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Secondary Infertility

Infertility

Dr. Suman

Sep 21, 2021

Your first pregnancy was a piece of cake. But now, you are unable to conceive your second child, which is called secondary infertility. It is common. Infertility affects almost 1 in every 8 couples. Secondary infertility constitutes 50 % of those infertility cases. We know it is difficult to understand such things, especially when the first pregnancy involved no fertility issues. Here, we will discuss about secondary infertility. Its causes in man and woman, its symptoms, treatment and other ways of getting pregnant. 

What is Secondary Infertility?

So, what is secondary infertility? You already have a child from a previous successful pregnancy. But now, you are unable to conceive or successfully carry full- term a second child. This is secondary infertility. In this, the previous pregnancy must not be with help of fertility medication or treatment. 

Secondary infertility can be traced to any or both of the partners. One-third of the cases stem from fertility issues with the female partner. Another one-third from the male partner. The rest can be a combination of fertility issues from both. The reasons can be similar to that of primary infertility. Let us first find out the causes of secondary infertility in women. 

Causes of Secondary Infertility in Female

For women, age plays a crucial factor. With age, the fertility of women also decreases. The reason is that the quality and quantity of the eggs depreciates. Some of the other factors could be: –

  • Problems with quality and quantity of the egg– Apart from age, autoimmune or genetic conditions and prior surgery or radiation can decrease the number of good quality eggs. 
  • Problems with the uterus or fallopian tube– Fallopian tube and the uterus are important parts of the female reproductive system. When there is a problem with these organs, it can cause infertility. Conditions like endometriosis, uterine fibroids, etc. can affect the uterus or the fallopian tube. 
  • Weight gain- Weight gain can cause some issues in the ovaries. Also, hormonal shifts are seen in women who are overweight or obese. These changes can disrupt the menstrual cycle as well. 
  • Infections- Infections in the pelvic area or sexually transmitted diseases can even cause infertility. 
  • Polycystic Ovary Syndrome- PCOS causes hormonal imbalance. This in turn can cause weight gain, irregular periods, and infertility. 
  • C- Section scarring- If you had the previous birth through the cesarean method, the possibility is there of scarring in the uterus. 20% of the women who gave birth through c-section suffers from it. This can cause inflammation, thus impacting the implantation of the embryo. 
  • Lifestyle factors- Drinking, smoking or not having a healthy balanced diet and regular exercise. All these or anyone can be the reason for infertility. 

We have seen the causes of female secondary infertility. We will now find out what are the causes of secondary infertility in men. 

Causes of Secondary Infertility in Male

In men also age plays a crucial factor. With age, the man’s sperm quality deteriorates. Other possible reasons are: –

  • Varicocele- Due to distended veins there is abnormal swelling in the scrotum. The swelling also increases the temperature in the testicles. This kills the sperms or decreases the count of healthy ones. 
  • Infection- Sperm count gets affected even by infections like tuberculosis, sexually transmitted diseases, mumps, etc.
  • Certain medications and drugs- Medicines like colchicine, calcium channel blockers, cytotoxic agents, etc. can cause harm to male fertility. 
  • Surgery or injury- Surgery like the genitourinary tract surgery or any other surgery near the pelvic region can cause infertility. 
  • Radiotherapy or chemotherapy- If you had any tumor near in the prostrate or the testicles which needed radio or chemotherapy, then that could also be the reason. 
  • Lifestyle issues- Consumption of alcohol, prohibited drugs and smoking can also be the contributing factors. Even weight gain can be an obstruction. 

But, wait! How would you know that you are having secondary infertility? Even with these causes or not, it was easy for the first pregnancy. Right? The next section will say when should you be concerned and consult the doctor. 

Symptoms of Secondary Infertility

The two evident symptoms of secondary infertility could be: –

  • The female partner is under 35 years old and the couple have been having unprotected sex for one year. Or, is older than 35 years and have been trying for six months. But still, is unable to conceive. Or, 
  • You are conceiving your second child but unable to carry it full term. 

If the causes are true for you. Plus, you have these signs mentioned above. Contact the doctor immediately. Early evaluation is very necessary for having varied treatment options. Also, early diagnosis will increase your chances of getting pregnant. Let us see how the investigations of secondary infertility begin.  

Diagnosis of Secondary Infertility

At first, the doctor will evaluate your medical history. It will help them find out what has changed since the first pregnancy. The doctor will then suggest tests. These tests are the same as for primary infertility. 

The tests could be: –

  • Semen analysis- to check the sperm count and quality.
  • Hormone test- for both man and woman. It would indicate any hormonal issues. 
  • Genetic test- to determine any genetic defect
  • X-ray of the uterus
  • Imaging test- is an ultrasound of the pelvic region.
  • Laparoscopy
  • Hysteroscopy
  • Ovarian reserve testing- it is done to check the quality and quantity of eggs needed for ovulation. 
  • Testicular biopsy

Once you are done with the diagnosis, the next step would be the treatment. In the diagnosis, you will be able to find out which of the partner is facing fertility issues. So, how to treat secondary infertility? We will know it in the next part. 

Treatment of Secondary Infertility 

The treatment is the same as it is for any infertility. The three treatment options are- medication, surgery and assisted reproductive options. We will discuss later in detail about ART. 

Medications are used to bring the hormonal level in control. Medicines like clomiphene or Clomid and letrozole is used to induce ovulation in women who have issues in ovulation. For men, antioxidant treatment is given which improves the quality of semen. Also, other hormonal therapies are done. 

Surgery is an option when there is any tumor in the ovaries or on the fallopian tube. It can remove scar tissue, polyps, fibroids from the uterus. In man, surgery is done when there is any obstruction on the male reproductive tract.

But even after medication or surgery, you are not able to conceive. Then what? Will your dream of having a second child never be fulfilled? No, your dream of having a second child will be fulfilled. Want to know how? See the next section. 

Getting Pregnant with Secondary Infertility

The best treatment option available for this type of infertility is assisted reproductive techniques. Some of the common and most successful options are: –

  1. In-vitro fertilization (IVF)- In IVF, the sperm, as well as the egg, are collected. They are fertilized in the lab. After fertilization, an embryo is formed. This embryo is then placed in the uterus of the mother. This process is very useful when there is a problem with the fallopian tube or obstruction in the way of the egg to the uterus. 
  2. Intra-uterine insemination- In this, the sperm is collected and placed in the uterus of the mother during the time of ovulation. 
  3. Surrogacy- When there is a problem in the uterus itself, one can consider surrogacy. In this, the sperm and egg are collected and an embryo is formed outside in a lab. Then the embryo is then placed in the uterus of a woman other than the mother. 

No matter what, but with these methods your chances of getting pregnant increase by a greater number. 

Conclusion

To conclude it all, you now know what issue you might be facing. Secondary infertility has more or less the same causes, diagnosis and treatment as primary infertility. Either or both the parent’s fertility issue can cause secondary infertility. Age and lifestyle issue plays a crucial role for both. When diagnosed with secondary infertility, the treatment options include medication, surgery or other reproductive techniques. 

Suggestion

We know that secondary infertility is more emotionally draining. It can take a toll on the mental health of the parents. So, seek help for mental health, if needed. Also, focus on getting healthy and finding support from your near and dear ones. Don’t take a lot of stress about it. Your wish of getting a baby will still be fulfilled through ART treatment. Sometimes there can be confusion related to ART. But here, at Fertility Zilla, we will clear all your doubts. Feel free to contact us at contact@fertilityzilla.com or +91 8882067985. We provide the best IVF treatment in India. 

FAQs

What are the causes of secondary infertility in men?

The possible reasons are low quality and quantity sperm, testicular problems, surgery, radiotherapy, and lifestyle issues. 

Is there any treatment for secondary infertility after having a child?

Yes, the treatment is the same as that of primary infertility. The treatment includes medication, surgery and/or assisted reproductive technique. 

When do you know have secondary infertility?

You had a healthy first pregnancy. Now you are trying for conceiving the second time. When the female partner is of 35 years or less and you are having unprotected sex for one year. Or, when the female partner is of 35 years and above and having unprotected sex for six months. In these two cases, you are unable to conceive, then it is this case. Other signs can be that you are unable to carry the pregnancy for full-term. 

Can a cesarean section cause secondary infertility?

Yes. In 20% of women who undergo c-section can suffer from it. The reason being the scar from the c-section can act as an adhesive in the uterus. This affects the implantation of the embryo in the uterus. 

References

  1. https://my.clevelandclinic.org/health/diseases/21139-secondary-infertility.
  2. https://flo.health/getting-pregnant/trouble-conceiving/fertility-problems/secondary-infertility.
  3. https://oladoc.com/health-zone/what-causes-secondary-infertility/.
  4. https://www.mayoclinic.org/diseases-conditions/infertility/expert-answers/secondary-infertility/faq-20058272#:~:text=Secondary%20infertility%20might%20be%20caused%20by%3A%20Impaired%20sperm,as%20age%2C%20weight%20and%20use%20of%20certain%20medications
  5. https://www.verywellfamily.com/what-is-secondary-infertility-1959932.
  6. https://www.healthline.com/health/infertility/secondary-infertility#treatment.
  7. https://blog.pregistry.com/secondary-infertility-a-common-and-emotional-diagnosis/
  8. https://parenting.firstcry.com/articles/secondary-infertility-what-it-is-and-how-to-deal-with-it/?ref=interlink
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