About one in eight couples in the United States experience infertility, which is defined as the inability to conceive or carry a baby to term. There are many different types of infertility and causes of infertility, but most of the information available focuses on primary infertility, or the inability to have a first baby. However, it's also possible to have infertility after you have already had a successful pregnancy or multiple pregnancies. This is called secondary infertility.
When to seek help for secondary infertility
Once you have had a previous child, if you have trouble getting pregnant again after one year of trying to conceive, if you are under 35, or have tried for six months if you are over 35, it is considered secondary infertility.
Resolve, an association that provides support and information about infertility, also suggests that you consider contacting your practitioner sooner if you are over 30 and if you know that your partner has a low sperm count or you have a history of:
Secondary infertility is diagnosed in the same manner as primary infertility. Both partners are tested with basic tests like lab work for blood disorders and a semen analysis or sperm count for the male partner. A comprehensive review of the menstrual cycle data will be done. If there are no issues detected during these basic tests, more extensive testing may be ordered.
More extensive testing can require procedures like a hysteroscopy or hysterosalpingogram (HSG) to explore the uterine cavity and test for blockages of the fallopian tubes.
Secondary infertility treatment will depend on the cause of the infertility. Typically, problems will be addressed in the same way in both primary or secondary infertility. For example, if there is a problem with sperm quality, that would be addressed the same way regardless of whether you have had a successful pregnancy before. The big question becomes: What's different now from when you got pregnant the first time?
For example, if you have a chronic condition now that you did not have when you first conceived, you may need to manage that before attempting to correct fertility issues. Treating other health conditions may also help resolve your fertility issues.
Can secondary infertility have causes related to previous pregnancies?
There are some things that can occur during childbirth that can make it more likely that you will experience secondary infertility. One example would be having a cesarean birth, which increases the likelihood that you will experience cesarean scar defect ― a small sac-like structure can form in the uterine scar. If you have a cesarean scar defect, you can get endoscopic surgical treatment to help fix the issue and hopefully increase your chances of getting pregnant. Symptoms of cesarean scar defects include odd uterine bleeding patterns, painful periods, and secondary infertility.
There are also cases that may increase the risk of infertility after a cesarean, like having remaining tissue in the uterus (called retained products of conception). This can lead to scar tissue in the uterus (adhesions). Adhesions can also result from Asherman’s Syndrome, which is also more common after a cesarean section or dilation and curettage procedures after miscarriage, which can cause some types of infertility after a problem-free first pregnancy.
While not common, there is also a possibility that you can retain fetal bone fragments in your uterus after pregnancy. These fragments can be seen and identified with ultrasound. Many times it can be corrected with surgery.
It’s also important to note that multiple miscarriages are a form of infertility. While it may be common to have a single miscarriage in the first trimester, if you have more than two, you need to seek help from a specialist. About 5 percent of women will experience two consecutive miscarriages, but less than 1 percent will experience three or more. These multiple losses mean that you need to seek treatment to try to find the cause and address it.
The bottom line
Secondary infertility may stem from changes in the health or medical history of you or your partner, including the circumstances surrounding any previous pregnancies. It can also be that your first pregnancy was a "lucky" chance, if you will, that some underlying issue wasn't noticed the first time around, or somehow did not play a part in preventing conception.
How secondary infertility is treated will depend on what your practitioner recommends. Being tested early will help you save time in the investigation and treatment and, hopefully, have you on the road to a healthy pregnancy soon.