What is Secondary Infertility? 

The joy of having a second child doesn’t happen as expected in some couples. The reason could be secondary infertility. Many may not even know what secondary infertility is, and the truth of not being able to conceive again can be unacceptable and devastating. The inability to conceive for the second time though you had conceived earlier without any difficulty is secondary infertility. Many couples don’t speak about this as they feel that they may eventually conceive naturally.

When should you meet a fertility specialist?

Age assumes a significant role in the management of infertility. In spite of trying for pregnancy for more than a year in a woman below 35 yrs and more than 6 months in a woman above 35 yrs, it’s time to meet the fertility specialist. Women’s fertility potential decreases with age; many studies point out that egg quantity and quality in females start to decline from their 30s. Hence it is important to consult a fertility specialist without unnecessary delay.

Women with a history of irregular cycles, very short/ prolonged cycles, coexisting medical disorders like hypertension, Diabetes Mellitus, hypothyroidism, autoimmune disorders, etc., and also who had difficulty in conceiving the first cycle should meet the fertility specialist early. Detailed evaluation and risk correction go a long way in the successful management of secondary infertility.

Diagnosis of Secondary Infertility:

• Blood tests – Reproductive hormones, thyroid hormones, and prolactin levels
• Ultrasound- Helps to detect evidence of ovulation, presence of uterine anomalies, fibroids, endometriosis, etc., and also to check for ovarian reserve
• Hysterosalpingography – This can be used to check the tubal patency (the condition of the fallopian tube and uterine cavity)
• Hysteroscopy- Done if there is the presence of polyps, uterine septum, etc.
• Laparoscopy – According to research, if the woman has a history of pelvic inflammatory disease or a previous ectopic pregnancy, then laparoscopy is the best method to evaluate for secondary infertility
• Simultaneous evaluation and management of the male factor is also necessary for a successful outcome

Causes of Secondary Infertility in Women

• Advanced maternal age

This could be the major reason as women’s fertility declines after 30 and there could be chromosomal abnormalities in the egg/embryo that might cause miscarriage and hamper conception.

• Endometriosis:

When the uterine layer (endometrium) grows on other areas like ovaries, peritoneum, etc. it is said to be endometriosis. Endometriosis leading to ovarian cysts and tubal pathology might be the cause of secondary infertility.

• PCOS:

One can become symptomatic with this condition at any time in life which can happen due to excess weight gain, consumption of junk foods, and a sedentary lifestyle. All these factors could affect the hormonal balance in a woman leading to PCOS. Not all women with PCOS suffer from infertility. But it is essential to manage PCOS symptoms by way of proper diet, exercise, medications, and lifestyle changes that can enable conception.

• C-section scar:

Previous C-section delivery may result in scars in the uterus that could hamper implantation.

• Uterine issues:

Structural problems in the uterus from birth (ex: Unicornuate uterus, septate uterus, etc.) fibroids, or polyps can affect fertility.

• Autoimmune disorders:

In an autoimmune disorder, one’s body system starts attacking its own healthy cells, which can result in infertility. According to studies, autoimmunity can lead to ovarian/testicular failure, pregnancy loss, etc.

• Blockage in the fallopian tube:

Blocked fallopian tubes post a previous pregnancy can be due to certain infections like Chlamydia, Gonorrhea, etc. Pelvic inflammatory diseases developing post-delivery or uterine instrumentation like post-D&C etc. can cause partial or complete damage to fallopian tubes resulting in infertility, ectopic pregnancy, etc.

• Lifestyle factors like sedentary habits, smoking, and alcohol consumption can also lead to secondary infertility.
• Obesity can also delay conception and cause miscarriage as well by affecting the quality of the oocytes and hormonal imbalance.

Treatment for secondary infertility (Female)

Assisted Reproductive Technologies like IUI, IVF, etc. are available to overcome secondary infertility.

• IUI/Intrauterine Insemination is used to improve the chance of pregnancy by placing the sperm into the woman’s uterus.
• IVF/In Vitro Fertilization – Here the female partner is given injections to stimulate the production of multiple eggs and these eggs are retrieved after maturation and allowed to fuse with sperms collected from the male partner. In this procedure, fertilization occurs outside the woman’s body and the embryo thus formed is implanted into the woman’s uterus for further growth.
• Fibroids, polyps, and other uterine issues can be corrected through surgery.

Causes of Secondary Infertility in Men

• Genital infections
• Diabetes
• Varicocele
• Tuberculosis
• Lifestyle factors
• Weight gain

Treatment of Secondary Infertility (Male)

Correction of medical conditions can help to improve semen parameters. In the case of men who have low sperm count, advanced sperm retrieval techniques like TESA, and Micro-TESE can be used to retrieve sperm directly from the testes. Healthy sperms can be separated from low-quality sperms by the use of techniques like MACS & Microfluidics.

Lifestyle modifications like having a healthy diet, doing exercise regularly, and quitting smoking and alcohol will improve sperm count and increase the chance of conception.

Important tips:

• If you are unable to get pregnant the second time, don’t delay consultation. The earlier the intervention, the better the results. Don’t forget that fertility decreases with age
• Have a check on your weight
• Avoid junk foods
• Exercise regularly
• If your periods get skipped regularly, consult a specialist if you are trying to conceive
• Get your hormone levels checked if you are above 30
• Go for Karyotyping (Genetic Testing) if there is history of abortions / still births etc.

The biological clock cannot be rewound. Don’t delay! Happy Parenthood!