The first one was easy, and now you’re ready for another. You keep trying, but it hasn’t happened yet. You know your body is capable of getting pregnant—so why isn’t it happening?
If you conceived and carried your first child, it may come as a shock to receive a diagnosis of secondary infertility. Medically, the term refers to couples who, after 12 months of unprotected sex, fail to conceive another child, but most experts also include recurrent miscarriage in the definition.
Nearly a quarter of couples seeking infertility treatment already have children. Yet parents are only half as likely to seek medical help for trouble conceiving as those suffering from primary infertility. They’re often reluctant to seek help because they assume that their previous successful pregnancies are proof that everything is in working order. But when it comes to fertility, past success is no guarantee of future success.
Sometimes secondary infertility is simply a result of age—by the time you have your second child, you’re older, and may not be as fertile. Other times, it’s the result of a new condition that wasn’t present before. In these cases, it’s worth exploring most of the same conditions that cause primary infertility as possible causes.
Even if you got pregnant quickly the first time, it’s perfectly normal for the second time to take longer. Remember, even at the peak of fertility, a woman’s chances of conceiving during any given cycle are only 30 percent. The amount of time you should allow before seeking medical advice depends on your age. If you’re under 30, give it a year. If you’re over 30, see a doctor after six months.
If you do see a doctor, these are the most common causes of secondary infertility that they’ll check for:
What Causes Secondary Infertility?
For most women, peak fertility happens between the ages of 15 and 30, with a drop-off after 30 and a plunge at 35 (by age 36, almost 25 percent of women may be infertile).
Just one or two years can change the quantity or quality of your eggs. You may have conceived easily at 31, and be running out of eggs at 33. Even if you’re ovulating each month, the older you are, the more likely it is that your eggs are suffering from chromosomal damage. Damaged eggs are less likely to become fertilized or go to term.
Sometimes, the decline in egg quality happens much earlier than expected. This is called premature ovarian failure.
If you’re cycles are irregular, it’s possible that you’re not ovulating, making it impossible to get pregnant. And even if you are ovulating, irregular cycles make it very difficult to track ovulation so you know the right time to have sex. A variety of factors can disrupt the normal menstrual cycle, but some of the most common ones include:
- Emotional or physical stress
- Endocrine disorders including PCOS, thyroid conditions, and diabetes
- Any other condition that causes menstrual irregularities
Luteal Phase Deficiency
In a normal menstrual cycle, after ovulation, the uterine lining thickens to prepare for a possible pregnancy. But in some women, the uterine lining does not thicken. Even if an egg is fertilized, the wall of the uterus is not thick enough for the egg to implant, and the pregnancy is lost before it has a chance to take hold.
The hormone responsible for telling the uterine lining to grow is called progesterone. Luteal phase defects can occur if you do not produce enough progesterone, or if the lining of your uterus doesn’t respond properly to progesterone.
If you’re tracking your cycle, you may be able to see some clues of a luteal phase defect. Normally, the luteal phase lasts 12-14 days. But if you find that you get your period more quickly after ovulation, it could be a sign that your body isn’t building up enough uterine lining.
Other symptoms include spotting between periods, difficulty getting pregnant, and frequent miscarriage (though you may miscarry before you even know you’re pregnant).
Possible causes of luteal phase defect include:
- Extreme exercise
- Thyroid disorders
It can be difficult to diagnose luteal phase defect since there’s so single, definitive test to check for it, but if your doctor suspects this is what might be going on, they might prescribe Clomid, hCG, or progesterone supplementation.
Tubal and Other Pelvic Problems
When both fallopian tubes are blocked, the egg has a hard time traveling from the ovaries into the uterus. Infertility can also be caused by physical problems with the cervix or ovaries, but these are less common than tubal defects.
Most of the time, the blocked fallopian tubes don’t cause any symptoms. But they’re often themselves the result of pelvic inflammatory disease. Other possible causes include:
- Chlamydia or gonorrhea
- Uterine infection caused by abortion or miscarriage
- Ruptured appendix
- Abdominal surgery
- Previous ectopic pregnancies
If only one tube is blocked, you may be able to get pregnant without any outside intervention. If both are blocked, laparoscopic surgery is an option, but it’s not for everyone. It’s more successful in younger women and when the blockage is not extensive. If laparoscopic surgery is not an option, IVF is your best bet.
Male infertility is usually caused by low sperm count or poor sperm motility. There are often no symptoms associated with this problem, so if you’re having trouble conceiving, it’s important to do a semen analysis. If sperm quality or quantity is the issue, your doctor may recommend exploring assisted reproductive technologies (ART) such as IUI or IVF.
The most common diagnosis of secondary infertility is no diagnosis at all. Unexplained infertility is simply the name for when all the usual infertility suspects have been ruled out, yet a couple still can’t get pregnant.
It’s particularly maddening to receive a diagnose of unexplained infertility when a couple has already had a successful pregnancy. Sometimes, there may have been an underlying issue in existence all along, and the couple was just lucky for the previous pregnancy, or the factor became exacerbated over time.
Let’s end on a positive note: if you have successfully conceived before, you have a better prognosis for overcoming infertility than someone who has never had a successful pregnancy.