Secondary Infertility

What is secondary infertility?

Secondary infertility is when you’re unable to get pregnant or carry a pregnancy to 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 (IVF). Healthcare providers typically diagnose secondary infertility after a couple tries to conceive for six months to a year.

How common is secondary infertility?

Secondary infertility is just as common as primary infertility. It affects about 11% of couples in the United States.

What are signs of secondary infertility?

The main sign of secondary infertility is being unable to get pregnant after having one or more biological children. If you’re younger than 35, your provider may suspect secondary infertility after one year (12 months) of trying to conceive. Trying to conceive is defined as having regular, unprotected sex. If you’re older than 35, your provider may classify it as secondary infertility after six months of regular, unprotected sex.

What are common causes of secondary infertility?

Secondary infertility can affect one or both partners. Sometimes, there’s no one cause of secondary infertility; it’s due to multiple factors. In fact, the cause of secondary infertility is equally split between assigned sexes and unknown causes.

Some of the most common causes are:

• Impaired sperm or impaired eggs.
• Age.
• Complications from a previous pregnancy.
• Complications from a previous surgery.
• An increase in body weight or BMI (body mass index).
• Medications or other medical conditions.
• Sexually transmitted infections (STIs).
• Lifestyle factors like drinking alcohol and smoking cigarettes.

What are the causes of secondary infertility in women and people assigned female at birth (AFAB)?

Causes of secondary infertility in women and people assigned female at birth (AFAB) include egg quality, structural problems with your uterus, certain health conditions and lifestyle factors.

Problems in the quantity or quality of eggs

Women and people AFAB are born with a limited supply of eggs and can’t create new eggs. As you approach your 40s, the number of eggs left in your ovaries decreases, and the remaining eggs have a higher chance of having chromosomal problems.

Autoimmune or genetic conditions and prior surgery or radiation are other reasons a person may have a low number of good-quality eggs.

Structural issues (like scars or blockages)

Infections and surgery can cause damage to parts of your fallopian tubes or uterus. Your fallopian tube carries an egg to your uterus. Complications from infections like chlamydia, gonorrhea and pelvic inflammatory disease (PID) can block your fallopian tubes.

Similarly, certain conditions can affect your uterus and cause secondary infertility. Scarring from certain procedures can interfere with pregnancy. These procedures include dilation and curettage (D&C) or C-section delivery. Uterine fibroids or polyps can also block portions of your uterus, impairing a pregnancy.

Polycystic ovary syndrome (PCOS)

PCOS is a hormonal condition that causes irregular and infrequent menstrual periods. Most people with PCOS don’t ovulate regularly, which can affect their ability to conceive.

Endometriosis

Endometriosis is a condition where tissue that normally grows inside your uterus grows in your ovaries or other body parts. While endometriosis is common, not all endometriosis causes infertility.

Weight gain or other lifestyle changes

Weight gain can lead to ovarian dysfunction in some people. Medications or treatments for certain conditions can also contribute to infertility. Things like smoking cigarettes or drinking alcohol can also impact ovulation and conception.

What are the causes of secondary infertility in men and people assigned male at birth (AMAB)?

Causes of secondary infertility in men and people assigned male at birth (AMAB) often include issues with hormone levels, certain medical conditions and lifestyle factors.

Reduced testosterone level

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

• Genital infections.
• Thyroid diseases.
• Diabetes.
• Tuberculosis.
• Mumps.
• Smallpox.
• Blood diseases.
• Benign tumors.
• Emotional stress.
• Myocardial infarction (heart attack).
• Coma.
• Stroke.
• Respiratory failure.
• Congestive heart failure.
• Burns.
• Sepsis.

The medical term for low testosterone is hypogonadism. Some studies show that about 2% of all men and people AMAB have low testosterone. Low testosterone is more common once you’re over 40 years old.

Testicular varicocele

Testicular varicocele is an enlargement of veins in your scrotum, or the sack of skin encasing your testicles. This condition is a common cause of low sperm production and infertility in men and people AMAB — about 30%.

Poor-quality semen

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

Low sperm count

Healthcare providers consider less than 15 million sperm per milliliter of semen to be a low sperm count. You may hear them call this condition oligospermia.

Prostate enlargement or removal

An enlarged prostate can lower sperm count and cause abnormal ejaculation. If your provider removes your prostate due to cancer or other conditions, it can cause semen to flow backward.

Certain drugs affect sperm count and quality

These drugs include some antibiotics and medications that treat high blood pressure. Treatments for the following conditions can affect sperm quality:

• Prostate cancer.
• Fungal infections.
• Urinary tract infections.
• Ulcerative colitis.
• Arthritis.
• Gout.
• Pain.
• Cancers.
• Seizures.
• Schizophrenia.

Lifestyle factors or chemicals

Certain lifestyle factors, including exposure to chemicals that damage sperm, can cause infertility. Some of these include:

• Using natural lubricants that are toxic to sperm. This includes certain oils and petroleum jelly.
• Being exposed to pesticides, lead, industrial chemicals and excessive heat can all impact fertility.
• Gaining a large amount of body weight. This can decrease testosterone levels and increase estrogen levels.

Who is at risk for secondary infertility?

Your risk for secondary infertility may be higher if you’ve had:

• Pelvic inflammatory disease (PID) or other STIs.
• Irregular menstrual cycles.
• Miscarriages.
• Low sperm count.
• Hormonal imbalances.

What should a couple do if they suspect secondary infertility?

If you suspect secondary infertility, schedule an exam with your healthcare provider, reproductive endocrinologist or urologist. Early evaluation is critical to ensure the widest variety of treatment options.

Your healthcare provider will:

• Review your medical history to determine if anything has changed since your previous pregnancy.
• Discuss your menstrual cycles to determine if you’re ovulating and producing eggs.
• Evaluate if certain diseases are affecting sperm count or sperm quality.

What tests will diagnose secondary infertility?

Your healthcare providers may want to perform certain tests to determine what could be causing infertility. Some of these tests include:

• A semen analysis.
• Blood tests to look at hormone levels.
• A transvaginal ultrasound.
• A hysterosalpingogram, a type of X-ray that allows your provider to see your uterus and fallopian tubes.

What are treatment options for secondary infertility?

Regardless of whether infertility is primary or secondary, treatments are similar and include:

• Medications, including clomiphene (Clomid®) and letrozole, to induce ovulation in people who aren’t ovulating regularly.
• Intrauterine insemination (IUI), which involves placing sperm inside your uterus to increase the chance of fertilization. You can use a sperm donor for IUI if needed.
• In vitro fertilization (IVF), a complex process that involves retrieving eggs from ovaries and manually combining them with sperm in a lab for fertilization.
• Surgery to repair uterine-related complications such as removing scar tissue, polyps and fibroids.
• Surgery to repair testicular varicocele. This is the most surgically correctible cause of male infertility.

Can secondary infertility be corrected?

Yes, there are many treatment options for secondary infertility. Your healthcare provider can work with you on a treatment plan that works for you based on your diagnosis and goals.

Can you get pregnant with secondary infertility?

Yes, you can get pregnant with secondary infertility. It’s a common condition that usually results in pregnancy with treatment.

What is the emotional impact of secondary infertility?

Infertility can be a devastating condition with a high emotional toll on individuals and partners. If treatments for secondary infertility don’t work, partners might suffer from a range of emotions, including anger, sadness, grief, guilt and loneliness. They might experience a lack of empathy from family members and friends, who may tell them they should be thankful to have one child. Unfortunately, even healthcare providers can lack sympathy, which adds to a feeling of isolation.

Partners and individuals with secondary infertility may need emotional support and may benefit from support groups or a mental health professional.

When should I see my healthcare provider?

You should see your healthcare provider if you’re:

• 35 or older and haven’t been able to conceive after six months of regular, unprotected sex.
• Younger than 35 and haven’t conceived after one year of regular, unprotected sex.

Remember, secondary infertility affects all genders and sexes and sometimes has no clear cause. If this diagnosis is causing you pain, reach out to support groups or resources that can help you stay positive.

A note from Cleveland Clinic

Secondary infertility is a real and common condition that can be disappointing to partners and families. If you’re trying to get pregnant and haven’t been able to, it might be helpful to talk to your healthcare provider. In some cases, there aren’t any apparent causes for secondary infertility. However, your provider can work with you on a treatment plan that matches your desire to expand your family. Know that most people with secondary infertility go on to have a healthy pregnancy.