What is secondary infertility?

Secondary infertility is the inability to conceive a child or carry a pregnancy to full term after previously giving birth. To classify as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization. Secondary infertility typically is diagnosed after trying unsuccessfully to conceive for six months to a year. A related condition is recurrent pregnancy loss where patients and couples are able to conceive but are unable to carry to term.

How common is secondary infertility?

Secondary infertility is just as common as primary infertility.

Are the causes of secondary infertility in the woman or the man?

Secondary infertility can be traced to either partner or both partners. About one-third of cases originate in women and about one-third originate in men. In the remaining one-third, the cause is due to a combination of factors or isn’t known. Increased age, complications from a prior pregnancy or surgery, increased weight, medications, sexually transmitted diseases, impaired sperm production, alcohol abuse, and smoking are all examples of secondary infertility in women and men.

What are the causes of secondary infertility in women?

Causes of secondary infertility in women include:

  • Problems in the quantity or quality of eggs: Women are born with a limited supply of eggs and are unable to create new eggs after birth. As women approach their 40s and beyond, the numbers of eggs left in their ovaries decrease, and the remaining eggs have a higher chance of having chromosomal problems. For women where age isn’t a concern, there are other reasons that they might have a low number of good quality eggs, including autoimmune or genetic conditions and prior surgery or radiation.
  • Problems with the fallopian tubes: The fallopian tubes, which carry eggs from the ovaries to the uterus, can become blocked due to pelvic infections such as chlamydia or gonorrhea.
  • Problems with the uterus: There are many conditions related to the uterus that can cause secondary infertility. Scarring can occur during a dilation and curettage (D&C) or Cesarean delivery that can create adhesions inside the uterus that interfere with future pregnancies Fibroids or polyps are benign (non-cancer) growths inside the uterus that can impair pregnancy. A retained placenta can cause infection and uterine scarring.
  • Endometriosis: Endometriosis is a condition where tissue that normally grows inside the uterus grows elsewhere in the body, such as on the ovaries or bowel surfaces. While endometriosis is common, not all endometriosis causes infertility.
  • Polycystic ovary syndrome: This is a hormonal disorder characterized by longer-than-normal or infrequent menstrual periods. A woman with this condition has an excessive number of male hormones, and the ovaries fail to release eggs regularly.
  • Breastfeeding: If a woman feeds her baby only by breastfeeding, her body stops ovulating or releasing eggs for potential fertilization.
  • Weight gain or other lifestyle changes: Weight gain can lead to ovary dysfunction in some patients. Certain diets may effect fertility. Medications may also effect fertility.

What are the causes of secondary infertility in men?

Causes of secondary infertility in men include:

Reduced testosterone level.

Testosterone plays a key role in sperm production. Testosterone levels can decline due to aging, injury to urinary or genital organs, or certain medical conditions. These conditions include:

Testicular varicocele.

This is an enlargement of veins in the scrotum, or the sack of skin encasing the testicles. This condition is a common cause of low sperm production and infertility in men. About 30% of infertile men have testicular varicocele.

Poor-quality semen.

Semen is the fluid that carries sperm. After age 40, the quality of semen tends to decline.

Prostate enlargement.

This can lower sperm count and hinder a normal ejaculation (the discharge of semen from the body).

Prostate removal.

The prostate may be removed due to cancer or other conditions. Removal of the prostate can cause semen to flow backward.

Late onset hypogonadism.

This is a condition where there is a reduction of hormone secretion.

Certain drugs that affect sperm count and quality.

These drugs include some antibiotics and medication that treat high blood pressure. Sperm quality can also be affected by treatments for the following conditions:

Use of certain commercial sexual lubricants that are toxic to sperm.

Nontoxic, natural lubricants include peanut, safflower and vegetable oils; raw egg white; and petroleum jelly.

Exposure to certain chemicals.

Being exposed to pesticides, lead, industrial chemicals and excessive heat can all impact a man’s fertility.

Excessive weight gain.

This can decrease testosterone levels and increase estrogen levels.

What are possible signs of secondary infertility?

If a man and woman 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without getting pregnant, they should suspect secondary infertility. This especially applies to women older than 30 who have experienced pelvic inflammatory disease, painful periods, irregular menstrual cycles or miscarriages, and to men with low sperm counts.

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