Secondary Infertility – Struggling to Get Pregnant a Second Time

Having a child can be one of life’s most fulfilling experiences, which is why it can feel especially confusing and distressing when you encounter difficulties conceiving again. This phenomenon, known as secondary infertility, affects many individuals and couples who have successfully had a child in the past yet find themselves unable to become pregnant or carry another pregnancy to term. In the sections that follow, we’ll explore what secondary infertility is, its common symptoms and causes, how it’s diagnosed, and the range of treatments and management approaches available. Whether you’re just beginning to suspect an issue or you’ve been trying for some time, this guide aims to inform and support you on the path to adding another member to your family.

What is Secondary Infertility?

Secondary infertility refers to the inability to conceive or carry a pregnancy to term after previously giving birth (Borumandnia et al., 2022). By contrast, primary infertility is when someone has never had a live birth. Although prevalence varies widely by region, research indicates secondary infertility can be more common than primary infertility in some areas (Jabeen et al., 2022). Like other forms of infertility, it can pose significant physical, emotional, and social challenges, emphasizing the importance of early evaluation and support.

Symptoms and Causes of Secondary Infertility

Symptoms 

The most common sign of secondary infertility is not being able to get pregnant or carry a pregnancy to term after previously having a successful pregnancy. Generally, if you’re younger than 35 and haven’t conceived after one year of trying, a healthcare provider may consider secondary infertility; if you’re 35 or older, they may do so after six months of trying. Often, people facing secondary infertility experience the same emotional and physical challenges as those with primary infertility, but they already have at least one child.

Women

In women, secondary infertility may first appear through irregular ovulation, changes in menstrual cycles, or pelvic pain. Some notice heavier or lighter periods, skipped cycles, or chronic pelvic pain, all of which can signal an underlying reproductive issue. These symptoms may be more pronounced if overall health or hormonal balance has changed since the first pregnancy.

Male

For men, secondary infertility symptoms frequently include changes in sexual function or decreased sperm count noted during fertility testing. Some individuals may experience low testosterone leading to reduced libido or energy. Difficulty with ejaculation or any noticeable changes to semen consistency or volume can also be an indicator of secondary infertility.

Causes

Female 

Secondary infertility in women can arise from multiple factors. Ovulation problems—such as those caused by polycystic ovary syndrome (PCOS)—disrupt hormone levels and make conception more difficult. Endometriosis can block or distort reproductive structures, and uterine fibroids or polyps can prevent a fertilized egg from implanting. Scar tissue from surgeries (including a C-section) can also create structural issues in the uterus. Additionally, lifestyle factors like smoking, alcohol use, or significant weight gain may affect fertility by altering hormone regulation.

Male

Causes of secondary infertility in men often relate to sperm quality or quantity. Low sperm count, poor morphology, and reduced motility may develop over time due to conditions like testicular varicocele or low testosterone. Existing medical issues (e.g., diabetes), prostate surgeries, and regular exposure to certain chemicals or high heat can also compromise sperm production. Moreover, smoking and excessive alcohol intake can harm sperm quality, making conception more challenging after a previously successful pregnancy.

	Female	Male
Symptoms	Irregular ovulation or menstrual cyclesPelvic pain or discomfort, sometimes linked to endometriosisUnusually heavy or light menstrual bleeding, which could point to uterine fibroids or polypsPast surgical scars (e.g., from a C-section delivery) potentially causing uterine complications	Difficulty with sexual function (e.g., problems with ejaculation)Noticeable changes in sperm (e.g., lower volume or thinner consistency)Reduced sex drive or signs of low testosteronePalpable varicocele (enlarged veins in the scrotum), which can influence sperm production
Causes	Diminished egg quality due to aging or ovulation disorders like PCOSBlockages or scar tissue in the fallopian tube or uterus, often from pelvic inflammatory disease (PID) or prior surgeriesEndometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, sometimes impairing a pregnancyUterine fibroids or polyps that disrupt implantationLifestyle factors such as smoking, alcohol consumption, or significant weight gain, which can all affect fertility	Low sperm count or poor sperm quality, often tied to varicocele or hormonal imbalances (e.g., low testosterone)Medical conditions (e.g., diabetes, infections) or certain medications that impair sperm productionPast surgeries (like prostate procedures) leading to abnormal ejaculationLifestyle factors such as exposure to chemicals, high heat, smoking, or excessive alcohol use, all of which can cause infertility over time

Diagnosis and Tests

When you’re experiencing secondary infertility, early evaluation is key. If you suspect a problem, consult your healthcare provider, reproductive endocrinologist, or urologist to explore what might be causing infertility. A thorough medical history and physical examination help identify any recent changes since your last successful pregnancy. Your provider may also review how long you’ve been trying to conceive this second time around and whether any lifestyle or health factors have shifted.

Female

For women, diagnostic steps often start with confirming whether ovulation is happening regularly. Blood tests check hormones like FSH, LH, and AMH to gauge egg quality and supply. Your provider may also recommend a transvaginal ultrasound to detect any uterine issues, such as uterine fibroids or polyps, as well as an HSG or saline ultrasound to confirm the fallopian tubes are open. In cases where previous surgeries (like a C-section delivery) might have left scar tissue, imaging helps identify any structural problems that could be impairing a pregnancy.

Male

For male infertility, diagnosis typically begins with a semen analysis to determine sperm production and identify any factors like low sperm count or reduced motility. Hormone tests, including testosterone levels, can uncover possible endocrine imbalances. If structural concerns are suspected—such as varicoceles—your provider may conduct a physical exam and order an ultrasound of the scrotum. Additional testing may be recommended if issues like low testosterone or certain medical conditions (e.g., diabetes or thyroid disease) are noted.

	Female	Male
Tests for diagnosis	Hormone testing (FSH, LH, AMH) to assess egg supply and ovulationTransvaginal ultrasound to detect uterine or ovarian abnormalitiesHSG or saline ultrasound to confirm patent (open) fallopian tubesInvestigation of scar tissue from prior deliveries or surgeries	Semen analysis to measure sperm count, motility, and morphologyHormone tests (including testosterone) to evaluate potential endocrine imbalancesPhysical exam and ultrasound if a varicocele or other structural issue is suspectedReview of lifestyle factors (e.g., smoking, alcohol use) that may affect sperm quality

Management and Treatment 

Secondary infertility can be emotionally draining, yet not all management strategies require immediate medical attention. Some individuals start by adopting lifestyle adjustments, such as reducing stress, maintaining a balanced diet, and limiting alcohol or smoking, which may benefit overall fertility. However, when these steps haven’t been able to resolve the issue, more comprehensive treatment options may be necessary.

• Intrauterine Insemination (IUI). IUI involves placing sperm directly into the uterus during ovulation to help increase the chance of fertilization. It’s often one of the first treatments recommended if low sperm count or mild male infertility factors are detected.

• In Vitro Fertilization (IVF). IVF treatment retrieves eggs and combines them with sperm in a laboratory. Once fertilized, an embryo is transferred back to the uterus. This method can be highly effective when ovulation or fallopian tube issues complicate natural conception.

• Intracytoplasmic Sperm Injection (ICSI). A specialized form of IVF, ICSI involves injecting a single healthy sperm directly into the egg, which may help overcome severe sperm or male infertility problems.

• Egg Donation. If egg quality or quantity is compromised, using donor eggs can offer a viable pathway to pregnancy. Donor eggs are fertilized (often via IVF) with a partner’s or donor sperm and then transferred to the recipient’s uterus.

• Sperm Donation. When male factors prevent fertilization, donor sperm may be used for IUI or IVF, creating the possibility of a successful pregnancy even if low sperm count or other concerns are at play.

Getting Pregnant With Secondary Infertility 

Even if you’ve already had a child and are now experiencing secondary infertility, there are effective solutions available to help you get pregnant again. Whether it’s IUI, IVF, ICSI, or donation options, modern treatments offer hope to couples and individuals ready to grow their families.

Don’t let secondary infertility stand in the way of having another child. If you’re trying to conceive and need guidance, reach out for professional support. Take the first step by scheduling a consultation with a fertility specialist who can tailor a treatment plan to your unique needs. With the right approach and expert care, you can overcome secondary infertility and look forward to welcoming the second child you’ve been hoping for.

Frequently Asked Questions about Secondary Infertility 

What is secondary infertility?

Clinically, infertility is defined as the inability to conceive after 12 months or more of regular, unprotected sexual intercourse. When you have already had a successful pregnancy in the past and now encounter difficulty becoming pregnant again, it is referred to as secondary infertility. Essentially, the difference between primary and secondary infertility lies in whether you have previously conceived and given birth.

When should you stop trying to conceive naturally when affected by secondary infertility?

If you have been having regular, unprotected sexual intercourse for 12 months (or six months if you’re over age 35) without a positive pregnancy test, it’s time to consider a fertility evaluation. Consulting a healthcare provider or fertility specialist can help identify possible barriers to conception and guide you toward the appropriate next steps for achieving your goal of parenthood.

How common is secondary infertility?

In Central Europe, secondary infertility rates are generally lower than in less developed parts of the world. In 2022, secondary infertility was experienced by approximately 11% of women in Central Europe, while it was less common for men, where around 5% were affected this condition. In the UK, around 5% of the population are affected by secondary infertility issues, where females again account for a slightly higher share. 

References

Borumandnia, N., Majd, H. A., Khadembashi, N., & Alaii, H. (2022). Worldwide trend analysis of primary and secondary infertility rates over past decades: A cross-sectional study. International Journal of Reproductive BioMedicine, 20(1), 37–46. https://doi.org/10.18502/ijrm.v20i1.10407

Jabeen, F., Khadija, S., & Daud, S. (2022). Prevalence of primary and secondary infertility. Saudi Journal of Medicine, 7(1), 22–28.