Secondary Infertility

By:    Medically Reviewed: Tom Iarocci, MD   Published: March 10, 2014

After sailing through pregnancy and childbirth the first time, many couples face secondary infertility when trying to add to their family.

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In Los Angeles, human resources specialist Heidi Pancake had no problem getting pregnant with her first child, Maggie, but when trying for a second baby, she ran into complications. Though she was able to conceive, Pancake couldn’t carry the fetus to term and then suffered multiple miscarriages.

More than 3 million women of childbearing age in the U.S. who have one biological child have difficulty getting pregnant again or carrying a fetus to term. Pancake has a common condition known as secondary infertility, which occurs when one or both partners have developed fertility problems since the last child was conceived. 

 

According to the National Center for Health Statistics, 800,000 U.S. women with one child are unable to get pregnant again after one year of having unprotected sex. While there is not always a clear explanation for secondary infertility, there are many possible causes that lead to the condition, including:

 

  • Endometriosis, which is one of the most frequent causes;
  • Irregular ovulation;
  • Fallopian tube disease;
  • Polycystic ovary syndrome;
  • Advanced reproductive age;
  • Scarring after childbirth;
  • Weight gain, which can lead to ovulatory dysfunction;
  • A decline in concentration or motility of the male’s sperm;
  • Smoking; and
  • Stress.

 

Physical cirumstances may be at the root of secondary infertility, but this frustrating situation can also take an emotional toll.  

 

In “How to Have a Baby: Overcoming Infertility,” authors and husband-and-wife doctor team Aniruddha Malpani, MD, and Anjali Malpani, MD, explain that the couple experiencing secondary infertility often finds it difficult to gain understanding or sympathy from family, friends and relatives. Couples are caught between two worlds — fertile and infertile — and are excluded from both.

 

A Physical and Emotional Journey

If you are younger than 35 and have been trying to conceive for at least one year — or you are over 35 and have been trying to conceive for six months — it may be time to talk to a specialist about fertility options.

 

An infertility exam with a reproductive endocrinology and infertility specialist may follow, says Aniruddha Malpani and Anjali Malpani in their book. This exam is likely to include a battery of tests, such as ultrasounds, blood work to check hormone levels, X-rays and semen analysis.

 

Pancake, now age 44, had an infertility workup and discovered that while she had plenty of eggs, many had become unviable due to her age. Eventually, she decided medications to enhance her fertility, such as clomiphene or injectable gonadotropins, were not for her. “I was tired of my body being taken over by this process,” Pancake explains. “It was more physically than emotionally draining for me.” Still, she says, she wanted her 4-year-old Maggie to have a sibling.

 

After discussing the possibility of donor eggs, Pancake and her husband decided to begin the adoption process.

 

Next Steps

Many struggling couples may decide to pursue other assisted fertilization options, too:

 

  • Depending on the specific infertility issues, doctors may recommend intrauterine insemination (IUI), in which a catheter is used to insert washed sperm directly into the uterus.
  • In vitro fertilization (IVF), in which a woman’s egg is fertilized in a laboratory dish and then transferred into the womb, has gained ground. However, it can be expensive and may have complications. (For women with tubal or pelvic disorders, IVF offers a way to circumvent the issues causing their secondary infertility.)
  • In addition to grief, many couples experience guilt for not providing their child with a sibling or delaying a second pregnancy until it is too late. Assistance from support groups or a counselor to process the secondary infertility experience may help the healing process. 
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sources
  • RESOLVE, The National Association of Infertility. Diagnosis and Management. “Secondary Infertility.” www.resolve.org/diagnosis-management/infertility-diagnosis/secondary-infertility.html. Accessed January 2014.
  • Chavkin D., MD. “The Second Time Around: Causes and Treatments of Secondary Infertility.” Updated Spring 2013. www.resolve.org/diagnosis-management/infertility-diagnosis/the-second-time-around-causes-and-treatments-of-secondary-infertility.html. Accessed January 2014.
  • Malpani A., MD, and Malpani A., MD. “How to Have a Baby: Overcoming Infertility.” UBS Publishers’ Distributors Ltd. Accessed January 2014.
  • National Institute of Health Statistics. “NIH Mental Health.” http://www.nimh.nih.gov/Statistics/index.shtml. Accessed January 2014.
  • Pancake H., Los Angeles mom with secondary infertility. Interviewed January 2014.
  • National Center for Health Statistics. “Infertility and Impaired Fecundity in the United States, 1982–2010: Data From the National Survey of Family Growth.” Updated August 2013. http://www.cdc.gov/nchs/data/nhsr/nhsr067.pdf. Accessed February 2014.
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