Secondary infertility: when you're unable to fall pregnant again

All About Secondary Infertility: What Happens When You Can’t Get Pregnant Again

by Balvinder Sandhu  /   April 27, 2023

If you’ve been struggling to have a second (or third) child to add to your family, it might not be as mysterious as you think

You’ve had your bundle of joy and are relishing being a parent. You’ve both decided that it’s time to expand your family and start trying for baby number two. Or maybe you already have a few children and want a bigger family. But it’s been months – or even years – and you’re just not getting pregnant. You’ve carried a baby to full term before so why is it so hard to get pregnant now?

When we think of ‘infertility‘, we often picture couples struggling to conceive for the first time. But infertility can strike even if you’ve already had a child – this is known as secondary infertility. It’s defined as “the inability to get pregnant after having given birth previously”, says Dr Chua Ka-Hee, consultant, department of reproductive medicine, KK Women’s and Children’s Hospital. Even though there are no local stats, Dr Chua says overseas studies show that secondary infertility affects around 10 to 12 percent of couples.

The general rule for when you should seek help when trying to get pregnant is the same whether it’s your first or subsequent child. “If the woman is younger than 35 years of age and has been trying to conceive unsuccessfully for one year, she should see a fertility specialist,” advises Dr Chua. “If the woman is older than 35 years of age, she should seek help after six months of trying to get pregnant.”

“However, if there are any known infertility factors such as fibroids, ovarian cysts, irregular periods or ovulation, blocked fallopian tubes or reduced egg or sperm count, then the couple should see a fertility specialist much earlier,” he adds.

What causes secondary infertility?

Dr Chua says that increased age is among the most common risk factors associated with secondary infertility. If you’re young and don’t have any health issues that could affect your fertility, lifestyle factors such as weight gain, poor diet and smoking since the previous pregnancy could be reasons why you’re not getting pregnant. 

He also says that patients who already had a baby have a much better chance of getting pregnant than those who do not, especially if the couple is under 35 years of age.  

“After 35 years of age, a woman’s egg quality decreases rapidly,” he adds. “Overweight or obese couples will also find it more difficult to get pregnant, and they are at risk of reduced sperm count and irregular ovulation. Certain medical conditions such as diabetes in men can also cause reduced sperm count and difficulty in having an erection.”

As with getting pregnant the first time, factors such as age, weight and stress affect your chances of having a second child. Dr Chua says that, for some couples, it may be the main factor. Some couples may also find it hard to find time for intimacy, while caring for another child, he adds.

There are also instances where a previous pregnancy or delivery experience could be the culprit. “A previous miscarriage or abortion treated by surgery may cause scar tissue to form in the womb lining and cause difficulty in getting pregnant,” says Dr Chua. “A previous ectopic pregnancy that occurred in the fallopian tubes can also cause damage or blockage to it. Women who have had a negative or traumatic experience during their first birth also tend to have less children and a longer interval to have their second child.” He also cites issues such as low sperm and egg counts, blocked fallopian tubes and irregular periods or ovulation as potential culprits.

secondary infertility

Getting a doctor’s help

Kim Unwin, 39, is a mum of two who always knew she wanted a third. She and her husband waited a year after having their second child to try for another as they weren’t getting any younger and also didn’t want a big age gap between their kids. It took six-and-a-half years before she finally got pregnant with their third, who is due very soon. The amount of time and effort it took to get pregnant with their third was a surprise as they got pregnant quickly the previous times, so didn’t expect to have any issues.

“We saw our regular gynae after about two years of trying again and he did some basic checks and said it was most likely a male sperm issue,” explains the business director. “So my husband went on supplements and we did get pregnant about a year later but, unfortunately, the baby had no heartbeat at 13 weeks and it ended with a D&C.”

“We continued trying for another year before seeing a fertility specialist. And that was when we found out I had a low ovarian reserve, scarring in my uterus as well as endometriosis and adenomyosis,” she adds. Endometriosis is when the tissue that lines the inside of the uterus grows outside of it, such as on the ovaries or in the cavities of the pelvis. Adenomyosis is when this tissue grows within the muscles of the uterus.

In the three years before her current pregnancy, Kim went through two rounds of IVF, many cancelled embryo transfers, a number of failed embryo transfers, a 13-hour surgery to get rid of scarring, endometriosis and adenomyosis, then another two embryo transfers before finally getting pregnant. 

Despite this, she feels this long wait was worth it as they had a child in the end. Though she admits that, in hindsight, had they known that it would have taken so much time, effort and money, they would have done things differently, such as looking for a fertility specialist sooner and doing the detailed fertility checks at the start. She also would have done more research instead of “going into this journey blindly”.

The emotional impact

It’s understandable that not being able to have another child takes an emotional toll on couples. Kim admits that she felt a lot of sadness, negative thoughts and self-doubt due to the number of obstacles they faced, not knowing if they would ever be successful.

She advises anyone dealing with secondary infertility to be prepared for the emotional aspects such as the constant disappointments with every failure and that feeling of why nothing is going smoothly. Plus, there is guilt as you know that there are women who are still trying for their first child, while you’re trying for your second or third. 

“My final advice is that it’s okay to feel what you feel,” says Kim. “The urge of wanting another child and the disappointment and sadness of not being able to have one is valid and you are certainly not alone on this journey. Get the right support with ladies going through the same thing who truly understand what you are going through. That is why I started a WhatsApp group for women facing secondary infertility.”

Dr Chua adds that secondary infertility can cause profound psychological and emotional anguish for the couple going through it. “They will often be wondering if there is anything innately wrong with them, or perceive to have done something wrong previously and thus blame themselves or each other. This, in turn, can cause a breakdown in the couple’s relationship. It is a recognised problem and couples should seek psychological assistance,” he advises.

Jane*, 37, and her husband started trying for a second child when their daughter turned one. That was in 2015 and she hasn’t managed to get pregnant since. Her husband believed that since they got pregnant once, there couldn’t be any issues to get pregnant again so they didn’t see a doctor until 2017.

“The doctor said that my husband had low to no sperm count and that it could possibly be caused by stress but my husband doesn’t want to meet with a urologist and pursue the follow-up tests,” she explains. 

Since then, Jane has gone through the various stages of wanting a child, feeling resentful that they haven’t “tried harder” and also now, peace with only having one, wonderful kid. “My daughter is now 8 and it feels a little ‘late’ for us to try for another,” she reflects. “In a sense, I’m okay with where we are now. At one point I was stressed and worried that it was ‘my fault,’ so I went through some testing myself. Knowing that the issue is with my husband but he is uncomfortable with taking things further means I can feel less guilty about it.”

secondary infertility

What the experts say

Dr Chua advises couples who are having issues conceiving another child to see a fertility specialist. However, he adds that before doing that, it’s important for the couple to have a good relationship and have regular sex. It’s equally important to have good lifestyle habits such as a balanced diet, regular exercise plus avoid smoking and excessive alcohol. 

Tina Padia, an accredited life coach and fertility coach, says dealing with secondary infertility can be as stressful as couples who don’t have any children. 

“My advice would be to openly communicate with each other and express how you are feeling and what is driving the desire and need for another child,” she says. “There are often hidden feelings of guilt and pressures around providing a sibling or feeling like your body is giving up or somehow failing you as you were once able to conceive and have a healthy pregnancy and baby.”

Women facing secondary infertility also feel alone as they feel like they don’t quite belong in some of the infertility support groups. They feel wrongly judged because they already have one or maybe more children. But both journeys are tough and the challenges faced may not be exactly the same but “no one has the right to judge another woman for wanting more children – it’s her body, her life and her dream,” says Tina.

She recommends speaking to a professional if you are feeling lost, alone or overwhelmed in your thoughts.

*not her real name