Secondary Infertility: A Common and Emotional Diagnosis

Couples diagnosed with secondary infertility often struggle with emotions like guilt, jealousy, frustration, and anger. They may feel isolated and ignored. Primary infertility is not being able to get pregnant or have a baby. Secondary infertility is just as common but gets much less attention and support.

The diagnosis of secondary infertility is having one child and wanting another but not being able to get pregnant or maintain a pregnancy. Couples may be diagnosed with this condition if:

  • They have had one child without needing an infertility treatment like in-vitro fertilization.
  • They would like to have another child but have not been able to conceive or have a full-term pregnancy despite unprotected sex for one year or for six months if the woman is age 35 or older.

What Causes Secondary Infertility?

In a few cases, secondary infertility is caused by a problem with the first pregnancy. The cause may be scarring in the uterus due to C-section or a placenta problem like placenta previa, or damage to an ovary or fallopian tube. In most cases, the causes are similar to primary infertility. Like primary infertility, the cause is just as likely to be the male partner as the female partner. And, in about one-third of cases the cause is unknown.

According to the Cleveland Clinic, some common causes of secondary female infertility include:

  • Poor egg quality that occurs over time
  • A pelvic inflammatory disease
  • Scarring from a D&C
  • Polycystic ovary
  • Endometriosis

Causes of male infertility may include:

  • Low level of testosterone that occurs over time
  • Poor sperm count or motility
  • Prostate problems
  • Testicular problems, like varicocele (swollen veins inside the scrotum)
  • Thyroid disease, diabetes, or mumps

Lifestyle factors like drinking alcohol, smoking tobacco or marijuana, being overweight, or not getting enough sleep can affect fertility for both men and women.

The Emotional Impact of Secondary Infertility

Couples with primary infertility have lots of resources and support. Almost everyone can identify with the frustration of wanting a child but being unable to conceive. On the other hand, many people have never heard of secondary infertility. Even doctors may take it less seriously than primary infertility and tell couples to just keep trying.

However, according to the National Infertility Association, secondary infertility can be just as emotionally stressful as primary infertility with far less social support. Couples may feel guilty about not being grateful enough for the child that they have or guilty about not being able to provide a sibling for their only child. They may feel frustrated that pregnancy seemed so easy the first time and so hard the second time. They may envy their friends and family who have children with a brother or sister.

What to Do 

If you are struggling with secondary infertility, don’t assume that because you have one child you shouldn’t ask for help to have another. The National Infertility Association says that if you are under age 35 and have been trying for one year or over 35 and have been trying for six months, you should see your doctor for a fertility consultation. Your doctor should evaluate you for infertility causes. If an obvious and treatable cause cannot be found, you should ask for a referral to a fertility specialist.

While you are still trying on your own, do all the things you did for your first pregnancy, like tracking your ovulation and making healthy lifestyle choices. If you are on a medication that you were not taking before your first child, ask your doctor if the medication could be interfering with fertility.

For many couples with secondary infertility the best treatment is assisted reproductive technology, most commonly IVF. You should not feel guilty about pursuing this option if your fertility work-up does not offer any other treatments. Secondary infertility is gradually becoming recognized as an important condition that deserves support and the best treatment available, just like primary infertility.

Organizations that offer support and information are now available to help. A good place to start is the National Infertility Association website for secondary infertility. You can find a link to support groups and health care providers at: Secondary Infertility – RESOLVE: The National Infertility Association

Christopher Iliades
Dr. Chris Iliades is a medical doctor with 20 years of experience in clinical medicine and clinical research. Chris has been a full time medical writer and journalist since 2004. His byline appears in over 1,000 articles online including EverydayHealth, The Clinical Advisor, and Healthgrades. He has also written for print media including Cruising World Magazine, MD News, and The Johns Hopkins Children's Center Magazine. Chris lives with his wife and close to his three children and four grandchildren in the Boston area.

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