Longing for a second baby and having a hard time? – Secondary infertility could be the cause!

Although it is a common misconception that infertility only affects couples who have never had a child before, the fact is it can affect couples post one or more successful pregnancies. 

Secondary infertility refers to having difficulty in conceiving or carrying a pregnancy to term after the birth of one or more children. In fact, it is harder for couples experiencing secondary infertility as they fail to gain sympathy and support from family, friends, and relatives. 

They may feel disregarded, as it is natural for people to assume that the couple who have already had one child would have no problem having another. 

It may be emotionally challenging for couples to be caught up between the two worlds - fertile and infertile. Read along to know more about secondary infertility.

What Are The Causes of Secondary Infertility? 

The causes of secondary infertility are not any different from those of primary infertility. However, the most important thing for you to know is that infertility is not your fault. Listed below are a few causes of secondary infertility:

  1. Age: Work and other personal commitments have pushed the timeline for the first child to almost 29 to 30 years of age. The idea to conceive again for the second child happens by 34 or 35 years of age. 

    By this time, women’s fertility is already on the decline due to physiological and lifestyle changes. Men can also experience a decline in fertility in terms of reduced count and quality of the sperm, with age. 
  1. Problems With The Uterus or Fallopian Tubes: Structural problems (like unicornuate uterus) either due to genetics, infections, autoimmune conditions, etc. can affect a woman’s ability to conceive by blocking the interaction between the sperm and egg (fertilization) or implantation per se. 

    Medical conditions such as endometriosis, tube blockage, ovulation disorders (polycystic ovarian syndrome or PCOS), uterine fibroids, sexually transmitted infections (STIs), etc. are a few common causes of secondary infertility in women. 
  1. Previous Pregnancy: If you have had a cesarean or C-section delivery or have gone through a medical termination of pregnancy (MTP)/dilation and curettage (D and C) procedure in the past, it could be a cause for concern. 

    These procedures tend to form a scar (also called isthmocele) or adhesions within the uterus that can affect future pregnancies by blocking the implantation once the fertilization of egg/ova has occurred. 
  1. Breast-Feeding: Women who breast-feed their baby tend to have long periods of postpartum amenorrhea (absent menstrual cycle) and infertility. 

    The length of this amenorrhea greatly varies from person to person and depends on several factors, such as age, number of previous pregnancies, and duration and frequency of breastfeeding. 
  1. Obesity And Lifestyle Changes: Obesity and unhealthy eating habits can lead to ovarian dysfunction in some women.

  2. Certain Medications: Drugs that belong to the group of antiepileptics, anti-depressants/anti-psychotics (such as selective serotonin reuptake inhibitors or SSRIs), steroids (cortisone/prednisolone), non-steroidal anti-inflammatory drugs ( NSAIDs), etc. can either affect ovulation or impair the endometrial/uterine receptivity towards pregnancy in women.

    Medications such as testosterone (as a hormonal replacement or supplemental), anabolic steroids, and substances such as alcohol, tobacco, and opiates (narcotics) can have a negative effect on male fertility (either by decreasing the sperm count or affecting the quality of the sperm).

How to Overcome Secondary Infertility?

Secondary infertility causes a lot of stress and disappointment as couples are frustrated because of their inability to produce a sibling for their existing child. This feeling of sorrow can often complicate the current parenting roles. 

A few things that you could do if you are trying for a second child are: 

  • Consult a Fertility Specialist: Gone are those days when you had to hear “keep trying” from your physician/family or friends. If you and your partner are 35 years old or younger and have had unprotected sexual intercourse for at least 12 months (or six months if older than 35) without getting pregnant, it is recommended that you see a specialist as this could be due to secondary infertility. 

    This applies especially to older women (>35 years) with past history of pelvic inflammatory disease (PID), painful or irregular periods, miscarriages, etc. and to men with low sperm count.
  • Adopt a Healthy Lifestyle: Eat healthily, exercise regularly, and manage your weight as being overweight (body mass index or BMI >30) or underweight can affect your ovulation.
  • Find Support Groups: It can be a very isolating and emotionally challenging diagnosis as most often couples experiencing secondary infertility retract from their close ones, and are reluctant to seek help or talk to others. Connect with people who “get it” or a mental health professional who can make this whole process easier. 
  • Treatment: Whether it is primary or secondary infertility the treatment options are quite similar and include:
  1. Medications: Medicines such as clomiphene citrate or letrozole are often prescribed to either normalise hormone levels or stimulate ovulation based on patient factors.

  2. Advanced Reproductive Therapy (ART): The two most common procedures are Intrauterine Insemination (IUI), which increases the chance of fertilisation and In-Vitro Fertilization (IVF), in which the fertilisation and growth of embryo happen in a lab and then the embryo is transferred or implanted into the uterus.

  3. Surgery: In women with structural uterine abnormalities (such as scar tissue, fibroids, polyps, or anatomical defects) surgery can solve the problem. In men, it can be used to treat testicular varicocele which is the most common surgically correctable cause of male infertility.

Secondary infertility can take a toll on the physical and mental well-being of you and your partner, which is why it is important to be aware and also seek help from the right sources (such as physicians and mental health professionals). 

This way, you can make informed decisions that can help you along your journey to conceive or get pregnant again. 

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.