy through ART and fertility treatments like in vitro fertilization (IVF). Each year, around 2% of babies are conceived, carried, and delivered as a result of successful IVF procedures. That said, some parents may be ineligible for IVF due to clinical reasons. If you’re interested in going this route, consult your healthcare provider.
• Adoption – For some couples, ART techniques may be prohibitive due to costs or medical conditions. Fortunately, adopting a child can be a wonderful way to grow your household when you can’t conceive on your own. Around a third of households in the US have considered adoption in planning the growth of their families.
• Nurturing a single-child household – The decision to grow your family—and how you’ll go about it—is an entirely personal choice. For some women, confronting fertility challenges may lead them to forgo a second child altogether. Ultimately, the only “right way” to raise a family is the choice you make and pour your heart into the best you can.

Coping with Secondary Infertility: Treatment and Care

Confronting fertility obstacles at any stage of life can be a trying, highly personal experience, whether or not you’re already a parent.

Many women facing fertility challenges experience:

• Depression
• Stress and anxiety
• Relationship pressures
• Family pressures
• Hormonal side effects caused by fertility treatment medications

One 2018 study found that many women report dealing with secondary infertility by over-exerting themselves at work, or avoiding discussions with their partners or loved ones altogether. While the way you cope is entirely up to you, there are some gentle guidelines for helping you process and hold compassion for yourself as you move through it.

Finding Healthy Ways to Express Yourself

In many ways, the discussions we have surrounding fertility depend on the cultures we grew up in. Some groups may treat anything reproduction related as taboo, while others don’t discuss it because they have difficulty coping with grief.

In still other circumstances, you may simply not feel comfortable opening up to your friends, or even your partner—12% of women struggling with fertility report exiting a room when babies or pregnancy is brought up.

Even so, it’s important to express yourself in ways you feel comfortable with. Some methods of doing so privately include:

• Journaling
• Recording voice memos on your phone
• Therapy or counseling
• Fertility support groups

Having an outlet for grief is essential for your well-being. It can also reduce your stress levels, which can be one small step towards increasing your likelihood of getting pregnant.

Keeping an Open Discussion with Your Healthcare Team

Because there are so many potential causes of secondary infertility, it’s crucial to keep an open channel of discussion between you, your healthcare team, and your partner. In some cases, the possibility of a second pregnancy may be foreclosed due to medical reasons—but in others, you may just have to accept your body’s timeline.

Regardless of the clinical circumstances, be communicative if you’re pursuing fertility therapies, which can be incredibly taxing on time, energy, and your body itself. Even if you aren’t up to discussing the issue directly, remind yourself that you’re entitled to ask for help from your partner or support network when you need it.

For more fertility tips, check out our resource center and make sure to read up on topics such as signs of high fertility in women, potential fertility diets to improve egg quality, and more. SneakPeek is here to help answer all of your pregnancy-related questions.

SneakPeek: Your Ally In Every Stage of Your Reproductive Journey

Every woman paves her own path through parenthood, and pregnancy isn’t any different. About 15% of couples experience infertility, and 11% of single, reproductive-aged women do. While it’s difficult to work through circumstances beyond our control, they don’t preclude the possibility of another child.

No matter where you are on your reproductive journey, SneakPeek is trusted by 1 million moms across the country. SneakPeek is OBGYN’s #1 pick for an At-Home Early Gender Blood Test, with over 99% clinically-proven accurate¹ results that can tell you your baby’s sex at just 6 weeks into pregnancy.

Whenever you’re ready, you have an ally in SneakPeek Test.

This post has been reviewed for accuracy by the following medical professional:

Katie Smith, MSN, APRN, CNM

Katie Smith is a seasoned Certified Nurse Midwife and a nurturing mother to six children, offering a unique blend of professional expertise and personal experience. She is the founder of Birth Your Way Midwifery and Women’s Wellness Center in Bay County, Florida. Katie's comprehensive approach to care is informed by her hands-on experience in motherhood and her passion for empowering women through their birthing journey. Her dedication extends beyond her center as she actively engages in community wellness and family health education.

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