Secondary infertility is the inability to get pregnant or have a full-term pregnancy after previously giving birth without difficulty. If you are experiencing secondary infertility, this can be a surprising and stressful time. You may deeply desire for your child to have a sibling or you may be remarried and would like to have children with your new spouse. Often couples in this situation do not receive as much support as those who are going through primary infertility. It’s completely natural and common, however, to be thankful for your current child(ren), but still desire more children.
According to the National Center for Health Statistics more than 3 million women of childbearing age in the U.S. who have one biological child have difficulty getting pregnant or carrying another to term (source). If you and your partner have successfully had a child or children without any previous problems, you may be wondering what could be causing it to be so difficult this time around. Here is a review of what can be behind secondary infertility and when you should seek help.
A woman’s fertility is dependent on her age. A woman’s fertility may start to decline as early as her late 20s (source) but typically is not a problem until after the age of 35 unless there is premature decline. You are probably familiar with the fact that women have a limited supply of eggs, but in addition, the quality of her eggs may also decline with age. This can lead to an increase in miscarriages due to DNA damage. Women under the age of 35 years have about a 15% chance of miscarriage, while women who are 35-45 years have a 20-35% chance of miscarriage (source),
Men aren’t off the hook either regarding the effects that advancing age has on fertility as previously believed. For men, sperm quality also declines starting in their 30s (source).
Dr. Don Aptekar, MD FACOG, says that when you are older it may be harder to get pregnant and stay pregnant, but this doesn’t mean you won’t get pregnant. It may simply take longer than it did the first time. For example, you may have had 12 good eggs in a year during your 20s and now you may have 6 good eggs.
Another factor with age, besides egg and sperm quantity and/or quality, is that it’s more common for abnormalities to develop with our menstrual cycles in our mid-to late 30s. This might include conditions such as the development of polyps, fibroids, anovulation (lack of ovulation), and endometriosis (growth of endometrial tissue outside the uterus) (source).
Due to a variety of factors, older men can have complications such as impaired sperm production, function or delivery. For example, these complications can be influenced by the use of medications, undiagnosed hormonal imbalance, untreated STD, or even having had low sperm count to begin with, but were lucky enough the first time around not to be aware of this (source).
Sarah and her husband Jon (names changed for privacy) had been trying to conceive for over a year. Jon had a son on the first try from a previous relationship, so they assumed the problem was with Sarah. After months of testing, all her tests came back normal. Finally, Jon had his sperm checked out and the lab results came back showing he had significantly low sperm count due to a physical abnormality he was born with. He had a 2% chance of conceiving without intervention. A 2% chance is not a 0% chance, however, so that is how he was able to conceive his first child.
Even a new habit such as riding a bicycle for hours each day can decrease sperm count. Check out this blog post here for more information on male-factor infertility:
Hormonal and Physical Complications
As mentioned above, some complications do not present themselves until a woman is in her 30s. Due to a number of factors, women can have fallopian tube damage, ovulation disorders, endometriosis or other complications due to surgery or injury during a previous delivery. Perhaps hormonal imbalances are causing ovulation problems that have developed as you have gotten older, such as an undiagnosed thyroid problem or Polycystic Ovary Syndrome (PCOS) (source).
Therefore, if you are having difficulty conceiving, it is recommended that you see your doctor if you have a history of pelvic inflammatory disease, painful periods, miscarriage or irregular cycles.
While doctors are still learning a lot about PCOS, diet and exercise has been shown to have a major impact on PCOS and you may be able to increase your fertility by changing your daily exercise habits and diet (source).
There are several lifestyle factors that no doubt have a negative impact on fertility in both men and women. This includes smoking and excessive drinking and certain medications. Smoking, for example, can damage eggs and cause ovulation problems and may damage sperm DNA as well.
Body weight also can cause challenges with conceiving. This goes for either being underweight or overweight. In women, being overweight can contribute to insulin resistance and elevated testosterone levels which can cause ovulation disorders. Also, implantation rates are lower for those who are either overweight or underweight. For men, excess weight can increase estrogen levels, leading to lower sperm counts (source). Who knew?
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In his 40 years of experience, Dr. Aptekar says that the timing of having intercourse is the number one factor he sees that affects couples’ inability to get pregnant. If you weren’t timing intercourse the first go around, it’s possible that you were having more intercourse as typical earlier in a marriage or just got lucky with the timing. Make sure you are using your own biological clues, such as temperature, cervical mucus or luteinizing hormone to help predict your fertile window. Women have been found to ovulate anywhere between day 8 and day 21 which can occur on different days each month even with regular cycles (source). So be careful assuming your fertile window is right in the middle of your cycle.
When to get help?
A preconception visit with your healthcare provider is a good idea for several reasons, including making sure you are up to date on your vaccinations, and to review your menstrual cycle history and any medications you may be taking. Not everyone, however, has insurance to cover a preconception visit. So if you haven’t seen a doctor yet, the recommendation for women up to the age of 35 is to try for a year before seeking a medical opinion. If you’re over age 35, consider talking with your doctor after 6 months of trying (source).
Last, but not least, recognize that secondary infertility can be an emotionally difficult experience for many couples. Keep in mind that while stress and anxiety does not cause infertility, it can disrupt fertility (source). You may find stress relief by joining a support group with others in the same situation. That can be a good thing. You should be able to find support groups in your area by searching online (source) or your healthcare provider may be able to offer suggestions as well.