You may be well-versed in a number of medical issues, but chances are you’ve never heard of “secondary infertility.” It’s the failure to confirm a clinical pregnancy after a prior pregnancy, regardless of whether or not the baby was born alive. The prior pregnancy has to be natural, i.e without the assistance of fertility treatments such as IVF or IUI treatment for pregnancy. Secondary infertility affects almost three million couples, more than twice the amount in 1995. It also accounts for about one-third of all fertility specialist visits.
In certain respects, secondary infertility is close to primary infertility, which occurs when a couple has been unable to conceive after a year of normal intercourse without utilizing birth control.
What is The Meaning of Secondary Infertility?
The failure to conceive a child or bring a pregnancy to term after having previously given birth is known as secondary infertility. The previous birth would have to have occurred without the use of fertility drugs or procedures, such as in-vitro fertilization, to be classified as secondary infertility. Secondary infertility is usually diagnosed after six months to a year of failed attempts to conceive. Recurrent pregnancy loss is a condition in which patients and partners are able to conceive but are unable to bring the pregnancy to term.
What is The Difference Between Secondary Infertility and Primary Infertility?
After 12 months or more of repeated unprotected sexual intercourse, infertility is described as the inability to achieve a natural pregnancy. Infertility is a shocking misfortune for many couples, leading to significant physical, social, psychological, and sexual instability in their lives.
According to the World Health Organization (WHO), primary infertility refers to a woman’s inability to conceive after she has never conceived, whereas secondary infertility refers to a couple’s inability to conceive after at least one effective pregnancy.
Infertility can be caused by problems with either the male or female reproductive systems or both partners’ reproductive systems. Several factors can sabotage the fertility process at any stage. Polycystic ovary syndrome, hormonal abnormalities, premature ovarian failure, genital infections, endometriosis, fallopian tube obstruction, congenital uterine defects, uterine synechiae, and other medical problems, for example, can all contribute to female infertility (diabetes and thyroid disorders).
Male infertility, on the other hand, is caused by hormonal imbalances and sperm defects. Infertility can also be caused by a couple’s age, occupation, and socioeconomic status.
Is Secondary Infertility a Normal Occurrence?
Infertility caused by secondary causes is just as normal as infertility caused by primary causes.
Is it the Woman Or The Man Who is Responsible For Secondary Infertility?
Secondary infertility may be attributed to one or both spouses. Around one-third of cases are caused by women, while the other one-third is caused by men. In the remaining one-third of cases, the cause is unknown or a combination of factors. Secondary infertility in women and men may be caused by advancing age, complications from a previous pregnancy or procedure, increased weight, drugs, sexually transmitted infections, decreased sperm output, alcohol abuse, and smoking.
What Are The Causes of Women’s Secondary Infertility?
Secondary infertility in women can be caused by a variety of factors, including:
Problems With Egg Quantity or quality
Women are born with a finite number of eggs and are unable to produce more after giving birth. The number of eggs left in a woman’s ovaries decreases as she approaches her 40s and beyond, and the remaining eggs are more likely to have chromosomal issues. Other explanations for a low number of high-quality eggs in women who aren’t concerned about their age include autoimmune or genetic disorders, as well as previous surgery or radiation.
Problems With The Fallopian Tubes
Endometriosis, as well as other scar tissue or adhesions, can cause a blocked fallopian tube. Pelvic infections like chlamydia or gonorrhea can also block the fallopian tubes, which bring eggs from the ovaries to the uterus.
In that case, the egg would not be able to enter the uterus to be fertilized. The blockage is usually removed by laparoscopic surgery.
A hysterosalpingogram is a test that involves injecting a dye up through the cervix and out the fallopian tubes to see if your tubes are blocked or accessible. The technique can also aid in the opening of the tubes.
Problems With The Uterus
There are a variety of uterine disorders that can lead to secondary infertility. During a dilation and curettage (D&C) or Cesarean delivery, scarring can form within the uterus, causing adhesions that can interfere with subsequent pregnancies. Fibroids or polyps are benign (non-cancerous) growths that can interfere with pregnancy, that is why IUI treatment for pregnancy may be prescribed as a solution. Infection and uterine scarring may result from a retained placenta.
Endometriosis
A disease in which endometrial tissue that should be developing within the uterus often develops outside of it on the ovaries, fallopian tubes, and other parts of the pelvic cavity—is not only painful, but it may also make it difficult to conceive. When the tissue breaks down each month but cannot be drained from the body, it causes inflammation and discomfort, and over time, it may cause scar tissue and adhesions that affect fertility, such as a tubal blockage.
If you have endometriosis, becoming pregnant spontaneously isn’t difficult, but it can be very painful during cycles and sex. Endometrial tissue may be surgically removed, but you will need to employ IVF or IUI treatment for pregnancy. If you have endometriosis, the doctor will help you with this.
Although endometriosis is normal, it does not always result in infertility.
Polycystic Ovary Syndrome
is a hormonal condition marked by abnormally long or infrequent menstrual cycles. A woman with this disorder has an abundance of male hormones in her body, and her ovaries don’t release eggs on a regular basis.
Breastfeeding
If a woman just breastfeeds her son, her body will avoid ovulating or releasing eggs for fertilization.
Weight gain or other lifestyle changes: In some patients, weight gain can lead to ovary dysfunction. Certain diets can have an effect on fertility. Medications may also have an effect on fertility.
C-Section
If you had a cesarean (C-section) or had uterus adhesions or pelvic scarring after the birth of your previous child, it will be difficult to have a successful second pregnancy, in such a situation the doctor may recommend IVF or IUI treatment for pregnancy. The scarred tissues will have an effect on the fertilization process in the future.
It’s common for scar tissue to form after a cesarean section. Internal scarring from a C-section will occasionally cause obstructions and inflammation in the abdomen and reproductive organs, which can make potential pregnancies impossible.
C-sections are linked to a number of other complications that may affect fertility in the future. The following are some examples of complications that can occur following a cesarean section:
- Infections inside the body
- Surgery-related hemorrhages
- Non-reproductive organ damage
- Fallopian tubes that are blocked or damaged
Age
We understand that this is a sensitive topic, but there is no way to avoid it. According to science, age does play a role in fertility. One of the most popular causes is age-related problems. This most certainly explains some of the rises in numbers, as women are delaying having children for longer. They could have trouble getting pregnant again if they have their first child in their thirties and expect to have a second child a few years later. Fertility rates drop dramatically as a woman gets older, and becoming pregnant after the age of 35 is more difficult.
Many women and men are unaware of how much their fertility decreases as they age, and are lulled into a false sense of security by media reports implying that much older women are giving birth. What the media fails to report is that these women are not getting pregnant naturally, they can do so with the help of IVF or IUI treatment for pregnancy.
Women’s fertility peaks around the age of 20 and starts to decline around the age of 30 — with a major decrease by the age of 40. This isn’t to suggest that a healthy pregnancy can’t occur at a later stage in a woman’s life. It can simply take longer or be more difficult. Even if no issues arise, growing older is often linked to a decline in egg quality or quantity. All of these factors may play a role in women’s secondary infertility.
What Are The Causes Of Men’s Secondary Infertility?
Secondary infertility is often caused by a combination of factors. Men can play a role in secondary infertility, just as they do in primary infertility. In fact, in about 25% of infertility cases, male infertility is the primary medical problem. Another 25% of the time, it is a contributing factor.
A low sperm count is a significant cause of male infertility, accounting for around half of all cases. Male infertility is caused by a combination of low sperm count, poor sperm content, or both in up to 90% of cases.
Quality, Quantity, Or Distribution Of Sperm
A drop in sperm production, quantity, or distribution may have a variety of causes. Sperm quality deteriorates with age, but at a slower rate than egg quality deterioration in women. When the man and his female partner are both older, this is a significant factor in secondary infertility. There are many conditions that are linked to sperm quality and quantity and they are:
Oligospermia
It is a disorder that occurs when the partner’s sperm count is less than 15 million per millilitre. In this scenario, the procedure entails removing healthy sperm from the sperm sample and conducting ICSI for fertilization.
Teratospermia
It is a disorder in which sperm have an irregular form that prevents them from reaching and penetrating an egg. The solution is to classify sperm with good morphology in the lab, and if the percentage of irregular sperms is too high, ICSI could be the best treatment choice.
Asthenospermia
It refers to sperm motility issues. The sperm’s movement is hampered by a lack of motility, and the sperm’s ability to swim to the egg for fertilization is reduced. Again, the best treatment would be to find sperm with strong motility in the laboratory.
Azoospermia
It is a disorder in which the testes are completely devoid of sperm. In this case, doctors will perform a testes biopsy (TESA) to check for the presence of sperm.
Elevated Temperature
Low sperm count has been linked to increased temperature exposure around the testicles. For optimal sperm function, the groyne area should be a couple of degrees cooler than the rest of the body.
Per degree above average is associated with a 40% reduction in sperm content. Excessive heat exposure may occur as a result of a job (e.g., hot room, long periods of sitting), too much time in a hot tub, or even placing your laptop in your lap for extended periods of time.
Chronic Illness
Sperm may be harmed by chronic disease. Thyroid disease lowers testosterone, which has an effect on sperm development. Importantly, a woman’s secondary infertility can be linked to a new male partner who may have issues that the first partner did not, such as chromosomal damage from a genetic condition.
Other Variety of Factors
Other common causes of primary male infertility that can lead to secondary infertility, in addition to advanced age, include:
- A varicocele is a type of varicose vein (a distended vein around the testes).
- Infections spread by sexual contact that cause epididymitis or other forms of inflammation that impair sperm function.
- Environmental and lifestyle factors.
- Stress.
- Obesity or being overweight.
- Consumption of alcoholic beverages or hard drugs.
- Exposure to certain chemicals.
What Are The Signs And Symptoms Of Secondary Infertility?
Secondary infertility may be suspected if a man and woman aged 35 or younger have had unprotected sex for at least 12 months (or six months if older than 35) without becoming pregnant. This is particularly true for men with low sperm counts and women over 30 who have had pelvic inflammatory disorders, painful periods, irregular menstrual cycles, or miscarriages.
Secondary infertility is often caused by a combination of factors. Furthermore, the issue may be the fault of one or both partners. As a result, a thorough but efficient diagnosis of the condition is needed.
To evaluate the best care, a detailed review is needed to identify the causal factors. This covers your current health, medical history, and, in particular, any medical events, health, or life changes that have occurred since your previous pregnancy. It is also to be noted if the first successful pregnancy was natural or through IVF or IUI treatment for pregnancy. In terms of practicality, the investigation and workup of primary and secondary infertility are almost identical.
When A Couple Suspects Secondary Infertility, What Should They Do?
Schedule an appointment with a women’s health provider, a reproductive endocrinologist, or a urologist if you suspect secondary infertility. Don’t wait any longer. To ensure the widest range of treatment choices, early diagnosis is crucial.
If something has changed since your last pregnancy, your doctor will check your medical history. The doctor may want to know whether you’ve had some abnormal menstrual cycles and whether you’re ovulating and generating eggs normally. A medical history will reveal whether thyroid disease, cancer, or age-related disorders have impacted sperm count or quality in men.
The doctor and the couple will talk about the various tests that may be done. A hysterosalpingogram, or HSG, for example, would show scarring or defects in the uterus. A semen examination can also be ordered by the doctor.
When Do You Seek Medical Advice From A Specialist?
If you have repeated sexual intercourse without being pregnant and are 35 or younger, you should see a fertility doctor after a year, according to recommendations. If you are over the age of 35, you can seek medical attention after six months. If you’re over 40, wait three months before looking for someone.
If you have any of the following symptoms, you can see your gynecologist or a fertility specialist right away:
- Menstrual periods that are abnormal
- Hormone issues causing excessive bleeding
- Fibroids
- Pelvic adhesions
- Sperm issues
- Trouble having intercourse
- Some other health issues
While it may be premature to begin fertility treatment, it is important to understand the condition and what can be done so that you can take control of your health.
What are the choices for treating secondary infertility?
Treatment for secondary infertility is based on the assessment of test results and the prognosis for various therapies, just as it is for primary infertility. If a woman is having trouble ovulating, she may be prescribed oral “fertility pills” to aid in the production of normal ovulation and/or more eggs.
If there are problems with the fallopian tubes, such as scarring or blockages, surgery may be recommended, or IUI treatment for pregnancy may be the best option. Depending on the nature of the condition, surgical removal of endometriosis lesions can result in pregnancy rates ranging from 20% to 80%. For serious endometriosis, severe tubal injury, or pelvic adhesions, IUI treatment for pregnancy may be recommended.
If egg donors are an acceptable choice for older patients or those with reduced ovarian reserve, where the quality and quantity of eggs has declined, they may use them. If a gestational carrier6 is an appropriate choice for them, women with serious uterine conditions such as scarring or a congenital abnormality can start a family with another woman carrying the implanted embryo.
Intrauterine insemination IUI treatment for pregnancy or IVF may be prescribed for male factor issues such as low sperm production, erectile dysfunction, or other physiological issues. Where a vasectomy has been performed previously, a vasovasostomy or partial reversal (reuniting the ends of the sperm ducts) may be a viable alternative. If a sperm donor with frozen sperm is an acceptable choice in cases where there are no sperm, it can be very good. Adoption can also be a very good option for all couples.
