What Is Secondary Infertility And What Can You Do To Treat It?

Infertility is often a taboo topic that comes with its own set of stigmas, especially in close-knit societies where couples feel the expectation of having children weighing heavily on their shoulders. According to the World Health Organization, 48 million couples and 186 million individuals globally have experienced infertility. The inability to get pregnant can leave women feeling frustrated, deeply hurt, and anxious. A 2022 press release from Ferring Farmaceuticals suggests that the psychological impact of infertility in couples is tremendous, with 60% experiencing mental health problems following their diagnosis.

The Massachusetts General Hospital Center for Women's Mental Health adds that the stress of not fulfilling one's wish for a child leads to withdrawal, social isolation, marital problems, and even sexual dysfunction. Feelings of inadequacy, incompetency, and diminished self-esteem set in. Parenthood is one of the most critical transitions in a person's adult life, and if they want it but can't reach it, it's traumatizing.

But what if a couple has already had one child — or more — and is actively trying to expand their family with another little bundle of joy? In that case, a woman who conceived easily and had an uneventful pregnancy decides on another child, thinking that everything will flow seamlessly, just like before. But after six months to a year of unsuccessful attempts, panic kicks in. What could be wrong?

If you or someone you know is struggling with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.

Suppose you have been pregnant before and already have another child. In that case, you may not expect a new pregnancy to be problematic, and infertility is definitely not a word on your radar. But after a year of unsuccessful attempts, it might be time to consider secondary infertility. Penn Medicine describes secondary infertility as the inability to become pregnant or carry a baby to full-term after previously giving birth to a healthy full-term baby. Sometimes a woman may have even given birth to more than one child and then suddenly experience infertility when trying for more.

Medical News Today suggests that the prevalence of secondary infertility among U.S. couples is around 11%. Unfortunately, couples who experience secondary infertility receive less social support than couples who experience primary infertility because they already have children (via Psychology Today). However, the emotional toll can be just as heavy, and the inability to see your family as you envision it can be painful. The National Infertility Association notes that couples who fail to produce a sibling for their child can experience a range of emotions, including guilt and sorrow.

Emily Huffstetler, M.D., an OB-GYN at Jefferson Obstetrics, tells PureWow that the causes of secondary infertility are similar to the causes of primary infertility. For example, a woman's age is crucial when trying to conceive, with women over 40 facing problems with the quantity and quality of their eggs. Another cause might be problems with the fallopian tubes. A blockage to these tubes due to pelvic infections will interrupt the natural process of carrying the eggs from the ovaries to the uterus. Alternatively, uterus problems and adhesions caused by a previous cesarean delivery or scarring during a dilation and curettage process interfere with future pregnancies.

Other conditions commonly known to cause infertility include endometriosis (where tissue instead of growing in the uterus grows on the ovaries) and polycystic ovary syndrome (where an excessive number of male hormones exist in the female body interfering with regular egg release from the ovaries).

Dr. Huffstetler further explains that several other causes may contribute to infertility besides underlying medical reasons (via PureWow). For instance, weight gain, smoking, alcohol use, lifestyle changes, and certain medications play a role. In addition, research published in the Global Library of Women's Medicine shows that psychological factors and stress can prevent a woman from getting pregnant. The more she tries, and with each failed attempt, the more her psychological well-being deteriorates leading to a vicious cycle.

Treatments for secondary infertility are similar to those used to treat primary infertility. However, to treat secondary infertility, doctors will first try to "figure out what (if anything) is wrong," Dr. Emily Huffstetler tells PureWow. Penn Medicine suggests that one in five secondary infertility cases are identified as unexplained. Consequently, a series of consultations, lab tests, medical appointments, and examinations such as ultrasound and hysterosalpingogram will help determine the underlying causes of infertility and decide on the appropriate course of treatment.

To induce ovulation, your doctor may prescribe medications, including clomiphene and letrozole. Your doctor may also suggest surgery to repair uterine-related problems by removing scar tissue, polyps, and fibroids from the uterus. Another option might be intrauterine insemination (IUI), whereby a doctor surgically places sperm inside a woman's uterus. Many women resort to IVF (in vitro fertilization) when all other treatments fail.

Whether primary or secondary, infertility brings a substantial emotional toll and critically impacts the mental health of a woman trying to conceive, further exacerbating the process. Research published in Cureus suggests that counseling, psychotherapy, and talk therapy are paramount in treating secondary infertility. Therapy can significantly reduce depression, anxiety, and related psychological problems, thereby increasing the possibility of successful conception.

While secondary infertility is typically associated with women, the Fertility Hub indicates that men are just as susceptible to experiencing infertility as their female partners, as one-third of all secondary infertility cases originate from men.

The causes of secondary infertility in men typically fall under one of two categories: varicocele and decreased testosterone levels. Varicocele refers to the enlargement of the veins in a male's scrotum, the sac encasing the sperm-producing testicles. As these veins become bigger, they cause blood pooling which overheats and weakens the sperm cells leading to infertility.

Decreased testosterone levels are responsible for the majority of cases of secondary infertility in men. As a male's levels of testosterone drop, sperm production decreases as well, resulting in infertility. Several factors may lead to reduced levels of the male sex hormone. The Urology Care Foundation cites aging, injury to the testicles, chemotherapy and radiation, pituitary gland disease, infection, and autoimmune disease as the primary reasons affecting a man's testosterone production.

UCLA Health indicates that surgery can reverse the effects of varicocele on infertility. Deemed a routine procedure, the surgery is carried out on an outpatient basis and involves tying off the enlarged vein to allow normal blood flow to reach the other veins. Typically 50% of men receiving varicocele treatment can father a child within a year. Moreover, research published in Heliyon shows that pregnancy success rates increase after varicocele surgery, despite sperm count and quality.

Fortunately, treating secondary infertility due to decreased testosterone levels and sperm quality is feasible. According to the Fertility Hub, returning to a healthier lifestyle and avoiding smoking and drug and alcohol use can restore a man's testosterone levels to normal. In addition, staying physically active and losing excess weight can improve both the quantity and the quality of sperm production.

Secondary infertility can be emotionally taxing, and unlike primary fertility, many couples do not receive the support or understanding they crave. In addition, social stigma, guilt, stress, and disappointment can adversely affect mental health, leading to a mental breakdown. However, there are ways to combat secondary infertility. Identifying the exact causes and receiving the emotional and psychological support needed, together with appropriate treatment, can help a couple conceive another child.

If you or someone you know is struggling with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.