Secondary Infertility
When getting pregnant again is harder than you expected.
Key Facts
- Definition: Difficulty conceiving or carrying to term after previously having a child
- Prevalence: Affects about 10-15% of couples; actually more common than primary infertility
- Treatable: Same treatments available as for primary infertility—with good success rates
- When to seek help: After 6-12 months of trying (depending on age)
What Is Secondary Infertility?
Secondary infertility is defined as the inability to conceive or carry a pregnancy to term after previously giving birth to one or more children without fertility assistance.
It's a surprisingly common experience that often catches couples off guard. After all, if you got pregnant before—especially if it was easy—you'd expect it to happen again. But that's not always how it works.
📊 The Numbers
Secondary infertility accounts for approximately 50% of all infertility cases—it's actually slightly more common than primary infertility (difficulty conceiving a first child). Yet it often receives less attention and support.
It's Real Infertility
One of the frustrating aspects of secondary infertility is that it's sometimes minimized—by others and even by yourself. "At least you have one child" doesn't erase the pain of wanting another. Secondary infertility is a legitimate medical condition that deserves the same diagnosis, treatment, and support as primary infertility.
Common Causes
The causes of secondary infertility are generally the same as primary infertility, but with some additional factors that may have developed since your first pregnancy.
Age
The most common factor. If there's been a gap of several years since your first child, both partners are older. Female fertility declines significantly after 35, and male fertility also decreases with age (though more gradually).
- Fewer eggs and lower egg quality
- Decreased sperm quality
- Higher rates of chromosomal abnormalities
Previous Pregnancy/Delivery Complications
Issues from your first pregnancy or delivery can sometimes affect future fertility:
- Uterine scarring: From C-section, D&C, or infection
- Asherman's syndrome: Scar tissue inside the uterus
- Damage during delivery: Rare but possible
Weight Changes
Significant weight gain or loss since your first pregnancy can affect hormonal balance and ovulation. Pregnancy itself can cause lasting metabolic changes in some women.
New Medical Conditions
Conditions that may have developed since your first pregnancy:
- Endometriosis: Can worsen over time
- PCOS: May develop or become more pronounced
- Fibroids: More common with age
- Thyroid disorders
- Diabetes
Male Factor Changes
Your partner's fertility may have changed:
- Age-related decline in sperm quality
- New medications affecting fertility
- Weight gain or lifestyle changes
- Varicocele development
- New health conditions
Lifestyle Factors
Changes since your first pregnancy:
- Increased stress (parenting is hard!)
- Less sleep
- Less time for intercourse during the fertile window
- New medications
- Different diet or exercise habits
Unexplained
In about 25-30% of secondary infertility cases, no specific cause is found. This doesn't mean there isn't one—just that current testing can't identify it.
When to Seek Help
The guidelines for when to see a doctor are the same as for primary infertility:
- Under 35: After 12 months of trying
- 35-39: After 6 months of trying
- 40+: After 3 months, or immediately
See a Doctor Sooner If:
- You have irregular or absent periods
- You had complications with your first pregnancy/delivery
- You know of any fertility-related conditions (endometriosis, PCOS, etc.)
- Your partner has known fertility issues
- You've had recurrent miscarriages
💡 Don't Wait Because "It Worked Before"
Many couples delay seeking help for secondary infertility because they assume if it happened once, it will happen again. But fertility changes over time, and the longer you wait, the more factors like age come into play. If you're struggling, it's worth getting evaluated.
What to Expect at Your Appointment
Your doctor will likely recommend:
- For her: Hormone testing, ultrasound, possibly HSG (to check fallopian tubes)
- For him: Semen analysis
- Both: Medical history review, lifestyle discussion
Testing for secondary infertility is essentially the same as for primary infertility.
Treatment Options
The good news: all the same treatments available for primary infertility are available for secondary infertility, with similar success rates.
Lifestyle Optimization
Sometimes simple changes can help—especially if specific factors have changed since your first pregnancy:
- Weight management
- Reducing stress (easier said than done with a child!)
- Improving diet and exercise habits
- Timing intercourse better (you may have less spontaneous sex now that you're parents)
Medications
- Clomid or Letrozole: If ovulation is irregular
- Metformin: For insulin resistance/PCOS
- Progesterone: If luteal phase support is needed
Intrauterine Insemination (IUI)
Often combined with ovulation-stimulating medication. Places washed sperm directly into the uterus around ovulation time.
IVF
May be recommended if other treatments fail, or if there are specific issues like blocked tubes, severe male factor, or advanced maternal age.
Surgery
If structural issues are identified (fibroids, polyps, uterine scarring, etc.), surgical correction may help.
The Emotional Side
Secondary infertility comes with unique emotional challenges that deserve acknowledgment.
Feelings You Might Experience
- Guilt: Feeling like you should be grateful for the child you have
- Confusion: Why isn't it working when it worked before?
- Isolation: Not fitting in with "infertility" groups or "parent" groups
- Grief: Mourning the family you imagined having
- Complicated feelings toward your child: Love mixed with sadness about siblings they may not have
- Pressure: Questions from family, your child, or yourself about "when's the next one?"
💜 Your Pain Is Valid
Having a child doesn't disqualify you from grieving difficulty having another. Secondary infertility is real, and so is your pain. You can be grateful for what you have AND sad about what you don't. These feelings coexist.
Coping Strategies
- Find community: Secondary infertility-specific support groups exist—online and in-person
- Communicate with your partner: You may grieve differently; that's okay
- Consider therapy: A fertility-focused therapist can help
- Set boundaries: It's okay to skip baby showers or avoid conversations about family size
- Cherish your child: Spending quality time with them can be healing (while also sometimes triggering—both are normal)
Talking to Your Child
If your child is old enough to understand and asks about siblings, keep it simple and age-appropriate:
- "We'd love to have another baby, and we're trying."
- "Sometimes it takes longer than expected to grow a family."
- "No matter what, our family is perfect with just us, too."
The Bottom Line
Secondary infertility is more common than many realize, and it's just as worthy of support, treatment, and compassion as primary infertility. If you're struggling to conceive again, don't wait—seek evaluation, explore treatment options, and find community.
And remember: having one child doesn't mean you can't be devastated about not being able to have another. Your feelings are valid. 💚