Secondary Infertility: I already have a child, so why can’t I fall pregnant again?
Dr Hossam Elzeiny | 20th Jan 2015
You already have a happy, healthy toddler, and you’ve been trying for more than six months to give them a sibling – but nothing is happening. Having had a child already is a key promising predictive factor to conceiving again, but it’s no guarantee.
You may not have heard the term ‘secondary infertility’ but unfortunately you may be familiar with the struggle to conceive a second child. You’re not alone as this is an increasingly common situation for many couples.
If you feel your family isn’t complete yet, secondary infertility can be just as emotionally challenging as any other fertility issue. You may feel guilty that you can't provide a brother or sister for your child, or a sense of loss that your family isn’t quite what you had planned.
It can also be quite isolating when all your friends – including your mother’s group and playground network – are busy with baby number two, three or four.
What may be causing secondary infertility?
There are a number of factors that may contribute to the problem of conceiving again. These may be female related, male related or a combination of both factors.
Female Factors affecting fertility
Female factors that affect fertility can usually be categorised as those relating to a woman’s eggs, uterus or fallopian tubes.
A woman’s age
One of the major causes of fertility issues is the woman’s age. Whether a woman has conceived easily or not in the past, egg quantity and quality declines with age. As many women are now waiting a little longer to have their first child, by the time they try to fall pregnant again they may have a significantly lower chance of conceiving. The decline of fertility in women is greatest once you are past your mid-30s.
If you conceived your first child in your early 30s, and are trying again in your late 30s or early 40s, your chances of conceiving will have substantially decreased due to a decline in egg quality.
Having low ovarian or egg reserve means that the number of eggs you are born with is becoming very low. It may be that your first conception was a lucky one; the right egg released with the right circumstances that lead to your first pregnancy. Low ovarian reserve is further compounded with age which leads to both the quality and quantity of eggs being compromised.
Quite often women have conditions that affect ovulation such as Polycystic Ovarian Syndrome (PCOS). In these sorts of cases, becoming pregnant might have been easier the first time, despite having long or irregular cycles that makes it difficult to pinpoint the time of ovulation.
Also, if you gained weight after your first pregnancy this may make it difficult to conceive. Excessive weight gain can lead to ovulation dysfunction in women and affect sperm production in men. A healthy diet and regular moderate exercise three times a week can have a positive impact on your chances of conceiving.
Pelvic adhesions, or scar tissue, which may be caused by endometriosis or prior abdominal surgery (including a caesarean birth) can affect the proper function of the fallopian tube or release factors that can negatively affect egg quality, fertilisation and implantation. You may also have developed a polyp, which is a benign growth attached to the lining of the uterus which can also prevent implantation. Fibroids and scarring in the inside of the uterus would also have the same impact.
There might be a blockage in the fallopian tubes where the egg meets with the sperm ready for fertilisation. A blockage may result from scarring as a result of previous surgery, pelvic infection or other causes like endometriosis. The blockage could be at the level of the tubal openings to the uterus, or at the distal ends of the tubes. This can lead to a build-up of toxic fluid inside the tubes called Hydrosalpinx that can negatively affect the implantation of the embryo.
Male Factors affecting Fertility
A man’s fertility can change over time, and health issues or medications can affect sperm quality or quantity. Even if you are with the same partner, male factors contributing to infertility must be investigated with a semen analysis. If you’re seeing a fertility specialist they will order this test or you can visit your local GP for a referral to a fertility specialist.
Life with a toddler
The everyday stress of parenthood can also be a contributing factor. Sleep deprivation, changing self-esteem or time pressures if you're juggling childcare, work and a busy household can make it slightly more challenging to have sex at the best possible times for conception.
How can we overcome secondary infertility?
There are many ways to treat secondary infertility, including simple lifestyle changes, medication to stimulate ovulation, surgery or treatment for underlying conditions such as endometriosis. In some cases, IUI (Intra Uterine Insemination) or IVF may be recommended, especially if you are of advanced maternal age.
Unfortunately, having one child is no guarantee that you can easily conceive a second time. I would recommend that you consult with your GP for a referral to a fertility specialist if you are unable to get pregnant again after six months of trying if you’re 36 or older, or one year of trying if you’re under 36.
Though diagnosis or treatment may sound daunting, seeking medical advice can make the difference, so don’t put off finding a solution that works for you.
All it takes is one appointment with a fertility specialist to feel more in control again, and get the support you need to expand your family.