What is secondary infertility?

Secondary infertility can be a painful setback for a couple that hopes to expand their family. It refers to the inability to conceive or carry a pregnancy to term despite having had a successful pregnancy in the past. While primary infertility, or the inability to have a first child, receives greater attention, the inability to get pregnant again is a growing concern that affects millions of families around the world. This condition can take a toll on a couple’s physical, emotional, and mental well-being, making it essential to recognize, understand and address the challenges that come with it.

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What causes secondary infertility?

Secondary infertility in female

This condition is often overlooked because of the misconception that having previous successful pregnancies would mean subsequent pregnancies will occur naturally. If you are wondering how common is secondary infertility, it occurs at about the same rate as primary infertility. It affects about 12% of the women trying for another child. Here are some causes that affect the secondary fertility problem as much as the primary one.

–       Age

As women age, their fertility naturally declines. It is due to decreased quantity and quality of their eggs. This decline typically starts around age 30 and accelerates after age 35. As a result, women trying to conceive later in life may have more difficulty becoming pregnant than when they were younger, even if they have previously had successful pregnancies.

–       Ovarian reserve

Women are born with a finite number of eggs, and this number naturally declines as they age. Women who have previously had successful pregnancies may have a lower ovarian reserve, making it more difficult for them to conceive again.

–       Uterine issues

The uterus or womb is where the fertilised egg implants and grows into a fetus/baby. Thus, any issues with the uterus can impact a woman’s ability to conceive and carry a pregnancy to term. Secondary infertility may be caused by fibroids, scarring or adhesions within the uterus, and polyps. These causes may interfere with implantation or cause miscarriage.

–       Fallopian tube issues

The fallopian tubes transport the egg from the ovary to the uterus/womb. If the tubes are blocked or damaged, it can prevent the egg from reaching the uterus and being fertilised by sperm. Some complications may occur in the form of chlamydia, gonorrhoea and pelvic inflammatory disease.

–       Endometriosis

Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. In some cases, endometriosis can lead to secondary infertility. The scarring and adhesions caused by endometriosis can interfere with the normal function of the fallopian tubes and uterus. It can make the egg and sperm difficult to fertilise and implant in the womb.

–       Polycystic ovary syndrome (PCOS)

PCOS is a hormonal disorder that affects women of reproductive age. It’s one of the most common causes of female infertility and can contribute to the condition. Women with PCOS typically have elevated levels of androgens (male hormones), which can interfere with ovulation and make it more difficult for the egg and sperm to meet. It can result in irregular or absent menstrual cycles, making it harder for a woman to conceive.

–       Secondary unexplained infertility

Unexplained infertility can be a frustrating and challenging issue for couples. It may be due to age-related decline, changes in hormone levels, or lifestyle modifications. Regardless of the cause, it is essential to recognise and address the problem with the same urgency and sensitivity as primary infertility to increase the chances of conceiving.

Secondary infertility in male

Male infertility can be a contributing factor in cases of secondary infertility. Male infertility is responsible for up to 50% of all infertility cases. Several factors can cause male infertility, including:

–       Low sperm count or poor sperm motility

If a man has a low sperm count or poor sperm motility, it can make it more difficult for the sperm to fertilise the egg. According to World Health Organisation (WHO), a healthy sperm count should be around 15 million per millilitre ejaculation or at least 39 million per ejaculation. Any amount lower than the optimal level is considered to have a low sperm count.

–       Abnormal sperm shape

If a man’s sperm have abnormal shapes, it can also cause fertility problems. It is due to difficulty when penetrating the egg.

–       Blockages or other structural issues

If a male has blockages or other structural issues in his reproductive system, it can interfere with the normal flow of sperm. Some common causes of blockages and structural problems may be vasectomy, Epididymitis (inflammation of the tube that transports sperm) and genetic causes.

–       Lifestyle factors

Lifestyle factors also play a role in affecting secondary infertility. Factors such as smoking, excessive alcohol consumption, and being overweight or underweight can all impact fertility.

Many factors can contribute to the fertility problem, and it’s often a combination of factors that leads to difficulty conceiving. It’s crucial for couples who are struggling with secondary infertility to work closely with a doctor to know what causes secondary infertility and develop a personalised treatment plan.

How to diagnose secondary infertility?

Diagnosing the problem involves thoroughly evaluating both partners to identify any underlying fertility issues. The diagnostic process typically begins with a comprehensive medical history and physical exam, followed by tests and procedures to evaluate fertility and identify potential problems.

For women, the diagnostic process may involve the following:

  • Ovulation testing

Ovulation testing involves tracking a woman’s menstrual cycle to determine if and when she is ovulating. It can be done using ovulation predictor kits, basal body temperature monitoring, or ultrasound.

  • Hormone testing

Hormone testing involves measuring the levels of various hormones in a woman’s blood. It includes Follicle-Stimulating Hormone (FSH), Luteinising Hormone (LH), estrogen, and progesterone. Abnormal hormone levels can indicate issues with ovarian function or other hormonal imbalances that may impact fertility.

  • Ultrasound

Ultrasound can evaluate the uterus and ovaries for structural abnormalities, such as fibroids or polyps.

  • Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that can evaluate the uterus, fallopian tubes, and ovaries for structural abnormalities or scarring.

For men, the diagnostic process for secondary infertility may involve the following:

  • Semen analysis

Semen analysis involves evaluating a man’s semen for factors such as sperm count, motility, and morphology.

  • Hormone testing

Hormone testing may be done to evaluate a man’s testosterone levels and identify any hormonal imbalances impacting fertility.

  • Ultrasound

Ultrasound can evaluate the testicles and prostate for any structural abnormalities. Once a diagnosis has been made, the doctor will work with the couple to develop a personalised treatment plan based on their specific needs and underlying issues.

What are the solutions for secondary infertility?

There are many treatments out there to overcome the fertility problem. However, the treatments suggested will depend on the underlying cause of the problem. Some couples may require combining treatments to increase the chances of pregnancy. Here are some of the possible treatments:

–     Medications – If hormonal imbalances cause infertility, medications can be prescribed to regulate ovulation or stimulate the release of multiple eggs.

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Surgery – In some cases, surgery may be required to correct issues such as fibroids, endometriosis, or blocked fallopian tubes.

–     Intrauterine Insemination (IUI) – It is a fertility treatment that involves washing and concentrating sperm to insert it directly into the womb. It is best to place it at the right time of ovulation to increase the chances of fertilisation.

–     In-vitro Fertilisation – IVF is a more complex procedure that involves retrieving eggs from the ovaries and fertilising them with sperm in a laboratory. The resulting embryos are then transferred to the uterus. IVF can be helpful in cases where multiple factors contribute to infertility, such as age-related decline in fertility, blocked fallopian tubes, or sperm abnormalities.

–     Intracytoplasmic sperm injection (ICSI) – ICSI is similar to IVF but involves injecting a single sperm directly into an egg. This technique can be helpful in cases where there are severe sperm abnormalities or low sperm count.

–     Lifestyle changes: In some cases, lifestyle changes such as weight loss, reducing alcohol or caffeine consumption, and quitting smoking can improve fertility.

How to cope with this condition?

Secondary infertility can be a challenging and emotional experience for couples who have previously conceived a child. Here are some ways to cope with it:

  • Seek emotional support from friends, family, or a support group.
  • Communicate openly and honestly with your partner about your feelings, fears, and frustrations.
  • Maintaining a healthy lifestyle by eating a balanced diet, exercising regularly, and getting enough sleep.

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  • Stay informed about the causes of secondary infertility, treatment options, and success rates.

Secondary infertility can be a difficult and emotional journey for couples who have previously experienced the joy of bringing a child into the world. It can be a confusing and frustrating experience. Understanding how common is secondary infertility would help couples give a sense of relief to know that they are not alone and there is a vast community of support available to help them handle the situation.

Learn more about secondary infertility here: Secondary Infertility

This blog is intended for educational purposes only. All contents here is general in nature and does not take into account your personal circumstances. Please consult with your health care professional to ensure you get the right diagnosis and treatment.

(Everybody has a chance to build a family) by Dr Navdeep

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