Making Sense of Secondary Infertility

You already have a child and want to get pregnant again, but so far it has not been happening. It might come as a surprise to you because you were successful before—so why does getting pregnant this time around seem so much harder? Unfortunately, having one child is no guarantee you will get pregnant easily again. This is struggle is known as secondary infertility.

Recent research has suggested that secondary infertility is the most common form of infertility in women in the world—so as difficult and isolating an experience as secondary infertility can be, it is safe to say, you are not alone.

What is secondary infertility?

There are two types of infertility people can experience: primary and secondary. Primary infertility is when you have not been able to get pregnant or carry a baby to term. Secondary infertility means you have already had one or more successful pregnancies but are having trouble getting pregnant again. About 12% of people have infertility issues, which is defined as trying for at least a year to get pregnant—or six months if you have certain health conditions or are over 35. 

What causes secondary infertility?

Most of causes of primary fertility are the same ones that can strike when you have already had a child. These can include:

• Problems with ovulation such as polycystic ovary syndrome (PCOS)
• A low amount of eggs in the ovaries (this is called 'diminished ovarian reserve') 
• Problems with the hypothalamus or pituitary gland (two main players in our hormone-producing endocrine system)
• Menopause or premature menopause
• Endometriosis (an often painful condition where uterine tissue grows outside of the uterus)
• An irregularly shaped uterus
• Scarring from a past cesarean section
• Uterine fibroids, polyps, or scarring
• Infections
• Autoimmune disorders (such as lupus)
• Age, as people who are in their mid-30s start having declining fertility
• Unexplained, meaning providers cannot find a reason for your fertility issues

How is secondary infertility diagnosed?

The general rule of thumb is to talk to your provider if you have been trying to get pregnant again for more than a year—or for six months if you are over 35 or have a pre-existing condition linked to infertility. Your doctor will want to get a medical history from you including how your last pregnancy and delivery went and any concerns with your menstrual cycle. At some point they may refer you to a specialist like a reproductive endocrinologist. You might have a physical exam and testing done such as a hysterosalpingogram, which is an X-ray of your uterus to check for any abnormalities. Blood work to check your hormone levels can give your provider a sense of your fertility status and how well your ovaries are functioning. If you have a male partner, he may have testing as well with a semen analysis, as 35% of couples have both male and female factors that cause infertility.

How is secondary infertility treated?

The treatments for infertility are the same regardless of whether you are grappling with primary or secondary infertility. 

• Medications: Medications, such as clomiphene or Clomid, can balance out hormones and help you ovulate. 
• Surgery: If there is a concern with polyps, fibroids, or scar tissue in your uterus, you may have surgery to remove these. 
• Intrauterine insemination (IUI): In this procedure a doctor will use a flexible tube called a catheter to place sperm directly into the uterus to give the best chances at fertilisation.
• In vitro fertilisation (IVF): IVF involves daily injection of hormones to stimulate the ovaries to produce lots of eggs to be surgically removed and then fertilised with sperm in a lab. Once embryos have developed, one or more is placed through the vagina up into the uterus with a catheter. The rest of the unfertilised eggs or embryos can be frozen for later use. You can use donor sperm, eggs, or embryos, and sometimes a gestational surrogate might be involved.

Where can you find support for secondary infertility?

Secondary infertility might stir up a lot of emotions as you simultaneously juggle the grief that comes with struggling to conceive, the gratitude for already having a child, and maybe even a little guilt. Fortunately, there is a lot of support out there for parents who are wrestling with secondary infertility. Members of the infertility community have also taken to social media to share their stories, act as virtual sounding boards and shoulders to cry on...and shaking all stigma in the process. A simple hashtag search can pull up influential voices on Instagram, and Facebook has a variety of groups dedicated to infertility. Not everyone is comfortable talking about their fertility journey, but seeking out people who have had similar experiences can help you cope with the emotional and mental worries you might be experiencing. Most of all, it can help you realise that you are not alone.

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