Secondary infertility can be heartbreaking, surprising and exhausting.

“We’ve been trying for #2 for over 3 1/2 years. We’ve tried almost everything except IVF. I’m frustrated and tired of trying to get pregnant. I hate the endless appointments, appointments, and meds,” says BabyCenter community member P.EngMomma at Secondary infertility and active TTC group.

Find out below what causes secondary fertility and how different treatments can help.

What is secondary infertility?

Secondary infertility is when a woman cannot conceive or carry a second pregnancy to term after giving birth to one child without the help of fertility treatment.

If you have been trying for a second child for six months (if you are over 35) to a year (if you are under 35), you may be diagnosed with secondary infertility.

Infertility can feel lonely, but know that many women share similar feelings and journeys.

– Dr. Layan Alrahmani, board certified gynecologist

What causes secondary infertility

The same factors that cause fertility problems in new parents can also cause secondary infertility. Some of these are the result of the ovaries producing fewer good quality eggs. Others are related to problems with the uterus or fallopian tubes. In men, infertility is often caused by something that interferes with sperm production.

Causes of secondary infertility in women

Problems with ovulation are caused by:

• age (the amount and quality of eggs your body provides declines after age 35)
• autoimmune or genetic conditions
• overweight or underweight
• polycystic ovary syndrome (PCOS)
• lifestyle factors such as smoking and drinking

Uterine problems caused by:

• previous infection or scarring from surgery or pregnancy
• polyps or fibroids
• endometriosis (when tissue normally found in the lining of the uterus grows elsewhere)

Blocked or damaged fallopian tubes caused by:

In some cases, complications during the first birth can cause a problem that affects your fertility. Or, you may have age-related fertility problems if it’s been a few years since your first pregnancy.

Read about your chances of getting pregnant at different ages.

Causes of secondary infertility in men

Male infertility can be caused by something that interferes with sperm production, such as:

• hormonal disorders
• genetic disorders
• heavy alcohol use
• some medical conditions, including testicular trauma or testicular varicocele (dilated veins in the scrotum)
• age (men’s fertility declines at age 40 or older)

Treatment of secondary infertility

“With the help of a specialist, there are fertility treatments that can help lead to a successful pregnancy,” says Layan Alrahmani, MD, a board-certified gynecologist and member of BabyCenter’s medical advisory board.

Treatments for primary and secondary fertility problems are the same, and the first step is usually to be evaluated by a fertility specialist.

If you haven’t gotten pregnant after a year of frequent, unprotected sex, it’s best to see a reproductive endocrinologist – a doctor who specializes in treating infertility. If you are over 35, seek help after six months of trying. Resolve, National Infertility AssociationOpens a new windowsays “if you’re over 30 and have a history of pelvic inflammatory disease, painful periods, pregnancy loss, irregular cycles, or if you know your partner has a low sperm count, don’t wait a year.”

The doctor will evaluate your medical history, including menstrual cycles and any conditions that may affect your ability to produce eggs or your partner’s ability to produce enough quality sperm. They will try to determine if you are ovulating and if your uterus and fallopian tubes are working well.

I can do a blood test for hormone levels, a transvaginal ultrasound, and an X-ray of your uterus and fallopian tubes. The doctor will also analyze your partner’s sperm.

Depending on the cause of your secondary infertility, treatment may include:

Changes in lifestyle. Maintaining a healthy weight, eating a nutritious diet, and quitting smoking, drug use, and drinking alcohol are positive steps you can take to possibly improve your fertility.

Operation. This would be addressing any obvious problems, such as removing polyps, fibroids or scar tissue, or treating PCOS, endometriosis or testicular varicocele.

Medicines. The drug can be used to address abnormal hormone levels that affect ovulation. Improving thyroid function in people with abnormal thyroid hormone levels can help with fertility, for example. Your doctor may also try to induce ovulation with fertility drugs such as clomiphene (Clomid) or gonadotropins.

Intrauterine insemination (IUI). Using a catheter, the doctor transfers your partner’s or donor’s sperm through the cervix directly into the uterus. You can take fertility drugs before the IUI procedure.

In vitro fertilization (IVF). The doctor will take eggs from your ovaries (or use donor eggs), combine them with your partner’s or donor’s sperm in the laboratory, and then transfer the embryo into your uterus. You will probably take gonadotropins before the IVF procedure.

Often, especially if male fertility is a problem, ICSI (intracytoplasmic sperm injection) is added to the IVF procedure. With ICSI, one sperm removed from your partner’s testicle is injected into one egg. After fertilization, the embryo is transferred to the uterus.

How common is secondary infertility?

Secondary infertility is not uncommon: About 13% of mothers have trouble conceiving or carrying another child, according to the Centers for Disease Control and Prevention (CDC).

CDC dataOpens a new window shows that from 2015 to 2019, there were 4.55 million women aged 15 to 44 in the United States with secondary fertility problems. For women aged 15 to 49, that number was 5.88 million.

Among men aged 25 to 49, 12.8% reported some type of infertility.

Coping with secondary infertility

Secondary infertility can lead to a host of painful feelings, including anger, sadness, depression, anxiety and frustration.

“Infertility can feel lonely,” says Dr. Alrahmani, “but know that many women share similar feelings and journeys.”

You may feel hurt and stressed, and you may experience a loss of self-esteem. You may feel emotionally drained and also deal with a heavy financial burden if you undergo fertility treatments. You may also struggle with the psychological side effects of medications and hormones.

For some women, the struggle to get pregnant after having already given birth to a baby or two is particularly shocking and difficult to accept. “I’m at a loss. We got pregnant right away with our previous two pregnancies but nothing seems to be working this time. I’m really upset and feel like I should just get on with my life but I so want another baby,” says one mum from the BabyCenter community.

If the emotional toll of infertility is affecting your well-being, talk to others who have also experienced secondary infertility. You can join an online support group such as Secondary infertility group in the BabyCenter community or view support groupsOpens a new window sponsored by Resolve, the National Infertility Association.

Here are other ways to deal with secondary infertility:

Educate yourself

Learn what you can about your situation and make a plan. If you’ve been diagnosed with a specific condition that affects your fertility, research it and—with your doctor’s help—develop a plan of action. If you’ve decided to try fertility treatments, find out what the process will look like and outline the steps yourself.

Take good care of yourself

Take care of your overall health as much as possible by eating well, sleeping well and exercising. Try meditation and other relaxation techniques, such as deep breathing and progressive relaxation (carefully relaxing one body part at a time, moving from your toes to your head).

Take time for yourself

Dealing with infertility is stressful and it’s okay if you sometimes need a break from parenting. Reach out to friends and family members, hire a babysitter, or make arrangements with your partner to have some time for yourself.

Work on sexual tension with your partner

Goal-oriented sex can become compulsive. Talk to your partner and try to be physically close in other ways (like cuddling and massaging each other). You might have sex even when you’re not on schedule.

If you’re feeling overwhelmed, don’t hesitate to seek professional counseling to help you deal with your feelings and learn stress-relief and relaxation techniques. Your doctor or midwife can provide a referral, preferably to a therapist who is familiar with fertility issues.