Secondary Infertility: Causes, Evaluation, and Modern Treatment Options

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• What is Secondary Infertility?
• Primary Cause: Age and Egg Quality
• Female Anatomy Changes: Fibroids and Scar Tissue
• Male Factor Fertility Changes
• Diagnostic Evaluation Process
• Secondary Infertility Treatment Options
• Importance of a Medical Second Opinion

What is Secondary Infertility?

Secondary infertility is defined as the inability to conceive or carry a pregnancy to term after previously having at least one successful birth. Dr. Heather Huddleston, MD, a reproductive medicine specialist, describes it as a very common situation her team encounters. A typical scenario involves a woman who had her first child in her mid-20s without any problems, but then ten or fifteen years pass before the couple tries to conceive again, at which point they encounter significant difficulties.

Primary Cause: Age and Egg Quality

Dr. Heather Huddleston, MD, identifies the most common cause of secondary infertility as the simple passage of time. A decade or more is a critical period that pushes a woman from the most fertile time of her life into a phase where her fertility is in natural decline. This decline is primarily related to problems that accumulate in the eggs, known as oocyte quality, which decreases with age. This age-related factor is often the underlying issue a fertility specialist must address when treating a couple experiencing secondary infertility.

Female Anatomy Changes: Fibroids and Scar Tissue

Other contributing factors to secondary infertility involve changes in the female partner's anatomy that occur over time. Dr. Heather Huddleston, MD, explains that some women develop uterine fibroids, which are benign tumors in the uterus. While non-cancerous, large fibroids can make embryo implantation difficult. Another potential cause is scar tissue, or adhesions, inside the uterus that could have formed from an infection related to the delivery of the first child. These anatomical changes, including tubal blockage, can physically prevent a successful pregnancy from occurring.

Male Factor Fertility Changes

Secondary infertility evaluation must also focus on the male partner, as changes in his fertility can be a significant factor. Dr. Heather Huddleston, MD, notes that the problem could stem from a different partner than before or from a change in sperm quality itself. A decrease in sperm count or motility over the intervening years is a common issue. A comprehensive evaluation for secondary infertility always includes a semen analysis, or spermogram, to rule out or identify male factor contributions to the couple's difficulty conceiving.

Diagnostic Evaluation Process

The diagnostic process for secondary infertility is a thorough investigation of both partners. Dr. Heather Huddleston, MD, emphasizes that it starts with a spermogram for the male partner to assess sperm count and quality. For the female partner, an ultrasound evaluation is crucial to examine the uterus and ovaries, checking for anatomical issues like fibroids or ovarian reserve. This complete workup is essential to identify all potential factors, from egg quality and uterine anatomy to tubal patency and sperm health, ensuring an accurate and complete diagnosis.

Secondary Infertility Treatment Options

Treatment for secondary infertility is highly personalized based on the diagnosed causes. Dr. Heather Huddleston, MD, expresses optimism because the couple has proven they can conceive in the past. Treatment options can include surgical removal of uterine fibroids to improve the implantation environment. For age-related egg quality issues or severe male factor infertility, advanced assisted reproductive technologies like in vitro fertilization (IVF) are often employed. A specific IVF technique called Intracytoplasmic Sperm Injection (ICSI) can be used to directly inject a single sperm into an egg to overcome male factor problems.

Importance of a Medical Second Opinion

Seeking a medical second opinion from a leading fertility specialist is a critical step for couples facing secondary infertility. Dr. Huddleston's discussion with Dr. Anton Titov, MD, highlights that a second opinion confirms the diagnosis is correct and complete. It also verifies that the proposed therapy is indeed required and is the best available option. This process builds confidence for the couple, ensuring they are on the most effective path to expanding their family and achieving a successful pregnancy after a previous child.

Full Transcript

Dr. Anton Titov, MD: When years pass after the birth of a child, a woman may encounter problems becoming pregnant again. This is secondary infertility. What causes secondary infertility? How do we treat secondary infertility?

Secondary infertility causes and treatment depend on which partner has the fertility problem. Evaluation and treatment start with a spermogram in the male partner and ultrasound evaluation of the female partner.

Anatomical changes in the uterus are common causes of secondary infertility. Treatment options require a medical second opinion from a leading fertility specialist. Treatments include removal of uterine fibroids, in vitro fertilization, and ICSI.

Secondary infertility is defined as infertility after one successful pregnancy. Uterine fibroids are a common anatomical change that causes secondary infertility. Women trying to conceive should get a medical second opinion from a leading expert in reproductive medicine.

A medical second opinion confirms that the secondary infertility diagnosis is correct and complete. It also confirms that therapy for secondary infertility is required. Secondary infertility causes identification and treatment help a couple to have a thriving family.

A medical second opinion helps to choose the best treatment for secondary infertility. Get a medical second opinion on secondary infertility and be confident that your treatment is the best.

Dr. Anton Titov, MD: It's not an uncommon situation when a woman will have a child in her mid-20s. Then ten or even fifteen years will pass. The first pregnancy happened without any problems; the conception happened quite quickly. But the couple has difficulties initiating a second pregnancy.

I have seen that a couple of times. What could be the cause of problems to conceive a second pregnancy after 10 or 15 years after the first pregnancy?

Dr. Heather Huddleston, MD: This situation can be very common. It's something that we see; it's called secondary infertility. I would say that the most common cause of secondary infertility is that simply time has elapsed.

Now the female partner in the couple is older. Those 10 or 15 years are really critical in terms of pushing the woman from being at the most fertile time of her life to a time when her fertility is in decline.

That decline in fertility that we see with age is really related to problems that accumulate in the eggs. So that's the most common underlying factor that I would expect is going on in a secondary infertility situation.

But other things can also contribute to secondary infertility. It may be that over that ten-year period of time, something in the female anatomy has changed.

We know that some women develop fibroids at this point in their life. Fibroids are benign tumors in the uterus, but they can make implantation difficult if they are quite large.

There could have been a change on the male side of the equation. Either a different partner or something has changed in the sperm quality.

Even difficulties that maybe arose in the delivery of the first child could be a cause of secondary infertility. Perhaps there was an infection in the uterus and scar tissue has formed.

So there can be a variety of things that will accumulate over time. Fortunately, we are quite optimistic in the treatment of secondary infertility in a couple because we know that they can conceive a child. They have conceived in the past.

So it's our general belief that if we are persistent in treatment, they would have very good chances.

Secondary infertility causes and treatment include uterine anatomy changes, tubal blockage in the female, and decreasing sperm counts in the male.