What to Know About Secondary Infertility

Medically Reviewed by Traci C. Johnson, MD on February 12, 2024
3 min read

Secondary infertility can come as an unwelcome surprise for couples who have previously managed to conceive naturally and give birth without fertility issues. Fortunately, there are several treatment options available for the condition, depending on its underlying cause.

Secondary infertility means an inability to conceive or carry a baby to full term after having conceived naturally and given birth in the past. The cause of secondary infertility can be traced to either partner.

If you and your partner have been unsuccessfully trying to conceive for six months to a year, even though you've had a baby before without fertility treatment, you may have secondary infertility.

Secondary infertility can be linked to fertility issues in either the male or female partner. About one-third of all cases is due to the female; another third can be traced to the male. In the remaining 30% of cases, secondary infertility is either linked to both partners or its cause is unknown.

The reasons for secondary infertility differ, though, for men and women.

Cause of secondary infertility in women include:

  • Mature age (35 years or above): A woman's fertility starts to decline after age 30.
  • Endometriosis: This condition means tissue resembling the uterus lining grows in parts of the body outside the womb. It can create problems getting and staying pregnant.
  • Blocked fallopian tubes: The tube which carries eggs from the ovaries to the uterus can become blocked due to pelvic infections like chlamydia or gonorrhea
  • Polycystic ovary syndrome (PCOS): This hormonal disorder causes high levels of male sex hormones and prevents regular ovulation and menstruation.
  • Excessive weight gain: Weight gain can lead to ovarian dysfunction in some women.

Causes of secondary infertility in men include:

  • Mature age (40 years or above): Semen quality usually declines after age 40. 
  • Low testosterone levels: Testosterone is crucial for sperm production but can decrease due to aging or genital injuries.
  • Enlarged prostate: Prostate enlargement can reduce sperm count and restrict ejaculation. 
  • Prostate removal: Removal of the prostate as a treatment for cancer or other conditions can cause sperm to flow in reverse. 
  • Late-onset hypogonadism: This is a condition that causes a reduction in male hormone secretion. 
  • Excessive weight gain: The chances of infertility increase by 10% for every 20 additional pounds a man gains.

The main sign of secondary infertility is the inability to become pregnant or carry a baby to term after a previous successful natural conception and birth. Since secondary infertility can be caused by a number of underlying conditions, you may experience a range of other symptoms depending on your specific diagnosis.

If you're a woman under age 35 who has regular unprotected sex but haven’t become pregnant within a year, speak to your doctor about secondary infertility. If you're over age 35 or have fertility-related conditions like infrequent periods or endometriosis, it's best to get a medical evaluation sooner rather than later. 

Dealing with secondary infertility can be stressful and emotionally draining, so make sure to get support from your partner, family, and friends in addition to seeking medical help.

If you and your partner are trying to conceive a child, your doctor will recommend a treatment schedule depending on the cause of secondary infertility.

Treatment options for women include:

  • Clomid is an oral medication that stimulates hormones that produce eggs in women with ovulation problems.
  • Uterine surgery clears unwanted growths in the uterus like scar tissue, polyps, and fibroids that impact fertility.
  • In vitro fertilization (IVF) is a procedure in which eggs are surgically retrieved from the uterus, fertilized in a lab with sperm, with the resulting embryos transferred back into the uterus. 

Treatment options for men include:

  • Intrauterine insemination (IUI) is a procedure in which sperm is inserted directly into a woman's uterus, often used when men have low sperm count or poor sperm quality (this is also an option for women with unreceptive cervical mucus). 
  • Testicular surgery can repair testicular varicocele, a condition that can affect sperm quality and count.
  • Supplements like antioxidant and anti-aging supplements can increase fertility in men while drug treatment can improve semen quality.

Lifestyle-related infertility, such as infertility caused by excess weight gain, can be reversed using weight management strategies.