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 11% of couples in the United States.

In females, the most common cause of secondary infertility is polycystic ovary syndrome (PCOS). However, endometriosis, genital infections, and other conditions can also cause it. Some causes in males include hormone imbalances, aging, and ejaculation disorders.

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.

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“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 one-third of secondary infertility cases, while conditions that affect males cause another third. The remaining cases are unexplained and stem from conditions involving both partners.

Primary infertility is relatively common and affects 19% of females in the U.S. This is nearly 1 in 5 people.

Secondary infertility is less common, affecting 11%, or about 1 in 10 couples.

There is a range of causes of infertility in females. Some common causes include:

Polycystic ovary syndrome

The most common cause of female infertility, polycystic ovary syndrome (PCOS) is the inability to ovulate or ovulate regularly. Ovulation is the release of an egg and normally happens once per menstrual cycle.

PCOS affects about 10% of females of childbearing age. It can lead to the formation of cysts, or fluid-filled sacs, in the ovaries.

Learn more about PCOS.

Endometriosis

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.

Learn more about endometriosis.

Genital infections

Chlamydia and gonorrhea are sexually transmitted infections (STIs) that can cause pelvic inflammatory disease (PID), an infection of the female reproductive system. Approximately 1 in 8 females with a history of PID has difficulty getting pregnant.

Learn more about PID.

Primary ovarian insufficiency

Primary ovarian insufficiency (POI) happens when a person’s menstrual cycle becomes irregular before the age of 40. About 5–10% of people with POI conceive and have a normal pregnancy, but many people with the condition have difficulty conceiving.

The cause is often not known, but chemotherapy, radiation to the pelvis, and other conditions may cause it.

Learn more about POI.

Hormonal disorders

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 can cause a female not to ovulate.

Learn more about hormonal imbalances.

Fallopian tube obstruction

An older 2013 study notes that fallopian tube obstruction occurs in 29% of females with secondary infertility. Chlamydia can cause an infection of the fallopian tubes, which may lead to permanent damage.

Learn more about blocked fallopian tubes.

Uterine conditions

Since the uterus is essential to becoming pregnant, any condition that affects it can increase the risk of infertility. Such conditions may include:

  • fibroids, which are noncancerous tumors
  • adhesions, accumulations of scar tissue
  • adenomyosis, a condition where the lining of the uterus grows into the uterine wall
  • congenital anomalies present at birth that lead a person to have an unusual uterus

The following are conditions that can cause secondary infertility in males.

Testicular or ejaculation function disruption

A variety of factors can cause this. They include:

  • 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

Hormonal imbalances

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 can result in a low sperm count or no sperm.

Aging

Some effects of aging may lead to problems that result in male infertility. Examples include:

  • prostate enlargement
  • reduced hormone production
  • complications of advanced diabetes
  • irritable male syndrome and other conditions that affect older males

Genetic conditions

Several genetic conditions can lead to a low sperm count or no sperm. These include:

  • 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

An exam

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:

Fertility medications

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

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.

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