Secondary Infertility
When baby #2 (or #3, or #4) isn't coming as easily.
What You Need to Know
- Definition: Inability to conceive after previously having a biological child
- Common: About 1 in 6 couples experience secondary infertility
- Valid struggle: Having a child doesn't diminish the pain of wanting another
- Treatable: Same options as primary infertility, often with good success
What Is Secondary Infertility?
Secondary infertility is defined as the inability to become pregnant or carry a pregnancy to term after previously giving birth to one or more biological children—without the use of fertility treatments for that previous pregnancy.
It's more common than many people realize, accounting for about 50% of infertility cases. Yet it often goes unrecognized and unsupported because of assumptions that "you've done it before, so you can do it again."
📊 By the Numbers
• ~3 million couples in the US experience secondary infertility
• It's as common as primary infertility
• Only 50% of those affected seek medical help (compared to 79% for primary infertility)
Why It Happens
Secondary infertility has the same causes as primary infertility. The difference is that something may have changed since your last pregnancy—or issues that were borderline before have now crossed a threshold.
⏰ Age
This is the most common factor. If there's a gap of several years between pregnancies, your eggs are older. Fertility declines significantly after 35 and drops more steeply after 40.
What changes: Egg quantity and quality decrease. Even if you conceived easily at 32, it may be harder at 37.
🔄 Changes in Ovulation
Conditions like PCOS or thyroid disorders may develop or worsen over time. Stress, weight changes, and lifestyle factors can also affect ovulation.
Signs: Irregular periods that weren't irregular before, very short or long cycles.
🩺 Complications from Previous Pregnancy or Delivery
C-sections can cause uterine scarring. Postpartum infections, hemorrhage, or retained placenta can lead to adhesions (Asherman's syndrome) or other uterine issues.
Signs: Lighter periods, no periods, or pain during menstruation after previous delivery.
🔬 Endometriosis or Fibroids
These conditions can develop or progress over time. You may not have had significant endo or fibroids before, but they can appear and worsen.
👨 Male Factor Changes
Sperm quality can decline with age, weight gain, medications, or new health conditions. Just because sperm was fine before doesn't mean it still is.
Always include: A new semen analysis when evaluating secondary infertility.
⚖️ Weight Changes
Significant weight gain or loss (in either partner) since the last pregnancy can affect fertility. Obesity impacts ovulation; being underweight can stop it entirely.
💊 New Medications
Some medications started since your last pregnancy may affect fertility: certain antidepressants, blood pressure medications, or medications for chronic conditions.
❓ Unexplained
Sometimes no clear cause is found. This is frustrating but doesn't mean treatment won't help.
When to Seek Help
The standard timelines apply:
- Under 35: After 12 months of trying
- 35-39: After 6 months of trying
- 40+: Immediately or after 3 months
However, if you have known risk factors or something feels "off" compared to your previous conception, don't wait the full timeline. Trust your instincts.
💡 What to Tell Your Doctor
• How long you've been trying
• Details about your previous pregnancy and delivery
• Any complications (C-section, infection, hemorrhage)
• Changes in your cycle since then
• Any new health conditions or medications for either partner
• Weight changes
The Testing Process
Evaluation for secondary infertility is similar to primary infertility testing:
For Her
- Ovarian reserve testing (AMH, FSH, AFC)
- Hormone panel (TSH, prolactin, testosterone)
- HSG or SIS to check tubes and uterine cavity
- Pelvic ultrasound
- Possibly hysteroscopy if uterine issues are suspected
For Him
- Semen analysis (even if it was normal before)
- Hormone testing if SA is abnormal
⚠️ Don't Skip the Semen Analysis
Just because he fathered a child before doesn't mean sperm is still optimal. Sperm parameters can change significantly over time. Always get a current semen analysis.
Treatment Options
Treatment for secondary infertility is the same as for primary infertility:
- Lifestyle modifications: Weight management, diet, reducing alcohol
- Ovulation induction: Clomid or Letrozole if not ovulating regularly
- IUI: Often combined with ovulation induction
- Surgery: For fibroids, polyps, uterine adhesions, or endometriosis
- IVF: For tubal issues, severe male factor, or when other treatments fail
Success rates are generally similar to primary infertility, with age being the biggest factor.
The Emotional Side
Secondary infertility comes with its own unique emotional challenges:
The "You Should Be Grateful" Problem
People (including yourself) may think you shouldn't struggle because you already have a child. This is false. Grief is grief. Wanting another child is a legitimate desire, and difficulty achieving it is a legitimate loss.
Isolation
You may not fit in with the infertility community (who may resent that you have a child) or the "trying for another" crowd (who conceive easily). You can feel stuck between two worlds.
Guilt About Your Existing Child
You might feel guilty that your desire for another child somehow diminishes your love for the one you have. It doesn't. You can be profoundly grateful for your child AND want another one.
Difficult Questions
"When are you having another?" "Don't you want a sibling for them?" These questions hurt when you're struggling silently.
💚 Your Feelings Are Valid
• You're allowed to grieve
• You're allowed to seek treatment
• You're allowed to struggle even with a child at home
• Having a child doesn't make infertility hurt less—it's just a different kind of pain
Coping Strategies
- Find your people: Look for secondary infertility-specific support groups online (Reddit, Facebook) or through RESOLVE
- Set boundaries: It's okay to skip baby showers or limit time with pregnant friends
- Consider therapy: A counselor specializing in infertility can help
- Communicate with your partner: You may be coping differently; stay connected
- Be present with your child: They can be a source of joy even amidst the struggle
- Give yourself grace: Some days are harder than others. That's okay.
The Bottom Line
Secondary infertility is common, real, and treatable. Having a previous child doesn't guarantee easy conception for the next. If you're struggling, you deserve support and medical care just as much as anyone experiencing primary infertility.
Your pain is valid. Your desire for another child is valid. And there are paths forward. 💚