Secondary Infertility: I already have a child, so why can’t I fall pregnant again?

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. 

Two children

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. 

Egg Reserve

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.

Ovulation Issues

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. 

Uterine factors

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.

Tubal Factors

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

Sperm issues

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. 

Read more about our fertility specialists: Melbourne IVF, IVFAustralia and Queensland Fertility Group



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Post mortem sperm retrieval – a matter of life and death

Further to his interview on Channel 9’s 60 minutes programme, Dr Ben Kroon of Queensland Fertility Group discusses the topic of post mortem sperm retrieval.

Thankfully for the vast majority of people, post mortem sperm retrieval will never become a reality.

It is an extremely complex and challenging area of reproductive medicine, involving retrieval of sperm after a man’s death so that it can be used by his surviving partner.

While new assisted reproductive technologies are allowing more people than ever to fall pregnant and start the family they desire, the law, at times, does not keep pace with these developments.

In Australia, the law does not specifically address the issue of retrieval and use of sperm after a man’s death. So, while a partner may be sure she knows what her partner ‘would have wanted’, without supporting legal documents explicitly stating those wishes, the question of retrieval and use of sperm is not clear.

In most cases, an urgent court order is needed to retrieve sperm. This is a problem because while the judge is coming to a decision, every hour that the sperm lies in the body after death decreases the chance of finding live sperm.

While 24 hours is the accepted time period for successful retrieval, there may still be a small chance up to 36 hours after death.  However, while retrieval might be medically successful, the court may never permit a woman to use the sperm.

I co-authored a paper, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, in which we surveyed 28 IVF clinics across Australasia to test attitudes towards posthumous sperm retrieval and use.

It appears that directors of IVF units are generally supportive of the practice, given the right circumstances, but that the lack of clear laws makes the response to requests for sperm retrieval very difficult.

Myself, and the papers co-authors, believe that ‘clear, accessible and consistent law in this area would benefit everyone involved, including the medical, legal and societal stakeholders’.

It is not only the law that needs to catch up. In the same way that people discuss organ donation, I believe that couples should discuss post mortem sperm use.

Men should consider and discuss with their partners whether they would want to father a child after their death, bearing in mind that they could not raise the child, and that the child could conceivably be raised by another man.

I need to be clear that I am not suggesting that more people should have their sperm collected and used after their death.

Personally, I wouldn’t want my sperm to be retrieved and used if I died suddenly, and my wife knows this. But, if couples don’t have the discussion and document their wishes, it is seldom clear what one would have wanted if one dies.

Have you considered discussing post mortem sperm retrieval with your partner?

Children of IVF parents as healthy as those conceived spontaneously

In 2007 a local Melbourne paediatrician approached me curious about whether girls conceived through In-Vitro Fertilisation (IVF) and other Assisted Reproductive Treatments (ART) enter puberty earlier than those conceived spontaneously. With the first babies born through IVF now reaching their mid-30s, this query was my early motivation and the catalyst to initiate a study on the effects of IVF and ART on the health and wellbeing of children conceived through these technologies.

How healthy are IVF children?

This project was the largest of its kind ever attempted, worldwide.

We found that children conceived by IVF grew into healthy, normal adults when compared to children conceived spontaneously.

The collaborative study initially funded by Melbourne IVF prior to a National Health and Medical Research Council (NHMRC) grant involved researchers from Murdoch Children’s Research Institute, Monash IVF, the University of Melbourne and Monash University. Interviewing 656 mothers who used ART and their 547 young adult offspring aged between 18 and 29 years, and compared this to reports from 868 mothers and their 549 young adult offspring who were conceived spontaneously.

Self-report of their health and wellbeing for the first 18 years of life found the ART children had a normal body mass index and similar history of pubertal development to those spontaneously conceived. Educational outcomes, including tertiary admission ranked scores and completion of tertiary education, were also similar.

Were there differences in the health of IVF-conceived children?

Mothers did report a higher rate of hospitalisation, as well as a higher rate of asthma and hay fever in ART children. We found this to be in line with what we already know as a common mild condition in the whole community. The rate is not much higher at 23% of spontaneously conceived children experiencing allergies, compared to 30% of ART children.

These problems are more common in premature babies and we know a higher proportion of ART babies are born prematurely for reasons still largely unknown. Premature births may be because of the age of IVF mothers, as having a baby in your early 40s is generally harder than having a baby in your late 20s or early 30s.

ART parents might take their children to the GP more often and consequently they are diagnosed at a higher rate. We found ourselves speculating if parents of IVF-conceived children are more protective reducing their baby’s exposure to dust and dirt in turn increasing their risk factor for later allergies.

The finding of increased hospitalisations, including in the secondary school years, has not been examined in other studies to date and the reasons for hospitalisation varied, with no consistent set of conditions. Again, we wonder if this is due to parental vigilance.

What will be done to investigate further?

This study fills an important gap in our knowledge about the long term health outcomes of children conceived via IVF and ART. Our results indicate that the perceived physical, mental health, social and environmental quality of life reported by the 547 ART-conceived adults is very similar to that of their non-ART conceived peers.

We have a responsibility to continue this research and gather further clinical review in long term follow up of those conceived through IVF and other ART. Further research will evaluate their health status and follow up to determine if there are any important lifelong medical or other legacies of IVF.

What does this mean for those considering IVF?

This study provides reassurance to those requiring IVF that there are no apparent substantial negative long term health and wellbeing effects on young adults compared to those spontaneously conceived.

This study is published in Fertility and Sterility. 

Learn more about IVF in Queensland, Victoria and New South Wales.


15 years of IVF patients – how have women changed?

The media is increasingly full of stories showcasing the latest 50 year old mum, or the celebrity who has undergone IVF. Even women who have used donor eggs are increasingly more comfortable discussing their medical history.

But, do these sensationalised stories really reflect the changing face of the IVF patient we see every day at our fertility clinic?

At Queensland Fertility Group Toowoomba we decided to assess the reality of these changes. In order to do this we conducted a retrospective study of 1587 women who had undergone IVF between 1998 and 2013 at our clinic in Toowoomba (based in the Darling Downs, west of Brisbane). We know that during this time there has been considerable social change, and we were interested to see how our patients may correspondingly have changed during this 15 year period.

Older women

Studies carried out by the Australian Institute of Health and Welfare informs us that the average age of women receiving treatment using their own eggs or embryos, is 36 years. We know too that over the last 20 years the average age of women giving birth has increased by 7.5%.

What did our study of 1,587 women show? The average age of women undergoing IVF treatment in Toowoomba has significantly increased by 6% - from 33 years in 1998 to 35 years in 2013.  Interestingly, the major shift has been the marked increase in the number of women aged over 39 completing treatment - which 15 years ago was just 3% and by 2013 had grown to 18%.

Rising obesity

The number of overweight and obese Australians has been gradually increasing for the past 30 years across all demographics – from wealthy, metropolitan suburbs to rural and disadvantaged communities.

An Australian Bureau of Statistics Australian Health Survey identified that between 1995 and 2011/12 the average adult woman’s weight had increased by 4kgs. The report likewise stated that in 2011/12 27% of all females aged 18 and over were overweight with a Body Mass Index (BMI) of 25 to 30.

Toowoomba is no exception to this trend. It’s therefore not surprising that the average IVF patient has become heavier. Women undergoing IVF treatment in 1998 at QFG Toowoomba had an average weight of 66kgs, and this had increased up to 77kgs by 2013. More significantly, their BMI (which also takes into account their height) moved from normal at 24 to overweight at 28 in 2013.

Single Women and Same-sex Couples

Shifts have occurred in the structure of families and as a result, we have seen a considerable increase over the past five years in single and same-sex couples accessing donor sperm to start their families.

Looking at the subset of patients where female cause was the sole reason for them having treatment, the proportion of single women and same-sex couples undergoing IVF increased from 2% in 2008 to 22% in 2013.

15 years later

Women attending our fertility clinic in 2013 are significantly older, heavier and have an increased BMI than they did in 1998. However, as women delay child bearing, by choice or circumstance, we need to ensure that there isn’t an unrealistic expectation that medical science can undo the effects of age.

What would you advise?

Unfortunately, we still cannot reverse the aging process, but we can ensure women are given the correct information to help them make informed decisions earlier. For example, the increasing use of the Anti-Mullerian Hormone (AMH) test or as it's more widely known, the egg timer test, can help a Fertility Specialist better assess a woman’s fertility and guide the direction of her fertility treatment.

Many women still remain unaware of the effect of weight on their fertility. We advise weight loss with simple lifestyle changes and, if necessary, dietician support. In addition to boosting a woman’s natural fertility, this can also have a beneficial impact on pregnancy and the health of the child.

This data was presented by Leita Fien, Fertility Nurse, Toowoomba at the 5th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2014) in conjunction with the Fertility Society of Australia Annual Conference held in Brisbane April 4-6, 2014.  Leita would like to acknowledge and thank her co-authors and colleagues Susan Lax, Julie Logan, Jeremy Osborn, and Dr John Esler, Clinical Director QFG Toowoomba.

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