If you have trouble conceiving after previous successful pregnancies, you may be suffering from secondary infertility. This can come as quite a surprise, especially if you have conceived easily previously.
Whilst those suffering from secondary infertility are not childless, the emotional pain of being unable to expand your family can be intense.
Here we discuss the causes of secondary infertility, when to seek help, and what treatment you can expect to receive.
What can cause secondary infertility?
The causes of secondary infertility can be similar to those of primary infertility (trouble conceiving with your first pregnancy).
These include:
Female fertility problems
- Ovulation problems, for example, with Polycystic Ovarian Syndrome (PCOS)
- Endometriosis
- Certain medications, for example, chemotherapy drugs
- Autoimmune or thyroid disorders
- A hormonal imbalance
- Structural problems, such as fallopian tube blockage
- Age – fertility starts to decline around the age of 35
- Lifestyle factors – obesity, smoking, and excessive alcohol consumption.
Male issues
- Decrease in sperm count, quality, or motility
- Testicular damage, may be due to infection, cancer or surgery
- Ejaculation problems
- Hormonal imbalances
- Certain medications
- Lifestyle factors – Excessive heat of testicles, drug or alcohol abuse, smoking, etc.
Besides the above, there also may be a specific reason why you are struggling to conceive after a previous pregnancy, which could be:
- Advanced age – even a couple of years between pregnancies can greatly affect your fertility
- Previous Caesarean section(s) – as this can leave scarring or uterine adhesions which may create fertility problems
- Previously retained placenta – this can also leave scarring
- Declining health – worsening of previous reproductive disorder
- Male infertility issues – such as advanced age or changes in health
- Lifestyle changes
When should I see my doctor?
It is usually suggested that if after a year of unprotected sex, you have not conceived then you should consult your doctor for further tests.
If you have a specific medical condition, such as endometriosis, which you believe is affecting your fertility, then you should seek medical help sooner.
Likewise, if you are over 35 you may wish to consult your doctor sooner—after about six months of trying but not being able to conceive. Secondary infertility is quite common; according to a National Health Statistics report, over 3 million women in the US alone have difficulties conceiving after having one child.
What tests will be performed?
Your doctor will initially perform a series of tests to investigate what is happening. These will be the same as fertility tests for women with primary infertility.
Your doctor may also wish to carry out some tests on your partner in order to rule out any male infertility issues.
The following tests are usually recommended:
- Physical examination – to check the pelvis for signs of infection, lumps or problems such as endometriosis
- Weight check – to ensure that your BMI isn’t too high
- Blood test – to determine hormone levels and check to see if you are ovulating
- A hysterosalpingogram (HSG) – this is a dye contrast X-Ray test which can determine whether your fallopian tubes are blocked
- An ultrasound scan – to check for any structural problems with the womb, ovaries and fallopian tubes
- Laparoscopy – this is keyhole surgery, where a camera is inserted to look more clearly at your womb, ovaries and fallopian tubes. This is usually only advised if other scans suggest there is a blockage or structural problem present.
- Hormone analysis – any imbalance in fertility hormones such as FSH, Prolactin, LH, AMH, and testosterone may indicate a problem.
The following test may be offered to your partner:
- Semen analysis – to check the sperm count, quality, and motility
Secondary infertility treatment options
Your treatment options will depend upon the results of your tests. The treatments for secondary infertility are usually the same as for primary infertility.
1. Medications
You may be offered medications, which are typically used to treat problems with ovulation. Commonly used fertility medications include:
- Clomifene (Clomid)
- Tamoxifen
- Metformin (typically used for women with PCOS)
In some women these medications may cause certain side effects such as nausea, headaches, and hot flushes, but they are usually temporary and go away in a few days.
2. Surgery
If you have been diagnosed with structural abnormalities, in the womb or fallopian tubes, you may be offered surgical treatments.
- Myomectomy – to remove fibroids or cysts. It is usually performed laparoscopcally.
- Ovarian drilling – Helpful in bursting cyst membranes to trigger normal ovulation in women suffering from PCOS
- Fallopian tube surgery – to break up any scar tissue in your tubes
Also if your partner has been diagnosed with a blockage preventing the release of sperm or if he has had a vasectomy, you may be offered surgical sperm retrieval.
3. Assisted Conception
Usually this will be offered to you after other, less invasive measures have been ruled out. Treatment options include:
Lifestyle modifications to improve fertility
Certain lifestyle modifications may just help you to conceive and if not, they will certainly get you healthier, ready for your pregnancy.
Lifestyle improvements recommended to improve fertility include:
- Losing weight
- Doing moderate exercise
- Limiting your caffeine intake
- Stopping smoking
- Cutting down alcohol consumption, or even better, eliminating it
- Taking prenatal vitamins
Secondary infertility – chances of conceiving?
Once the cause of your infertility problems has been identified and treatment sought, it should be possible to have a successful pregnancy.
In fact, research shows that the prognosis for secondary infertility is usually better than that for primary infertility. This has been associated with a higher proportion of ovulation problems in women with secondary infertility, which can be more easily treated.
It has also been shown that having a previous pregnancy increases the likelihood of your success with IVF treatment.
Therefore, you should seek medical treatment as soon as possible in order to find out what is happening. Fertility testing and the whole treatment planning can take quite a while, so it important to start this process early, especially if you are somewhere in your mid 30s.
