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What is Secondary Infertility?

You got pregnant without much difficulty with your first baby, but now it’s been months (or years) and you’re still not pregnant again. You talked with your doctor, who told you not to be concerned because you’ve gotten pregnant before, but you can’t help worrying that something is wrong.

You’re not alone. Twelve percent of couples have trouble conceiving after already having a successful pregnancy, also known as secondary infertility. This can be caused by a number of factors, including:

Age—A woman’s age is a very common cause of secondary infertility. Unlike men, women are born with all of the eggs they will have, so as a woman ages, her chances of getting pregnant decrease and her miscarriage rate increases. This is true even if she conceived easily in the past.

Anatomy—In order to conceive, a woman must have a healthy uterus and open fallopian tubes. If a woman has fibroids, she may have a harder time having a baby. Additionally, if her fallopian tubes are blocked because of infection or pelvic adhesions—caused by endometriosis or prior abdominal surgeries—the egg and sperm cannot come together normally, and no pregnancy will occur.

Sperm—Sperm quality and quantity can decrease as a man ages or in response to changes in health, weight, or medication. For couples struggling with secondary infertility, a semen analysis should be among the first tests ordered.

Overall, one-third of secondary infertility is due to female factor, one-third is caused by male factor, and the remaining cases are due to either a combination of both partners or are unexplained.

Whatever the reason for your infertility, secondary infertility can be stressful. Many couples who are struggling to conceive their second (or third or fourth) child often receive less support than couples who are trying to have their first baby. They may experience frustration, sadness, guilt, and isolation as a result of their infertility. Parents also worry about how their current child(ren) will be affected by their struggles. They may feel guilty for wanting another child or for not being able to provide a sibling.

Friends and coworkers who were previously supportive may question a decision to seek treatment, and may even go so far as to tell parents that they should just be thankful for the child(ren) they already have. Wanting to have another baby does not make you selfish or ungrateful. The size of your family is a very personal decision—one that no one else should question—and coping with infertility can be very difficult.

In most cases, you don\’t need to be worried about secondary infertility unless you have been trying to get pregnant for at least six months (if you are over 35) or at least a year (if you are under 35). However, couples in which the woman has a history of irregular periods or recurrent miscarriage or the man has a low sperm count should see a fertility doctor sooner. Talking with a specialist is the best way to sort fact from fiction. Your reproductive endocrinologist can help determine why you haven’t conceived and can help you formulate a plan to maximize your chances of having another baby soon.

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