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What is secondary infertility?

Medically reviewed on February 17, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


Individuals who’ve already had one baby often want to grow their families and give their child a sibling. And if they didn’t have trouble conceiving the first time, they may assume that getting pregnant again will happen easily.

Unfortunately, this isn’t always the case. Some people get pregnant quickly with their first baby, only to struggle to conceive the second time around. This experience, known as secondary infertility, can cause frustration and confusion.

What is secondary infertility and why does it happen? Below, we’ll review the signs of secondary infertility, its potential causes, and how it may be treated as well as how fertility testing can help. (Consider learning more about fertility-related hormones with the at-home Women's Fertility Test.)

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Secondary infertility defined

According to the CDC [1], infertility is defined as the inability for a person assigned female at birth to get pregnant after having regular, unprotected sex for at least:

  • One year if they’re under 35
  • Six months if they’re over 35

Secondary infertility is simply infertility that occurs after a person has already had one or more successful pregnancies in the past.

How common is secondary infertility?

Primary infertility impacts around 12% of individuals assigned female at birth aged 15–44 [1]. Secondary infertility is just as common as primary infertility—roughly 50% of all infertility cases involve secondary infertility [2].

When a person struggles to get pregnant for the second time, they may assume it’s due to changes in their body. However, either partner can contribute to secondary infertility.

Consider these statistics [3]:

  • In one-third of infertility cases, the person with female sex organs is directly experiencing infertility.
  • In another one-third of infertility cases, the person with male sex organs is directly experiencing infertility.
  • In one-third of infertility cases, both sex partners are directly experiencing infertility or the root cause cannot be determined.

What are the signs of secondary infertility?

The signs of secondary infertility are very similar to the signs of primary infertility. The most significant sign of secondary infertility is having trouble getting pregnant after one year (if the partners are age 35 or younger) or six months (if the partners are above age 35) of having unprotected sex [4].

Some signs and symptoms that may be related to secondary infertility include [4]:

  • Irregular periods
  • Painful periods
  • Pelvic inflammatory disease
  • Miscarriages
  • Low sperm count

What causes secondary infertility?

Like primary infertility, a wide variety of underlying conditions can cause secondary infertility. Below, we’ve listed a few of the potential causes of secondary infertility [1].

Women:

  • Changes in age, weight, or medications
  • Ovulation issues
  • Endometriosis
  • Fallopian tube blockages
  • Polycystic ovary syndrome
  • Uterine abnormalities, such as scarring, fibroids, or polyps
  • Sexually transmitted infections
  • Egg quality issues related to age
  • Alcohol consumption or smoking
  • Poor diet
  • Complications from a previous pregnancy
  • Breastfeeding

Men:

  • Changes in age, weight, or medications
  • Testicular varicocele
  • Problems with sperm production, sperm quality, or delivery
  • Low testosterone levels
  • Enlarged or removed prostate
  • Late-onset hypogonadism
  • Alcohol consumption or smoking
  • Exposure to certain chemicals, such as pesticides or lead

Since either partner can cause secondary infertility, both people may need to undergo a medical evaluation to determine the root cause of their secondary infertility struggles.

What are the treatment options for secondary infertility?

Modern medicine has enabled the invention of many innovative infertility treatments. Some of the treatment protocols for secondary infertility include [5]:

  • Taking medications – If infertility is caused by a lack of ovulation, a healthcare provider may prescribe certain fertility medications to induce ovulation, such as clomiphene or letrozole [6].
  • Uterine surgery – If infertility is due to structural issues with the uterus, surgery may be needed to remove any polyps, fibrosis, or scar tissue.
  • Intrauterine insemination (IUI) – IUI is a procedure that can surgically place sperm into the uterus to increase the chances of fertilization if infertility is caused by poor sperm mobility.
  • Testicular surgery – If infertility is caused by testicular varicocele, testicular surgery may be needed to correct this condition.
  • Medication for semen quality improvement – Specific drug protocols may help enhance semen quality, and therefore, fertility.
  • In vitro fertilization (IVF) – IVF is the process of fertilizing an egg outside the womb. During IVF, a person administers daily injections to stimulate their ovaries. After that, their eggs are surgically retrieved and fertilized in a lab. Once embryos are created, they’re placed into the uterus.

While a fertility problem may be alarming, especially for an individual trying to have a successful pregnancy, there's hope in finding the right fertility treatment option.

Improve your fertility awareness with Everlywell

If you’re struggling with secondary infertility, it’s a good idea to schedule an appointment with a healthcare provider. They can perform exams to determine the most likely cause of fertility challenges.

You can also monitor your fertility from the comfort of your own home with help from Everlywell. With our physician-reviewed at-home Women’s Fertility Test, for instance, you can measure 5 hormones that play a key role in female fertility, including estradiol, luteinizing hormone, and follicle-stimulating hormone. Once you receive your fertility test results, you can review them with a healthcare provider and determine an appropriate fertility treatment protocol.

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References

1. Infertility FAQs. Centers for Disease Control and Prevention. URL. Accessed February 17, 2022.

2. Katib AA, Al-Hawsawi K, Motair W, Bawa AM. Secondary infertility and the aging male, overview. Cent European J Urol. 2014;67(2):184-8. Epub 2014 Jun 23. PMID: 25140235; PMCID: PMC4132591.

3. How common is infertility? National Institutes of Health. URL. Accessed February 17, 2022.

4. Secondary Infertility. Cleveland Clinic. URL. Accessed February 17, 2022.

5. Evaluation and Treatment of Infertility. American Academy of Family Physicians. URL. Accessed February 17, 2022.

6. Aromatase Inhibitors Such as Letrozole (Femara) vs. Clomiphene (Clomid) for Subfertile Women with PCOS. American Academy of Family Physicians. URL. Accessed February 17, 2022.

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