If you have given birth before but are having difficulties trying to grow your family for the second or third time, your physician may suspect secondary infertility. However, secondary infertility doesn’t mean that you cannot grow your family — it just means that you may need a helping hand. In this article, we’re going to examine the primary causes and the treatment options available.
What is Secondary Infertility?
Secondary infertility occurs when a person has difficulty conceiving or carrying a baby to full-term — even though they have previously given birth at least once before (without the use of fertility treatment or medications).
The causes of secondary infertility are typically the same as primary or unexplained infertility. Fertility challenges can occur during any stage of the reproductive process, including ovulation, fertilization, and implantation.
How Common is Secondary Infertility?
Secondary infertility is as common as primary infertility. On average, a third of all IVF cycles are for secondary infertility.
Causes of Secondary Infertility
Overall, secondary and primary infertility have similar causes. In the following sections, we explore the causes of secondary infertility in females and males/assigned females and males at birth (AFAB and AMAB).
Causes of Secondary Infertility in Females/Assigned Females at Birth (AFAB)
For the causes of secondary infertility in females/AFAB, the most common problems involve egg quality or quantity, fallopian tube or uterine issues, scarring from a previous c-section, certain conditions, and lifestyle factors.
Egg Quality or Quantity
While you are born with millions of eggs — from 1 to 2 million — this number declines throughout your reproductive years. Over time, the quality of the eggs also decreases. Additional challenges with egg quality and quantity can happen because of autoimmune conditions, genetic conditions, surgery, radiation treatment, lifestyle, or other medical circumstances. This can lead to difficulties getting pregnant or carrying a pregnancy to full term.
Problems with the Fallopian Tubes
The fallopian tubes carry the eggs from your ovaries to your uterus. However, these tubes can become blocked for various reasons, such as illnesses, infections (for example, chlamydia or gonorrhea), surgery, radiation, or endometriosis.
The health of your uterus can affect the implantation of the embryo. However, various conditions can affect the uterus, including endometriosis, fibroids, uterine scarring from a c-section, or a retained placenta.
Scarring in the uterus from a c-section is referred to as isthmocele. This can create further inflammation in the uterus, which can make implantation and pregnancy difficult. However, the good news is that scarring can be resolved via surgery.
Endometriosis is a disorder where tissue, similar to what lines the uterus, grows elsewhere in the body. This may affect your ovaries or fallopian tubes, or uterus, even the organs involved in the bowels. This can cause issues with egg quality and egg release and embryo implantation.
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder, which can cause cysts on the ovaries, as well as prevent ovulation from happening. When ovulation does not occur, there is no egg for the sperm to fertilize.
An unhealthy lifestyle can affect reproductive function — such as chronic stress or being overweight or underweight — and lead to ovary dysfunction. Certain medications or certain diets can also contribute to reproductive issues, making it difficult to conceive.
Infections that affect the reproductive organs can also lead to fertility challenges. These include sexually transmitted diseases, such as chlamydia and gonorrhea.
Autoimmune disorders cause the body’s immune system to attack its own cells. In some circumstances, this might involve the reproductive organs, causing fertility problems, such as miscarriages and premature ovarian failure.
Causes of Secondary Infertility in Males/Assigned Males at Birth (AMAB)
Causes of secondary infertility in males/AMAB might involve reduced testosterone, testicular varicocele, sperm quality or count, and prostate problems. We explore these fertility issues in more detail below.
Testosterone is essential for adequate sperm production. There are many circumstances that might affect testosterone production, including injury to the genitals, age, and medical conditions, such as thyroid diseases, diabetes, emotional stress, tuberculosis, and more.
Testicular varicocele happens when the veins in the scrotum, which holds the testes, become enlarged. This can occur from valve dysfunction, which may require surgical intervention to fix.
Sperm Quality or Count
After the age of 40, sperm count and quality naturally decline. Certain medications for prostate cancer, seizures, arthritis, and more can also affect sperm count. A low sperm count or quality decreases the chances that one of the sperm will make it to the fallopian tubes to fertilize the egg.
If the prostate is enlarged, this may cause issues with ejaculation. Or, if the prostate had to be removed or undergo treatment because of cancer or other medical issues, this will also contribute to infertility.
When to See a Specialist for Secondary Infertility
If you suspect secondary infertility, consider booking an appointment with your doctor or a reproductive specialist. Early assessment and detection of fertility issues can give you a variety of treatment paths to help you expand your family.
Secondary Infertility Treatment Options
Similar to primary infertility, there are many options available for treating secondary infertility. Common secondary infertility treatments include lifestyle changes, cycle monitoring/medication, surgery, IUI, and IVF.
Medication for Secondary Infertility
Medications are typically used to help the process of ovulation occur. These medications may include or letrozole. They help stimulate ovulation so that your ovaries release an egg that can become fertilized.
Surgery for Secondary Infertility
Your medical team will recommend less invasive options first. However, surgical intervention may be helpful in the following situations: removing any uterine scarring, polyps, or fibroids, hydrosalpinx, and correcting testicular varicocele.
IUI and IVF for Secondary Infertility
IUI, intrauterine insemination, improves your chances of becoming pregnant by “washing” the sperm (of the partner or pre-arranged sperm donor) and inserting it into the uterus at the optimal time. To do so, your fertility team may use fertility medication combined with cycle monitoring.
IVF, in vitro fertilization, is one of the most well-known fertility treatments. Many patients turn to IVF when other treatments have been unsuccessful. The IVF process involves fertility medication injections to help facilitate the maturation of multiple eggs, which are then retrieved in a procedure by your fertility team. The eggs are then fertilized in a lab before being transferred to the uterus with the goal that implantation will take place.
Coping With Secondary Infertility
From frustration to feelings of overwhelm and loneliness, secondary fertility can, understandably, come with an array of emotions. If you are having difficulty coping, consider speaking with a fertility counsellor or joining a fertility support group. You aren’t alone.
At TRIO Fertility, we understand how difficult infertility can be. Together, we can help you overcome it and expand your family. Contact us today for more information.