What’s Secondary Infertility?

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Secondary infertility is the inability to conceive or carry a second child to term, and affects about 20% of women. Age, ovulation problems, and uterine issues are common causes, and medical tests can determine the cause and recommend treatment.

Secondary infertility occurs when a woman who has already carried a baby to term is unable to do so a second time. Women who conceive fairly easily, but then miscarry repeatedly, also have secondary infertility. Secondary infertility should not be confused with primary infertility, which means that a woman is unable to get pregnant at all. Women who have had unprotected, carefully planned sex for one year without conception may have secondary infertility and should visit their obstetrician/gynecologist (OB/GYN) or reproductive endocrinologist immediately. Women in their thirties are advised to seek medical attention after six months of trying.

About 20% of women experience secondary infertility at some point in their lives. While it is more common than primary infertility, it does not receive as much attention as primary infertility. Many women who are “primary” or have primary infertility resent women who already have a child and seek emotional support and fertility treatment to have more children.

Although some women will never know why they are unable to conceive and carry a second child to term, there are some common medical explanations. Endometriosis, bodily trauma, surgery, complications from previous births, and Asherman’s syndrome can all contribute to secondary infertility. Other factors such as a new partner, weight gain, aging and stress can also cause secondary infertility.

Age is one of the primary causes of secondary infertility. Women are born with all the eggs they will ever have in order to have children. Peak fertility is from the mid-20s to the mid-30s. By the age of 35 there is a marked decrease in fertility. By age 40, the pregnancy rate drops even lower, and by age 45, there’s only a 6 percent chance that a woman, with carefully timed, unprotected sex, will conceive each cycle.

Over time, there is also a decrease in the quality of the eggs, which can explain the miscarriage or other problems. Paternal age also plays a role as the quality of sperm a man produces throughout his life decreases with age. Some women find that the gap between their first and second child turns out to be too long and their ability to reproduce has diminished.

About a third of infertility cases can be traced to fallopian tube blockages or abdominal adhesions that can interfere with conception. Ovulation problems such as irregular, anovulation, defined as the lack of ovulation or premature ovarian failure, can cause secondary infertility. These complications account for approximately 25% of infertility cases. Age and uterine problems such as endometriosis account for a further 30% of the causes of infertility.
To determine the cause of secondary infertility, a specialist will conduct tests to monitor hormone levels at specific points in a woman’s cycle, analyze semen, and perform a hysterosalpingogram (HSG). An HSG is an x-ray procedure that examines the uterus and fallopian tubes for tubal blockage, Asherman’s syndrome, or malformations of the uterus. The doctor will then recommend an infertility treatment tailored to the patient’s specific type of infertility.

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