What Is Infertility?
Infertility is a disease of the reproductive system that impairs the ability of a couple to successfully conceive a child and carry that child to term. Infertility may be diagnosed after a couple has been having well-timed, unprotected sexual intercourse for a full year.
Read more about primary infertility.
If the woman is over thirty-five, infertility may be diagnosed after six months of well-timed, unprotected sexual intercourse.
Read more about trying to conceive.
Infertility may also be diagnosed if a woman is under age thirty-five and has suffered multiple miscarriages.
There are two types of Infertility:
- Primary Infertility - is a diagnosis for couples who haven't been able to conceive after a year of well-timed, unprotected sexual intercourse who do not have any living children.
- Secondary Infertility - secondary infertility is diagnosed when couples have been pregnant at least once but are unable to conceive again or carry subsequent pregnancies to term.
There are a number of reasons that a couple may become infertile - both male and female infertility factors. Infertility isn't simply a disorder of the reproductive system - it's much greater than that. The emotional pain and stigma attached to being infertile can leave scars upon a couple that may last a lifetime.
Read more about how to cope with infertility.
What Is Secondary Infertility?
Secondary Infertility is the inability to become pregnant or carry a pregnancy to term after the birth of one or more biological children who were not conceived using any type of fertility medications or assisted reproductive technologies.
In order to be considered secondary infertility, the couple must have been trying to conceive for over a year, or at least six months if the couple is over age 35.
Read more about trying to conceive.
Because the couple has already carried one or more biological children to term, a diagnosis of secondary IF can be both stressful and emotionally shocking to both partners.
Why Does Secondary Infertility Occur?
Secondary infertility shares many of the same causes as primary infertility. In many cases, the cause is unexplained. Some causes for secondary infertility can include the following:
Advanced Maternal Age:
Maternal Age - AMA (advanced maternal age) is one of the more common causes for secondary infertility. Many couples who have had previous pregnancies put off trying to conceive a sibling for their child(ren) as they've already conceived without difficulty.
Over time, a woman's ovarian function declines naturally and as it does, the quality of the egg decreases which increases the chances for miscarriage.
Male Factor Secondary Infertility:
Male Factor IF - based upon new health conditions or medications, sperm quality may be affected, especially if a male used a testosterone supplement, which can dramatically reduce sperm production.
There are a number reasons a woman may have tubal or pelvic problems affecting her fertility. These can include:
- Sexually Transmitted Infections - can lead to scaring of the reproductive organs.
- Ruptured Appendix
- Asherman's Syndrome
- Complications following previous deliveries.
Secondary IF Lifestyle Issues:
There are a number of lifestyle problems that can impact the ability to conceive. These include:
- Being Overweight (Women): extra weight on a woman increases her risks for ovulation disorders.
- Insulin Resistance: from weight gain can lead to elevation of male hormones (like testosterone) and impact ovulation.
- Being Overweight (Men): extra weight on a man can increase levels of estrogen in a man - this can affect sperm production.
- Smoking: cigarettes can affect the quality of a woman's eggs as well as increase complications in a pregnancy.
Okay, I Have Secondary Infertility - Now What?
If, after a year of trying to conceive another child, you have been unable to conceive or carry a pregnancy to term, you and your partner should each make an appointment to see your general practitioner. This can help to rule out - or treat - any of the underlying causes of secondary infertility.
However, if you have a history of pelvic inflammatory periods, miscarriages, irregular cycles, or if it's known that your partner has a low sperm count (or other male factor infertility), don't wait a year. Find a specialist, a reproductive endocrinologist, within six months.
What Kinds of Tests Will Help Diagnose Secondary Infertility?
Many of the tests used to diagnose primary infertility are used to diagnose secondary infertility. These tests may include:
- Laboratory Blood Tests to check the levels of the hormones progesterone, thyroid hormone levels, and levels of FSH (Follicle Stimulating Hormone).
- Basal Body Temperature Readings - a woman will record her body temperature every morning for several months to ascertain whether or not she is ovulating (there is a slight increase in temperature during ovulation).
- Pelvic Ultrasound - to look for any signs of endometriosis, uterine abnormalities, and examine the Fallopian Tubes.
- FSH and Clomid Challenge Test - levels of FSH and Estradiol values on day three of a woman's cycle. On days 5-9 of her cycle, she will take Clomid, then the level of FSH is again measured on day 10 of her cycle. Results from this test may show whether or not a woman has diminished ovarian reserves.
- Hysterosalpingography (HSG)- an x-ray of the uterus and Fallopian Tubes that uses a contrast dye inserted into the cervix.
- Diagnostic Laparotomy - a surgical procedure in which a doctor is able to look at the contents of a person's ovaries, uterus, and Fallopian Tubes to ascertain if damage to these organs has occurred.
For a couple experiencing secondary infertility, it's often that men will be tested as well. Tests to diagnose secondary infertility in males may include:
- Semen Analysis (Sperm Count) - a test that measures both the amount and the quality of a man's semen and sperm.
- Testicular Biopsy - a rarely-performed procedure in which a piece of tissue from the testicles is surgically removed and examined.
Treatment of Secondary Infertility:
The treatment for secondary infertility, like that with primary infertility, is focused primarily upon managing or treating the underlying cause of secondary infertility.
Treatment of secondary infertility can include:
Education for the couple about proper timing of intercourse - having sex every month at least every other day before and during ovulation - especially within 72 hours of ovulation (ovulation occurs about two weeks after the first day of a woman's last menstrual period, or CD14).
Fertility Treatments, including assisted reproductive technology such as the use of fertility drugs and/or IUI or IVF.
Read more about IUI.
Read more about IVF.
Treatment of any infections and/or blood clotting disorders.
Management and treatment of underlying problems.
Medications to treat ovulatory disorders in women.
Changing lifestyle factors, such as quitting smoking and losing weight.
How Do I Cope Emotionally With Secondary Infertility?
One of the hardest things for any couple dealing with infertility is the emotional toll infertility takes. Here are some tips for coping with secondary infertility:
Because a couple has already carried another child (or many children) to term, learning that they have secondary infertility can come as quite a shock.
The first thing for any couple experiencing secondary infertility (or primary infertility) should do is to take charge of the situation. It's tempting to succumb to the grief of the emotional shock of a diagnosis of secondary infertility - but taking the power back can be incredibly liberating and make a couple feel as though they are working toward a solution.
Many couples who experience secondary infertility don't realize that secondary IF is fairly common - it's just not often discussed. Even doctors can downplay the possibility of a couple having secondary infertility if a couple has had one or more previous term pregnancies.
Many couples who experience secondary IF may run the emotional gamut of emotions - anger, grief, depression, feeling isolated, guilty, jealous, as they feel their lives are now spinning out of control.
Compounding that guilt is the fear that the emotional state of a couple may affect their current children.
Secondary IF can produce great feelings of sorrow and self-blame, especially if their living children (and other clueless family members) continue asking if the couple will be giving their other child(ren) a sibling.
It's important to note that many people will downplay a diagnosis of secondary infertility by stating things like, "well, at least you have OTHER children." The isolation and lack of social support for those struggling with secondary IF is even greater than that experienced by couples with primary infertility.
People will often tell a couple who has confessed that they're dealing with secondary IF that, "you should be grateful for the child(ren) you DO have!" or "why would you want to try assisted reproductive technology when the world is so overpopulated!" This is unhelpful and guilt-inducing.
A couple can be incredibly grateful to have living child(ren) and still want to increase the size of their family - it's neither selfish, nor is it something to be dismissive about.
A couple should acknowledge their feelings about secondary infertility - they are allowed to feel the way that they feel without any judgement. It's very common for couples dealing with secondary IF to go through the stages of grief, as secondary IF is a loss - a loss of the ability to get pregnant easily.
Read more about grief and grieving.
Talk to each other about how you're feeling - with the understanding that no two people grieve in the same manner. Do not allow secondary IF drive a wedge between you and your partner.
If feelings about secondary IF and the grief associated with this type of loss become too much, a couple should not hesitate to see a therapist or counselor trained in these types of issues. Sometimes, an alternate point of view can be refreshing.
A couple should make it a point to spend some quality time with their living children. This can ease the guilt a couple may feel about "not focusing on their living child(ren)" and provide a much-needed distraction.
Related Pages on Band Back Together:
Additional Secondary IF Resources:
Resolve provides timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.
The InterNational Council on Infertility Information Dissemination, INC. (INCIID – pronounced "inside") is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or child-free lifestyles.
March of Dimes - Guidance and information for couples who are trying to get pregnant.
Still Standing Magazine - an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.