When we hear the term "infertility," we probably think of it as impacting those who are trying to have their first child. But what about those who can’t get pregnant after they’ve successfully had a child? What if we told you that secondary infertility is also a very real thing, and it's more common than you might think? If you've never heard of secondary infertility, or you're looking for more information about it, get ready - we're here to fill in the blanks for you.
What even is secondary infertility?
Secondary infertility is defined by the World Health Organization as, “when a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or previous ability to carry a pregnancy to a live birth.”
According to the American College of Obstetricians and Gynecologists (aka ACOG), infertility is considered when patients have not gotten pregnant within one year of actively trying to conceive, or within six months of actively trying to conceive if over age 35 or with a history of a possible fertility problems (such as irregular periods or PCOS). In 2010, 1 in 8 couples encountered primary infertility, and 10.5 % of women struggled with secondary infertility.
What causes secondary infertility?
Unfortunately, we don’t always know for sure why secondary infertility happens. It’s likely that factors that can cause primary infertility can also cause secondary infertility, and vice versa. While some of these typically present as problems earlier on (and thus found during primary infertility), it may be that complications don’t arise until later on, after one (or a few) successful pregnancies. Let’s break down a few potential causes of both primary and secondary infertility.
- Age: We know that fertility declines with age, with the biggest decline beginning at age 37. By age 40, a woman’s chance of getting pregnant naturally is less than 35%. Because fertility changes with age, and one is inevitably older when they pursue having another child, age can be a factor in challenges to conceiving.
- Hormonal issues: Hormonal imbalances (whether they're too high or too low), can disrupt the brain-ovary connection. Without the proper signals being sent from the brain, the ovary doesn’t get the message that it’s supposed to release an egg each month. It’s possible that some of these hormonal imbalances can present later in life. Hormonal irregularities can include problems with the thyroid, pituitary gland, or a diagnosis of polycystic ovary syndrome.
- Endometriosis: Endometriosis is a progressive, chronic disease that can cause scarring that can physically block the fallopian tubes. According to ACOG, 40% of women with infertility have endometriosis.
- History of sexually transmitted infection: Exposure to a sexually transmitted infection (like gonorrhea or chlamydia) can put you at risk for developing pelvic inflammatory disease, or PID. While it’s more common in women under 25 , PID can affect women at any age. Pelvic inflammatory disease, if left untreated, can cause scar tissue to form in the fallopian tubes, leading to infertility.
- Scar tissue from prior surgeries: Scar tissue seems to be a theme here. Surgeries can leave scar tissue behind, and scar tissue will increase with each subsequent gynecologic or abdominal surgery. Scar tissue can block fallopian tubes (which means the egg and sperm can’t get to each other) or cause scarring in the uterus, which can prevent a fertilized egg from successfully implanting in the uterine wall. Laparoscopic surgery can be an effective means of treating troublesome scar tissue, and the issues can often be obviated by IVF.
- Weight: In order to ovulate properly, your body needs to produce the right amount of certain reproductive-related hormones. While the link between weight and certain hormone levels can be a little complicated, to put it simply, being overweight or underweight can cause those hormones to fall outside of their ideal range, and stop your body from ovulating.
- Male infertility: Inability to get pregnant may actually be an issue with your partner, not you. Men can typically have a semen analysis test done through a fertility clinic to evaluate for male factor infertility, which includes issues like low sperm count. According to UptoDate, male infertility accounts for about 8% of infertility, while a combination of both male and female infertility makes up 35%.
If you're dealing with secondary infertility
If you aren’t having regular menstrual cycles, or haven’t been able to conceive within six months-1 year of trying (depending on how old you are), pay your women’s health provider a visit for a work-up. Your provider may recommend further testing, which may mean seeing a fertility specialist. While many of the risk factors for infertility aren’t within our control, make sure you’re paying attention to those factors that are, like maintaining a healthy weight.
Secondary infertility can come with a lot of stress and guilt. Women may feel guilt for already having had a child, minimizing how stressful secondary infertility can be. Self-blame is also common and can take a huge emotional toll. Therapy can be greatly beneficial in dealing with these emotions, and a quick google search can get you to a local (or even online) secondary infertility support group. Resolve: The National Fertility Association is a non-profit that offers support for couples dealing with infertility. Their website has both online support options as well as a local support group search tool. Meeting other women in similar situations and talking through the questions, confusion, and stress that can accompany trying to conceive reminds us that we’re not alone in our journeys.