Secondary Infertility

What is Secondary Infertility?

Becoming pregnant after having your first baby is not always easy. Secondary infertility is a term used for a woman or couple who have one or more children together but are now having difficulty conceiving.

Why does Secondary Infertility happen?

There are many reasons why secondary infertility can happen. Where a heterosexual couple is involved, it’s important to realise that both men and women’s fertility can change with age and other medical and environmental factors. Just because a man has fathered a child in the past doesn’t mean his sperm function hasn’t significantly deteriorated over time. Women often blame themselves for the problem of secondary infertility but often the cause may in fact involve a male infertility factor. It’s important to investigate couples together so as to reach a timely diagnosis and institute appropriate interventions.

At least you have one child, right?

Couples have set ideas and expectation as to what their completed family will ideally be like. Secondary infertility can cause significant distress, frustration, anger tension and guilt related to a couple not being able to provide their existing child with a sibling. Friends and family can assume the couple are actively choosing not to conceive again. Couples with secondary infertility often face frequent well meaning but painful probes and questions about when “baby number two” is to be expected. Pressure from family and friends can be upsetting and unhelpful. Seeing other couples around you expanding their family while you are struggling can be particularly hard.

Are the causes of primary and secondary infertility different?

After 35, a normal and natural decline in female fertility occurs. 50% of women at the age of 40 will not be able to conceive successfully without the aid of a donated egg from a younger donor.

Many factors that cause infertility can be acquired or worsen in severity over time. Therefore, there is a great deal of overlap in the kind of conditions that cause primary infertility and secondary infertility.
Among the possible causes of secondary infertility are the following problems:

  1. Impaired sperm production and function
  2. Sexual problems and impaired sperm delivery
  3. Varicose veins of the scrotum impairing sperm production (varicocoele)
  4. Suboptimal frequency of sexual intercourse
  5. Ovulation disorders
  6. Fallopian tube damage from infection or inflammatory causes
  7. Endometriosis
  8. Uterine conditions in women including fibroids and adenomyosis
  9. Complications relating to previous surgery or pregnancy, including surgical adhesions and Asherman’s syndrome
  10. Medical conditions affecting either the male or female including diabetes, thyroid disorders or other chronic diseases, and side effects of medications used for these problems
  11. Environmental factors, exposures or toxins
  12. Smoking and alcohol use
  13. Age and poor oocyte (egg) quality
  14. Weight and obesity
  15. Genetic problems such as karyotype abnormalities that may by good luck not have affected a couple’s first baby.

How long should couples with secondary infertility wait to seek the help of a doctor?

By it’s nature, couples suffering secondary infertility are generally of more advanced age than couples who face primary infertility. Time becomes a precious and important factor as eventually, all couples face the problem of female age related infertility. Over 35 years, oocytes become fatigued and are more likely to make critical errors in forming embryos. If other factors are also present, this makes helping a couple with secondary infertility more challenging.
If a woman is over 35 years and has been suffering secondary infertility with her partner over 6 months, both she and her partner should have a thorough fertility evaluation. Younger couples may choose to try to conceive for 12 months before seeking help.
Secondary infertility can be stressful. Our advice is, if you are feeling nervous or anxious, it is very reasonable to have a thorough evaluation to look for an accurate explanation as to why your fertility has changed.

What are some common myths about secondary infertility?

  1. It can’t be the man. Oh yes it can. Sperm production, transport and functional problems commonly develop in men as they age. Just because their swimmers got over the line the first time doesn’t mean they were every that terrific. Genetic concerns in men like balanced chromosomal translocations can be an easily missed cause of secondary infertility. This can happen in women too and can only be uncovered by performing a test called a karyotype. Like women can experience ovarian failure, men can experience testicular failure. A range of medications and drugs can cause sperm problems as can acquired hormonal imbalances and other medical conditions.
  2. Age isn’t such a big deal. Unfortunately yes it is. While the most fertile among us can have babies in their 40’s, this is an age where most women struggle to conceive due to egg quality issues. For a woman at age 40 years, the chance of conceiving each month has fallen from 20% to 5%. Patience can be a virtue, but equally don’t wait too long to seek help. If you are over 35, getting the help you need in a timely fashion can majorly influence your ultimate treatment outcome.
  3. You don’t need to have that much sex to get pregnant. Yes you do. Frequent, well timed intercourse before and around ovulation is important to achieve your best chance of conception.
  4. Being overweight is not the issue. For many women and men, being overweight can cause tissue inflammation, disturb ovulation and impair sperm production. Sperm is meant to be made in an environment that is several degrees cooler than body temperature. Overweight men and women may also display hormonal problems, or may have undiagnosed diabetes which is associated with delay to conception and increased risk of pregnancy losses or miscarriages. It’s easy to put on weight during a first pregnancy which can be very challenging to lose afterwards.
  5. It’s not because I smoke, that hasn’t changed. Women who smoke go through menopause earlier than women who don’t smoke, display impaired fertility and are more likely to suffer miscarriages. Men who smoke make a higher proportion of DNA damaged sperm, impairing their number, shape and function and ability to swim to find the egg.
  6. Stress doesn’t matter. The everyday stresses of parenthood can definitely contribute to secondary infertility. Time pressures and sleep deprivation can interfere with a couple’s relationship and the frequency of sexual intercourse. Having regular sex can be difficult for couples facing the pressures of bringing up small children but this is needed to achieve a pregnancy. Less “me time” can also lead to poorer diet and a lack of physical exercise, impairing parents general health and monthly chance of natural conception. Tackling weight and lifestyle issues will help some couples to achieve a natural pregnancy.
  7. My new partner can’t be the reason, they have had kids before. Not every “union” is equally fertile. A common reason for suffering secondary infertility is in context of a new partnership. Often issues are multifactorial, with problems contributing on both sides.

How can we overcome secondary infertility?

The first step is to have a thorough evaluation. Seeing your GP is an excellent first step. It is likely that your GP will refer you to be examined by a specialist. Specialists with a dual qualification in Obstetrics and Gynaecology and Infertility and Reproductive Endocrinology (FRANZCOG CREI) are the best qualified to assist you. CREI qualified specialists have been highly trained in the expert management of the full spectrum of complex male and female infertility. The first step will be to identify factors involved in your situation. The second step will be to correct reversible factors to assist natural conception. If needed, assisted reproductive technologies like IUI (intrauterine insemination) and IVF (in vitro fertilization) can be used to assist you to conceive.

What should I do now?

Make a plan. If you and your partner are struggling with secondary infertility, make an appointment at Women’s Health Melbourne for a thorough assessment for both of you. We will endeavour to identify all the issue and build a multidisciplinary team lead by fertility expert and CREI subspecialist Dr Raelia Lew to help you achieve the family you crave.