Secondary Infertility: Causes, Symptoms & Treatment

Reviewed By: Dr. S. Shashant, fertility specialist at Ferty9 Fertility Center, Secunderabad

Parenthood is a dream for many couples, and the inability to conceive a child can be a heartbreaking experience. While primary infertility, the inability to give birth to a child, is well-known, secondary infertility is a lesser-discussed but equally challenging condition. This article delves into the intricacies of secondary infertility, exploring its causes, symptoms, risk factors, and available treatment options.

Also read: The Role Of Fertility Centers In Modern Reproductive Medicine

What is Secondary Infertility?

Secondary infertility refers to the inability to carry a pregnancy to term after giving birth to at least one child. It is a complex fertility condition that can affect both men and women, often leaving couples bewildered and emotionally drained. Despite having successfully conceived and delivered a child in the past, various factors can contribute to the development of secondary infertility.

How Common is Secondary Infertility?

Secondary infertility is more prevalent than many realise. Centres for Disease Control and Prevention (CDC) adduces that approximately 10% of women aged 15-44 in the United States experience secondary infertility. This statistic highlights the significance of raising awareness and providing support for couples struggling with this condition.

Secondary Infertility Causes

The causes of secondary infertility can be multifaceted, ranging from age-related factors to underlying medical conditions.

Age-related Factors

As women grow older, their fertility declines due to a depletion in ovarian reserve and decreased egg quality. Men also experience a gradual decline in sperm quality and quantity as they grow older. These age-related changes can contribute to secondary infertility, particularly for couples who delay their second or subsequent pregnancy.

Ovulation Disorders

Polycystic ovary syndrome (PCOS), or hypothalamic amenorrhea, can disrupt the usual egg release from the ovaries, making conception difficult. These conditions may have been present but undetected during the first successful pregnancy.

Uterine or Fallopian Tube Problems

Structural abnormalities or scarring in the uterus or fallopian tubes are among the common causes of secondary infertility in females. They can impede the journey of the egg or the implantation of the embryo. These issues may arise due to previous surgeries, infections, or conditions like endometriosis or uterine fibroids.

Impaired sperm or impaired eggs

In some cases, causes of secondary infertility in males and females can be attributed to a decline in sperm quality or egg viability. This may be caused by factors such as lifestyle changes, exposure to environmental toxins, or underlying medical conditions.

Increase in BMI

Significant weight gain or obesity can disrupt hormonal balance and ovulation, potentially contributing to secondary infertility. Maintaining an optimal healthy body mass index (BMI) is crucial for optimal fertility in both men and women.

Lifestyle Changes

Lifestyle factors, such as stress, excessive alcohol consumption, smoking, and exposure to certain medications or environmental toxins, can negatively impact fertility and increase the risk of secondary infertility.

Complications from a previous pregnancy

Complications during a previous pregnancy, such as placental abnormalities, uterine scarring, or postpartum infections, can sometimes lead to secondary infertility by affecting the reproductive organs or hormonal balance.

Symptoms of Secondary Infertility

While the primary symptom of secondary infertility is the inability to conceive after a year of unprotected intercourse, there are other signs that may indicate an underlying issue:

Inability to conceive after a year of trying

If a couple has been actively trying to conceive for a year or more without success, it may be a sign of secondary infertility. It is essential to seek medical advice to identify and address any potential causes.

Irregular menstrual cycles

Irregular or absent menstrual cycles can indicate hormonal imbalances or ovulation disorders, which can contribute to secondary infertility.

Pain during intercourse

Pain or discomfort during intercourse may be a symptom of underlying conditions like endometriosis or pelvic inflammatory disease, which can impact fertility.

Hormonal changes

Fluctuations in hormone levels, such as changes in oestrogen or progesterone, can disrupt ovulation and fertility.

Also read: Reasons to Consider an Infertility Evaluation

Who is at Risk for Secondary Infertility?

While secondary infertility can affect any couple, certain factors may increase the risk:

• Advanced maternal age (over 35 years)
• History or presence of pelvic inflammatory disease (PID) or sexually transmitted infections (SID)
• Previous ectopic pregnancy or miscarriage
• Endometriosis or uterine fibroids
• Obesity or significant weight changes
• Exposure to environmental toxins or certain medications
• Lifestyle factors like smoking, excessive alcohol consumption, and stress

Treatment for Secondary Infertility

The treatment approach for secondary infertility depends on the underlying cause and the couple's individual circumstances. 

Lifestyle Modifications:

Making lifestyle changes can improve fertility outcomes. These may include:

• Maintaining a healthy weight and diet
• Reducing stress through relaxation techniques or counselling
• Quitting smoking and limiting alcohol consumption
• Exercising regularly

Also read: The Role of Stress in Fertility and IVF Outcomes

Fertility Medications:

Fertility medications (clomiphene citrate or gonadotropins) may be given to boost ovulation or regulate hormonal imbalances.

Surgical Interventions:

Sometimes, doctors may recommend surgery to address structural issues or remove blockages in the reproductive organs. Examples include:

• Laparoscopic surgery for endometriosis or uterine fibroids
• Tubal ligation reversal
• Varicocele repair for male infertility

Assisted Reproductive Technologies (ART)

In cases where other treatments are unsuccessful or not suitable, assisted reproductive technologies (ART) may be recommended. These include:

• In vitro fertilisation (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Intrauterine insemination (IUI)
• Use of donor eggs or sperm

Counselling and Support

The emotional trauma associated with secondary infertility can be significant. Seeking counselling or joining support groups provides coping strategies & a sense of community for couples navigating this challenging journey.

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Conclusion

Secondary infertility is complex. It is an often overlooked condition that affects many couples. By understanding the causes, symptoms, and available treatment options, couples aspiring for their second child can take steps towards achieving their dream of expanding their family. Seek medical advice and support, as early intervention can improve the chances of success. With patience, perseverance, and the correct treatment approach, many couples can overcome secondary infertility and experience the joy of parenthood once again.

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