Secondary infertility happens when a person cannot conceive or carry to term after giving birth in the past. The cause may stem from factors involving one or both partners.
Secondary infertility affects approximately
In females, the
Treatment may include medications to improve fertility or surgery to manage an underlying condition. Doctors may also recommend assisted reproductive technology methods, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
This article explores the causes and diagnosis of secondary infertility, treatment options, and more.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
“Infertility” describes when a couple cannot conceive after having a year of unprotected sex. There are two types of infertility: primary and secondary.
Primary infertility refers to a couple who has never conceived. In contrast, secondary infertility describes a couple who is unable to conceive or carry to term after having at least one successful conception in the past.
Conditions that affect females cause approximately
Primary infertility is relatively common and affects
Secondary infertility is less common, affecting
There is a range of causes of infertility in females. Some
Polycystic ovary syndrome
PCOS affects about
In people with endometriosis, tissue similar to the uterine lining grows outside of the uterus.
Researchers do not know exactly what causes endometriosis, but we know it can impact fertility in several ways. Endometriosis can cause inflammation, which can affect the quality of the eggs. It can also cause scar tissue to form, which can distort or change the reproductive anatomy and may make it harder for the serum to reach the egg. Endometriosis can also affect implantation.
Chlamydia and gonorrhea are sexually transmitted infections (STIs) that
Primary ovarian insufficiency
Primary ovarian insufficiency (POI) happens when a person’s menstrual cycle becomes irregular before the age of 40. About
The cause is often not known, but chemotherapy, radiation to the pelvis, and other conditions may cause it.
Hormonal disorders happen when a malfunction occurs in the hypothalamus and pituitary glands in the brain. These make hormones that maintain the working of the ovaries, so issues with them can affect the reproductive system. A malfunction here
Fallopian tube obstruction
An older 2013 study notes that fallopian tube obstruction occurs in
Since the uterus is essential to becoming pregnant, any condition that affects it can increase the risk of infertility. Such conditions may
The following are conditions that can cause secondary infertility in males.
Testicular or ejaculation function disruption
A variety of factors
- trauma to the testes, which may decrease sperm production
- varicocele, a condition involving large veins within the testicle that may affect the shape and number of sperm
- lifestyle habits, such as excess alcohol consumption and smoking
- cancer treatment that involves radiation, certain types of chemotherapy, or surgery to remove one or both testes
The hypothalamus and pituitary glands produce hormones that regulate testicular function. Various conditions that affect these structures may damage them and change their hormone production. This
Some effects of aging
- prostate enlargement
- reduced hormone production
- complications of advanced diabetes
- irritable male syndrome and other conditions that affect older males
Several genetic conditions can lead to a low sperm count or no sperm. These
- Y-chromosome microdeletion, a condition that affects sperm production
- Klinefelter syndrome, a condition that causes small testicles and low testosterone production
- myotonic dystrophy, a condition where muscles progressively weaken
Most genetic causes contribute to primary infertility, but can still be a factor in secondary infertility.
Diagnosis of secondary infertility may involve the following:
A medical history
The doctor will ask for information about:
- past illnesses, STIs, and surgeries
- any previous pregnancies or deliveries
- a history of pregnancy loss
- previous breastfeeding
- current medications
- exposure to harmful drugs or chemicals
- the menstrual cycle
- damage to the testes
This may involve a pelvic exam to check the reproductive organs. It can also include:
- semen analysis to look at sperm number and characteristics
- blood tests to detect hormone insufficiency
- ultrasound to check for structural abnormalities, such as tumors, enlarged veins, or a blockage in the tube that carries the sperm out of the testes
Treatment may include:
The main treatment for females with ovulation problems involves clomiphene (Clomid) as well as injections of follicle stimulating hormone and luteinizing hormone. Clomid induces ovulation, while the injections mature eggs and induce ovulation.
Fertility medications like clomiphene and other hormonal medications may also help males with fertility issues due to hormone imbalances.
Surgery for females may remove fibroids, endometrial growths, scarring, or uterine polyps. In some cases, doctors may consider surgery to open a blocked fallopian tube.
Surgery for males may involve:
- repair of a blockage in the sperm transport system
- reversal of a vasectomy
- repair of enlarged veins in the spermatic cord, although this may not restore fertility
Assisted reproductive technology
If other treatment options do not work, people can consider conceiving with assisted reproductive technology. Some options include:
- inserting collected sperm into the uterus
- injecting a single sperm into an egg
- mixing sperm with an egg outside of the body and later placing it in the uterus
- freezing eggs
Experiencing infertility can be emotionally challenging for both partners. The National Fertility Association recommends the following coping strategies:
- encouraging family members to educate themselves about fertility and letting them know how they can help
- giving a spouse or partner permission to feel differently
- giving oneself permission to cry or grieve
- telling a spouse or partner how one would like help or support
- acquiring information about infertility to have an idea about what to expect
- joining an infertility support group
Secondary infertility refers to a couple who cannot conceive or carry to term after having at least one successful birth in the past. It is not the same as primary infertility, which refers to a couple who has never conceived.
Doctors base the diagnosis on a medical history, exams, blood tests, and, in some cases, ultrasound. Treatment depends on the cause, but a range of options is available.
Infertility can take a toll on emotions, but coping strategies, such as joining a support group, may help.
- Al Subhi, T., et al. (2013). Prevalence of tubal obstruction in the hysterosalpingogram of women with primary and secondary infertility.
- Benksim, A., et al. (2018). Difference between primary and secondary infertility in Morocco: Frequencies and associated factors.
- CDC. (n.d.).
- Coping techniques. (n.d.). https://resolve.org/get-help/helpful-resources-and-advice/managing-infertility-stress/coping-techniques/
- Katib, A. A., et al. (2014). Secondary infertility and the aging male, overview.
- Polycystic ovary syndrome. (2021).
- Reproductive infertility. (2022). https://www.endocrine.org/patient-engagement/endocrine-library/infertility