What Causes Secondary Infertility?

Mayo Clinic defines secondary infertility as the inability or difficulty in becoming pregnant or to carry a child to term after already giving birth to a baby—after a year of unprotected sexual intercourse (for women under 35).

While there are many causes that are similar between primary and secondary infertility, there are some issues that are particular only to secondary infertility. Read on to find more about secondary infertility, causes and treatment options. 

What are the causes of secondary infertility?

Causes of infertility can be either due to sperm defect or ovarian defect. In men, impaired sperm production, immotile sperm, defect in function or delivery can be the cause of secondary infertility.

On the other hand, causes in women include damage to the fallopian tube due to an infection (like pelvic inflammatory disease), ovulation disorders, and endometriosis. Conditions in which the uterus or the uterine tissues get affected can also impair fertility.  

Other physical issues like complications in prior surgery or pregnancy can also affect fertility. Apart from physical causes, age-related factors, the effect of hormones and certain medications can also impair fertility. 

Diagnosis of secondary infertility can be tricky

According to the United States Department of Health and Human Services, there are close to 6 million women who are struggling to get pregnant—and of these, one-third are those who have secondary infertility. 

University of Southern California’s assistant professor of OBGYN and fertility specialist, Dr. Jacqueline Ho, M.D. states that parents often find it difficult to understand that they cannot conceive again, despite already having a child. Therefore, giving advice to such patients can be complicated. Moreover, the exact diagnosis and cause of secondary infertility are often hard to pin down. 

Risk factors for secondary infertility

The common risk factors include:

Advanced age: Many women today are waiting longer to have children, and this can pitch age-related issues against them. Women who are trying to conceive for the third or fourth time, especially, have to face stronger physical issues than first-time moms.

In a natural life cycle, 46 is the age whereby the natural end of a woman’s reproductive life occurs. According to the American College of Obstetrics and Gynecologist (ACOG), women below the age of 30 have 25 percent chance of getting pregnant in any given cycle. This probability decreases to 10 percent by the age of 40 according to ACOG, and 5 percent according to American Society for Reproductive Medicine. 

Weight gain: Studies suggest that having more body fat can increase the risk of secondary infertility. While the exact link between weight gain and infertility cannot be established directly, there has been seen hormonal shifts in obese or overweight women that disrupts the menstrual cycle, and ovulatory patterns. These shifts can increase the risk of secondary infertility. 

Infections: pelvic inflammatory diseases and other sexually transmitted infections can cause scarring or adhesions in the reproductive organs that can hamper fertility. If there are adhesions or scarring involving one or both fallopian tubes, then this blockage will prevent the sperm from reaching the egg.

In certain cases like those of ectopic pregnancy, the fallopian tube can get damaged to the extent that it might require surgery. One such consequence is post-surgical scarring that can impair conception. 

For some women, surgery to clear adhesions can help in conception, but for others, in vitro fertilization (IVF) is a better option. According to Dr. Zev Rosenwaks, M.D., at the Center for Reproductive Medicine, New York, most women with internal scarring or damage fare better at IVF rather than resorting to surgery to clear up the adhesions. However, this option might be cost-prohibitive for some people. 

Other health conditions: chronic health conditions, such as endometriosis, PCOS, uterine fibroids and even thyroid conditions can interfere with conception. 

Endometriosis: occurs when the internal uterine lining grows at a site other than the uterus. This can cause inflammation and scarring inside the ovaries, fallopian tubes, and other internal organs. This can affect the egg quality and the implantation of the embryo. For women suffering from endometriosis, pregnancy can be a challenge. 

Uterine fibroids: Fibroids are another common problem that many women suffer from that can make pregnancy difficult. Fibroids are non-cancerous growths in the uterus that grow bigger due to hormonal impact and can bock fallopian tubes and crowd the uterus. With age, PCOS and Fibroids worsen, and that can partially explain why early pregnancy was not possible. 

PCOS: is the polycystic ovary syndrome, in which hormonal imbalance causes irregular periods, weight gain, hirsutism, and difficulty in getting pregnant. 

Male infertility:

The reason for infertility can also stem from the male partner even though the female partner is often the one making appointments, according to Dr. Jeanne O’Brien, M.D., a urologist at male infertility centre in the University of Rochester. The commonest issues causing infertility or decreased fertility is low sperm count, steroid use and obesity. 

Secondary infertility can often be difficult to diagnose and can require frequent investigations and workups. However, all hope is not typically lost as there are high chances of getting pregnant even if infertility persisted for two years. If you have concerns about fertility then you should timely seek professional help.

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