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Secondary Infertility: What You May Not Know About TTC the Second Time Around

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November 29, 2012

Whether you’ve battled primary infertility or having your first child was a breeze, many couples do not realize that they are at risk for secondary infertility. Some believe that having a baby after primary infertility suddenly flipped the “fertility switch” so they will not experience difficulty conceiving in future attempts. Those who have never faced fertility struggles may be taken by surprise when they realize they are not getting pregnant as easily as expected.

What is Secondary Infertility?

Secondary infertility is the inability to conceive after 6 to 12 months of well-timed intercourse, despite already having one or more children with your current partner. Mazen Abdallah, M.D., of Bethesda Fertility in Cincinnati, Ohio, says it is important to differentiate that a couple who has children from their respective previous relationships, but not together, is experiencing primary infertility rather than secondary infertility.

The causes of secondary infertility are similar to those of primary infertility with one major difference: age. Current research suggests there is a mild decline in a woman’s fertility around the age of 32, and more significantly between the ages of 37- 39. Particularly for women who have previously conceived, they may not feel the urgency to seek treatment from a fertility doctor. The later a woman waits to see a specialist, the more difficulty it is likely to be for her to get pregnant. If she has experienced primary infertility, advanced age further compounds her ability to conceive.

Alfred Rodriguez, M.D.,of the Texas Health Presbyterian Hospital ARTS Program in Plano, Texas, agrees that age is the most common problem when it comes to secondary infertility. “However, anything that might impact one’s fertility status such as a change in partner, infection, change in lifestyle, significant weight change, certain surgeries, stress, or a myriad of health conditions of the female or male can impact the ability to conceive”, he says. Current medical guidelines suggest that depending on age, couples trying to conceive should consult a fertility doctor sooner than later:

  • Under the age of 35, and trying to conceive with regular intercourse for one year unsuccessfully.
  • Over the age of 35, and trying to conceive with regular intercourse for six months unsuccessfully.

If you have a known fertility diagnosis or suspect a problem like secondary infertility, you should contact a fertility doctor after approximately 3 to 6 months. Male fertility should not be ruled out as a contributing factor to the couples’ infertility. Abdallah says, “Male infertility or problems with the sperm can account for up to 40% of these incidences.” Additionally, unexplained factors account for up to 20% of primary and secondary infertility cases.

According to Leo Bonaventura, M.D., of American Health Network in Carmel, Indiana, “Getting pregnant is a very sophisticated process which can break down or have problems without any rhyme or reason.” For couples with known or suspected fertility conditions, he continues, “seeing a Reproductive Endocrinologist is imperative at this juncture.”

Diagnosis and Treatment of Secondary Infertility

Secondary infertility is diagnosed and treated similar to primary infertility. The patient consults with the fertility doctor and baseline Day 3 blood work and ultrasound are performed. Additionally, a fertility doctor may request a hysterosalpingogram (HSG), or x-ray of the uterus and fallopian tubes with dye contrast. It is also important for the male partner’s fertility to be tested via a semen analysis. Bonaventura assures patients, “Getting and taking a good history and a physical exam is always the best starting place.”

Treatment of secondary infertility varies per individual, but can typically be addressed through monitored cycles of ovarian stimulation with fertility drugs and either timed intercourse, intrauterine insemination (IUI), or in vitro fertilization (IVF).

Pelvic surgery, donor egg IVF cycles, or surrogacy may be recommended depending on the suspected cause of secondary infertility and outcome of treatment cycles. If severe male factor infertility is an issue, donor sperm may be required.

All in all, it is important to explore and understand your treatment options with a fertility doctor.

Finding Support for Secondary Infertility

Secondary infertility, like primary infertility, has many emotional implications. Abdallah states, “For a couple, particularly the woman, infertility definitely has a big impact. Achieving pregnancy is often the greatest goal of the relationship.”

“Women experience a wide range of emotions and reactions including anger, depression, loss of self-esteem and confidence, and an overall sense of loss of control,” adds Rodriguez. Many couples with infertility struggle with their need for another child, but fear they will be seen as greedy because they already have a child to be thankful for. These feelings are normal for anyone diagnosed with infertility and they should not feel guilty for their emotions.

Dr. Bonaventura recommends in-person support groups through RESOLVE: The National Infertility Association., or online support forums like, as an emotional outlet during this difficult journey.

The essential thing for patients to keep in mind is that time is of the essence when it comes to fertility. Dr. Rodriguez urges couples with secondary infertility to take the diagnosis as seriously as primary infertility. Often, a consultation with a fertility doctor is enough to ease your concerns about building a family. Your fertility doctor will rule out underlying fertility conditions and will evaluate all aspects of the couples’ fertility. Though many couples fear they will advance through stages of treatment quickly and uncomfortably, Dr. Abdallah assures them that consulting a fertility doctor is not a long term commitment and does not necessarily mean advanced fertility treatments are the only option for addressing secondary infertility.

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