Coping with secondary infertility

Secondary infertility can be heartbreaking, surprising, and exhausting.

"We've been trying for #2 for more than 3 1/2 years. We've tried pretty much everything but IVF. I'm frustrated and tired of trying to conceive. I hate the endless appointments, the scheduling, and the medications," says BabyCenter Community member P.EngMomma in the Secondary Infertility and Actively TTC group.

Below, find out what causes secondary fertility and how various treatments can help.

What is secondary infertility?

Secondary infertility is when a woman is unable to get pregnant or carry another pregnancy to term after having one child without the help of fertility treatments.

If you've been trying for another child for six months (if you're older than 35) to a year (if you're younger than 35), you may be diagnosed with secondary infertility.

Infertility can feel lonely, but know that many women share similar feelings and journeys.

- Dr. Layan Alrahmani, board-certified ob-gyn

What causes secondary infertility

The same factors that cause fertility problems for first-time parents can also cause secondary infertility. Some of these result from the ovaries producing lower numbers of good-quality eggs. Others are related to problems with the uterus or fallopian tubes. In men, infertility is often caused by something that disrupts sperm production.

Causes of secondary infertility in women

Problems with ovulation caused by:

• age (the quantity and quality of eggs your body provides declines after age 35)
• autoimmune or genetic conditions
• being overweight or underweight
• polycystic ovarian syndrome (PCOS)
• lifestyle factors such as smoking and drinking

Uterine problems resulting from:

• previous infection or scarring from surgery or pregnancy
• polyps or fibroids
• endometriosis (when the tissue normally found in the uterine lining grows someplace else)

Blocked or damaged fallopian tubes caused by:

• previous sterilization
• sexually transmitted infections (STIs)
• pelvic inflammatory disease (PID)

In some cases, complications during a first labor and delivery can trigger a problem that affects your fertility. Or, you may have age-related fertility issues if several years have passed since your first pregnancy.

Read about your chances of getting pregnant at different ages.

Causes of secondary infertility in men

Male infertility can be caused by something that disrupts sperm production, such as:

• hormonal disorders
• genetic disorders
• heavy alcohol use
• some medical conditions, including trauma to the testes or a testicular varicocele (enlarged veins in the scrotum)
• age (male fertility declines at age 40 or older)

Treatment for secondary infertility

"With the help of a specialist, there are fertility treatments that can help lead to a successful pregnancy," says Layan Alrahmani, M.D., a board-certified ob-gyn and member of the BabyCenter Medical Advisory Board.

Treatments for primary and secondary fertility problems are the same, and the first step is usually to be evaluated by a fertility specialist.

If you haven't become pregnant after a year of having frequent, unprotected sex, your best bet is to visit a reproductive endocrinologist – a doctor who specializes in managing infertility. If you're older than 35, reach out for help after six months of trying. Resolve, The National Infertility AssociationOpens a new window, says "if you're over 30 and have a history of pelvic inflammatory disease, painful periods, pregnancy loss, irregular cycles, or if you know that your partner has a low sperm count, do not wait one year."

The doctor will evaluate your medical history, including your menstrual cycles and any conditions that may affect your ability to produce eggs or your partner's ability to produce enough quality sperm. They'll try to determine whether you're ovulating and if your uterus and fallopian tubes are functioning well.

They may do a blood test for hormone levels, a transvaginal ultrasound, and an X-ray of your uterus and fallopian tubes. The doctor will analyze your partner's semen, too.

Depending on the cause of your secondary infertility, treatment may include:

Lifestyle changes. Maintaining a healthy weight, eating a nutritious diet, and quitting smoking, using drugs, and drinking alcohol are all positive steps you can take to possibly improve fertility.

Surgery. This would be to address any obvious problems, such as removing polyps, fibroids, or scar tissue, or treating PCOS, endometriosis, or a testicular varicocele.

Medication. Medicine can be used to address abnormal hormone levels affecting ovulation. Improving thyroid function in people with abnormal thyroid hormone levels can help with fertility, for example. Your doctor may also try to induce ovulation with fertility drugs such as clomiphene (Clomid) or gonadotropins.

Intrauterine insemination (IUI). Using a catheter, a doctor transfers sperm from your partner or a donor through your cervix directly into your uterus. You may take fertility drugs before the IUI procedure.

In vitro fertilization (IVF). A doctor will remove eggs from your ovaries (or use donor eggs), combine them with sperm from your partner or a donor in a lab, then transfer an embryo to your uterus. You'll probably take gonadotropins before the IVF procedure.

Often, especially if male fertility is an issue, ICSI (intracytoplasmic sperm injection) is added to the IVF procedure. With ICSI, a single sperm removed from your partner's testicle is injected into a single egg. After fertilization, the embryo is transferred to your uterus.

How common is secondary infertility?

Secondary infertility isn't uncommon: About 13% of moms have trouble conceiving or carrying another child, according to the Centers for Disease Control and Prevention (CDC).

CDC dataOpens a new window shows that from 2015 to 2019 there were 4.55 million women ages 15 to 44 in the United States with secondary fertility problems. For women 15 to 49, the number was 5.88 million.

Among men ages 25 to 49, 12.8% report some type of infertility.

Coping with secondary infertility

Secondary infertility can lead to a host of painful feelings, including anger, sadness, depression, anxiety, and frustration.

"Infertility can feel lonely," says Dr. Alrahmani, "but know that many women share similar feelings and journeys."

You may feel hurt and stressed, and you may feel a loss of self-esteem. You may feel drained emotionally and also be coping with a heavy financial burden if you're undergoing fertility treatments. You may also be struggling with the psychological side effects of medications and hormones.

For some women, struggling to become pregnant after having already had a baby or two is especially shocking and hard to accept. "I'm at a loss. We got pregnant right away with our prior two pregnancies, but nothing seems to be working this time around. I'm truly bummed and it feels like I should just move on with my life, but I so want another baby," says one BabyCenter Community mom.

If the emotional toll of infertility is affecting your wellbeing, talk to others who have also experienced secondary infertility. You can join an online support group such as the Secondary Infertility group in the BabyCenter Community, or check out the support groupsOpens a new window sponsored by Resolve, The National Infertility Association.

Here are other ways to cope with secondary infertility:

Educate yourself

Learn what you can about your situation and have a plan. If you've been diagnosed with a specific condition that's affecting your fertility, research it, and – with your doctor's help – develop a plan of action. If you've decided to try fertility treatments, learn what that process will be like and outline the steps for yourself.

Take good care of yourself

Tend to your overall health as much as possible by eating well, getting good sleep, and exercising. Try meditation and other relaxation techniques, such as deep breathing and progressive relaxation (mindfully relax one part of your body at a time, moving from your toes to your head).

Take time for yourself

Dealing with infertility is stressful, and it's okay if you need a break from parenting sometimes. Reach out to friends and family members, hire a babysitter, or trade off with your partner so you can have some time for you.

Work through sexual tension with your partner

Goal-oriented sex can become a chore. Talk with your partner and try being physically close in other ways (such as snuggling and giving each other a massage). Maybe have sex when you're not on a schedule, too.

If you're feeling overwhelmed, don't hesitate to seek professional counseling to help you handle your feelings and learn techniques for stress relief and relaxation. Your doctor or midwife can provide a referral, preferably to a therapist familiar with fertility problems.