What Is Secondary Infertility, and What Can You Do About It?
Getting pregnant the second time around isn't always easy.
It's no secret that fertility can be a tricky process. Sometimes an inability to conceive is related to issues surrounding ovulation and egg quality or low sperm count, and other times there's seemingly no explanation at all. Whatever the cause, according to the CDC, an estimated 12 percent of women in the United States between the ages of 15-44 have trouble getting or staying pregnant.
What Is Secondary Infertility?
Still, maybe you're one of those lucky people who get pregnant the first go at it, or within a few months. Everything goes smoothly until you start trying for a second baby…and nothing happens. Secondary infertility, or an inability to get pregnant after easily conceiving a first baby, isn't as commonly discussed as primary infertility—but it affects an estimated three million women in the U.S. (Related: Women Are Using Menstrual Cups to Get Pregnant Faster and It Might Work)
"Secondary infertility can be very frustrating and confusing for a couple who got pregnant quickly in the past," says Jessica Rubin, an ob-gyn based in New York. "I always remind my patients that it can take a normal, healthy couple a full year to get pregnant, so not to use the amount of time they tried to get pregnant previously as a yardstick, especially when it was three months or less."
What Causes Secondary Infertility?
Still, many women understandably want to know why secondary infertility happens in the first place. Perhaps unsurprisingly, the primary factor is age, according to reproductive endocrinologist Jane Frederick, M.D. "Usually women have their second baby when they're older. Once you're in your late 30s or early 40s, the quantity and quality of eggs isn't as good as it was in your 20s or early 30s. So egg quality is the first thing I'll check on."
Of course, infertility is hardly a women-only issue: Sperm count and quality dip with age, too, and 40-50 percent of cases can be attributed to male-factor infertility. So, Dr. Frederick suggests that if a couple is struggling, to make sure you do a sperm analysis, too.
Another cause of secondary infertility is damage to the uterus or fallopian tubes. "I do something called an HSG test to check for this," says Frederick. "It's an X-ray, and it outlines the uterus and fallopian tubes to make sure there's nothing wrong with them. For example, after a C-section, scarring can prevent a second baby from coming."
How Do You Treat Secondary Infertility?
The rules around when to see a reproductive specialist are the same for secondary infertility as they are for primary infertility: If you're under 35 you should try for a year, over 35 you should try for six months, and if you're over 40, you should see a specialist as quickly as possible.
Luckily, there are a lot of treatment options available for a couple struggling with primary infertility. If the issue is sperm quality, Frederick would encourage men to make lifestyle changes. "Smoking, vaping, marijuana use, drinking alcohol excessively, and obesity can all impact sperm count and motility," she says. "Spending too much time in a hot tub can, too. Male infertility is very treatable, so I make sure to ask men the right questions and find out what's going on with their diet and exercise program." (Related: What Ob-Gyns Wish Women Knew About Their Fertility)
When the issue is more complicated—such as a very low sperm count or motility or issues with the woman's egg quality—Dr. Frederick encourages for you to start treatment ASAP. Your doctor will be able to map out the best treatment options for you, as every woman is different.
How to Cope with the Secondary Infertility
As frustrating as secondary infertility can be, Dr. Frederick notes that if you had a baby once, it's a good sign for your reproductive future. "It's a good prognosis that you'll have a second successful baby," she explains. "If they come to see the specialist and get answers, it will help with the anxiety many couples experience and help them get them to that second baby more quickly."
Still, dealing with secondary infertility is no walk in the park for a women's overall mental health. Jessica Zucker, a Los Angeles-based psychologist specializing in women's reproductive and maternal mental health, suggests keeping the lines of communication open if there's a relationship involved. "When talking about the issues at hand, be sure to steer clear of blame and shame," she suggests. "Remember that mind-reading is not a thing, so try your best to be open and honest about what you are going through, the toll it's taking, and what support you need from your partner."
Above all, Zucker suggests sticking with science and doing your best to avoid inflicting any kind of self-blame. "Research suggests that fertility struggles, like miscarriages, are typically not within our immediate control," she says. "If anxiety, depression, or any other mental health issue pops up along the way, be sure to reach out for help."
If you're struggling with secondary infertility, know you're not alone—and that with modern medicine, quite a bit can be done. "My main piece of advice to anyone going through this?" says Dr. Frederick. "Don't give up."