If you're struggling to get pregnant after a prior smooth fertility journey, you're not alone. Getting pregnant again isn't always filled with passionate sex and exciting pregnancy announcements. Sometimes getting pregnant again is really hard — and for some people, it's impossible.
Under the umbrella of infertility, there are two types: primary infertility and secondary infertility. "Primary infertility is used to describe those who have never been pregnant before," explains Dan Nayot, MD, an ob-gyn and the chief medical advisor at Bird&Be. If you have been pregnant before and given birth but are now having trouble conceiving, "you're considered to have secondary infertility," Dr. Nayot says.
According to Cleveland Clinic, about 11 percent of women trying for another child have trouble conceiving, making secondary infertility a pretty common occurrence. POPSUGAR talked with reproductive specialists to find out everything you need to know about secondary infertility, including why it happens, the signs and symptoms, and when to see a doctor.
What Is Secondary Infertility?
Simply put, secondary infertility is the inability to get pregnant or carry a baby to term after previously getting pregnant and giving birth without issue, says Dr. Nayot.
"To classify as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization," Cleveland Clinic states. Once a couple have been trying for six months to a year with no success after a previously successful pregnancy, a healthcare provider will consider a diagnosis of secondary infertility.
What Causes Secondary Infertility?
Everyone's fertility journey is unique, but the main causes of secondary infertility (which can be very similar to those behind primary infertility) typically stem from ovulatory dysfunction, fallopian tube disease, uterine issues, and poor egg or sperm quality, says Dr. Nayot.
That said, age is a major factor in fertility. As you get older, especially over 35 for females and over 45 for males, your quality and quantity of eggs or sperm gets lower, says Lisa Becht, MD, FACOG, a reproductive endocrinologist and fertility specialist at HRC Fertility. As a result, this can lead to difficulty getting pregnant.
Medical conditions like high blood pressure, diabetes, increased weight, and an unhealthy lifestyle (poor diet, inactivity, smoking, high alcohol consumption, and major stress) can also impact eggs and sperm and lead to secondary infertility, Dr. Becht says.
Additionally, if a previous pregnancy resulted in any complications or gynecological conditions like intrauterine scar tissue, polyps, fibroids, placenta tissue, and/or uterine surgery, this may also be the culprit of secondary infertility, adds Ashley Wiltshire, MD, a reproductive endocrinologist, infertility specialist, and ob-gyn at Columbia University Fertility Centre.
Other times, just like with primary infertility, secondary infertility can happen without explanation. According to Penn Medicine, one in five cases of secondary infertility is classified as unexplained.
How Is Secondary Infertility Diagnosed?
The inability to get pregnant is the main sign, symptom, and clinical diagnosis of infertility, says Dr. Nayot. "Infertility is defined as the inability to get pregnant after a year or more of having unprotected sex," he explains. For those older than 35, this time span shrinks to six months, adds Dr. Becht. Secondary infertility follows the same clinical diagnosis but takes into account your overall reproductive history and whether that included a previous pregnancy.
What Are the Signs of Secondary Infertility?
Most of the time there aren't any clear signs or symptoms of secondary infertility, aside from trying to get pregnant without success, but Dr. Nayot says there can be some red flags. Some of the clear ones include issues with ovulation (not having regular menstrual cycles) and the inability to have intercourse (due to erectile dysfunction or vaginismus, for example).
Tips For Dealing With Secondary Infertility
Infertility can be physically, emotionally, and mentally taxing, but there are certainly some pro tips to improve and optimise your pregnancy journey. Dr. Nayot recommends dealing with secondary infertility in two ways: education and optimization.
Education: When it comes to fertility, the earlier you talk with a doctor, the better. "Educate yourself about infertility, and don't wait to seek care if there might be a possible underlying issue," Dr. Nayot says. "If there are no clear warning signs and a year has passed without success (or six months if you're older than 35), make an appointment with a fertility doctor to investigate."
It's also important to screen for any signs or symptoms that might suggest there's an underlying issue preventing you from conceiving, says Dr. Nayot. For example, talk to your doctor immediately if you're experiencing irregular menstrual cycles, because that's a common sign you may not be ovulating regularly or at all. "Since ovulation is a prerequisite to getting pregnant, it's an issue that needs to be addressed in order to be successful," says Dr. Nayot. Other warning signs like painful periods and pain with sex also warrant a trip to the doc.
Optimization: Unfortunately, there are many fertility variables that are out of your control, like your biological age and genetics, but there are a few ways to optimise your chances of getting pregnant, says Dr. Nayot.
First, you want to quit smoking. "Smoking and nicotine increase oxidative stress, decrease egg quality, interfere with egg movement along the fallopian tubes, and cause uterine changes that can prevent implantation," Dr. Nayot explains. Biological males should also cut out smoking since cigarettes are linked to greater sperm DNA mutations and chromosomal abnormalities, he adds.
Alcohol should also get the boot since it negatively affects estrogen, testosterone, and progesterone levels, Dr. Nayot explains. Excessive drinking is also linked to low semen, poor sperm count, and decreased sperm mobility, so biological males should also cut the booze, Dr. Nayot says.
Prenatal nutrition is also incredibly important. "Vitamin B12 and folic acid are used to make and control DNA, and getting these nutrients from a high-quality prenatal can provide the cofactors that are needed for proper cell and DNA division," Dr. Nayot says. "CoQ10, L-carnitine, and vitamin E are also all mighty antioxidants that can support egg and sperm quality." Antioxidants help to reduce cellular inflammation and immune dysfunction, and CoQ10, in particular, is a powerful antioxidant that protects cells from damage and boosts mitochondrial function.
Lastly, it's best to reduce or eliminate saturated fats, trans fats, processed and red meat, processed sugars, and simple carbohydrates, Dr. Nayot says. Instead, stick to plant-based proteins, fruits, veggies, and fresh, whole foods.
Can You Treat Secondary Infertility?
If you experience secondary infertility and want to give birth again, it's imperative to talk with your doctor and visit a fertility clinic, says Dr. Wiltshire. "I recommend speaking with a reproductive endocrinologist as soon as possible, because together we can strategize a plan for a thorough evaluation in order to determine the cause and appropriate treatment."
Once you meet with a doctor, you'll undergo a full fertility workup including an ultrasound, blood work, and a potential hysterosalpingogram (an X-ray procedure used to view the uterus and fallopian tubes), says Dr. Becht. Males may have a semen analysis to evaluate sperm quality, Dr. Nayot adds.
From there, Dr. Becht says your doctor may recommend a fertility treatment such as intrauterine insemination or in vitro fertilization. Fertility pills like Clomid or Letrozole may also be used to help the ovaries develop and ovulate high-quality eggs, she adds.