Everything You Need to Know About Secondary Infertility

By Julia Howard

The word “infertility” carries with a lot of weight for many women. The clinical definition according to Borght & Wyns (2018) is “failure to establish a clinical pregnancy after 12 months of regular and unprotected sexual intercourse. It is estimated to affect between 8 and 12% of reproductive-aged couples worldwide.” This diagnosis is also shortened to 6 months for those over age 35. There is a myriad of ways in which infertility manifests itself; physically, mentally, emotionally, and spiritually. The most cited fertility complaint is secondary infertility, which is the failure to conceive or carry a pregnancy to term following at least one prior live birth.

Though secondary infertility can feel confusing as the body is unable to naturally carry out a function that it previously has, the causes are overlapping with those of primary infertility. Dr. Charles Coddington of Mayo Clinic cites male factors such as low sperm count in addition to:

as some of the main causes of secondary infertility. Unlike primary infertility, other causes for secondary infertility include complications with prior pregnancy. This is an extremely frustrating diagnosis, especially for those with the history of a prior conception.

While the causes and epidemiology of secondary infertility can hardly be pinpointed from a population basis, several treatments exist to assist in patients with their individual anatomy and physiology, aiding even in circumstances of unexplained infertility. Of course, diagnostic testing is required to determine a treatment plan that is best suited for each person’s fertility history. And there are many different ways secondary infertility can be treated, making it very similar to primary infertility.

For example, if a couple’s infertility could be caused by male factors, one potential solution proceeding with Intrauterine Insemination (IUI), if not severe. Alternatively, if the male factor is more significant, then you may need to proceed with IVF using a non-conventional insemination technique, namely ICSI, PICSI, or Zymot. On the other hand, if women have cycles with irregular ovulation, the primary goal in this case is to stimulate and make that ovulation more predictable. This is where Timed Intercourse Cycles (TIC) comes into play, a medical methodology that employs ovulation-inducing injectable and/or oral medications. Other nuances exist, such as whether this is due to an underlying condition like Polycystic Ovary Syndrome (PCOS). In these cases, medications must be considered more carefully, as you may not be a responsive to stimulation. TIC and IUI cycles are the least invasive, and good first steps in these scenarios.

People for whom IUI and TIC are unlikely to be successful include those with tubal blockage. Blockage in the fallopian tubes most often coincides with endometritis, Pelvic Inflammatory Disease, or a history of Sexually Transmitted Infection. For women experiencing any of these, you may need to proceed directly to In Vitro Fertilization to override the dependence on the egg to travel down the fallopian tube during ovulation. The medication protocol use during IVF cycles varies, largely based on the Andro follicle count (how many follicles are in each ovary at the beginning of the cycle), the Anti-Mullerian Hormone level, and generally age. After analysis of each of these factors, little stimulation may be needed – which is actually more effective for women who have low egg reserves - following a natural IVF regimen. Conversely, for women with a relatively high egg reserve and AMH level are good candidates for Conventional IVF.

For women with no underlying diagnosis, it’s best to start off with the least invasive treatment then moving on from there if not successful. That typically means starting off with timed intercourse then IUI. If IUI fails to result in a positive pregnancy test, then the next step is IVF. All of these medical terms, diagnoses, treatment plans, and basic information can be found on our website: https://www.generationnextfertility.com/tubal-blockage/.

Overall, these treatments are helpful combatting underlying issues, but still may not lead to pregnancy. If everything possible has been done along with several rounds of IVF, depending upon their own goals, then the next option is using donor eggs.

Donor Egg IVF has the highest live birth rate of all treatment options, with rates over 50% in the US (Klenov et. Al, 2018). Egg donation is the medically obvious solution in complicated cases that appear unresponsive to autologous IVF treatment, however potential for this route is highly dependent upon the individual journey of the individual woman.
The unique nature of secondary infertility can have potentially alienating emotional consequences on patients. In a study following the psychological toll on women with differing fertility complaints, twice as many women with secondary infertility (as compared to primary) acknowledged that they never talk about the causes or results of the tests and examinations (Sormunen et. al.,2018). In one New York Times article, author Anne Miller (2020) wrote on her experience with secondary infertility, detailing “Instead, it took us a little more than two years to conceive. The process hit us like a shock wave, draining our savings and deflating our dreams.”

Donor Egg IVF has the highest live birth rate of all treatment options, with rates over 50% in the US (Klenov et. Al, 2018). Egg donation is the medically obvious solution in complicated cases that appear unresponsive to autologous IVF treatment, however potential for this route is highly dependent upon the individual journey of the individual woman.
The unique nature of secondary infertility can have potentially alienating emotional consequences on patients. In a study following the psychological toll on women with differing fertility complaints, twice as many women with secondary infertility (as compared to primary) acknowledged that they never talk about the causes or results of the tests and examinations (Sormunen et. al.,2018). In one New York Times article, author Anne Miller (2020) wrote on her experience with secondary infertility, detailing “Instead, it took us a little more than two years to conceive. The process hit us like a shock wave, draining our savings and deflating our dreams.”