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SECONDARY INFERTILITY

Struggling to conceive again? If you've had a baby before but are now struggling to conceive, we can help you grow your family.

Understanding secondary infertility

Secondary infertility is when someone who’s had one or more pregnancies naturally (or through treatment) finds it difficult to conceive again or carry a pregnancy to term. 

It can feel particularly frustrating. Many people expect that once they’ve had a child, having another should be straightforward. But the truth is, fertility can be influenced by age, health, and even factors that didn’t exist the first time around. 

If standard fertility tests show no identifiable cause, this is called unexplained secondary infertility. While that can feel like a difficult diagnosis, it’s not the end of the road. Many of our patients in this position go on to have successful treatments—and pregnancies—with the right support. 

How is secondary infertility usually assessed?

Fertility testing for secondary infertility involves assessing both male and female factors. 

Male fertility testing: 

  • Sperm count – The number of sperm in a sample, which determines overall sperm availability. 
  • Sperm motility – The ability of sperm to move effectively towards the egg, crucial for natural conception. 
  • Sperm morphology – The shape and structure of sperm, as abnormalities can affect fertilisation. 

Female fertility testing: 

  • Ovulation tracking - Blood tests and ultrasound scans determine if ovulation is occurring regularly. 
  • Ovarian reserve testing – Blood tests measuring AMH (Anti-Müllerian Hormone) help assess egg quantity. 
  • Tubal patency tests – A HyCoSy or HSG test checks if the fallopian tubes are open. 

If all your test results are within the normal range and there’s still no pregnancy, your doctor may discuss a diagnosis of unexplained secondary infertility. At that point, we may suggest further investigations or recommend a treatment such as IVF. 

What are the possible causes of secondary infertility?

Several underlying factors could be affecting fertility, identifying these causes can help tailor treatments for better outcomes. 

Age-related fertility decline

As women age, egg quantity and quality naturally decrease, affecting fertilisation and embryo development. This decline can happen gradually or accelerate after a certain age, often around 35-40. For men, sperm quality also declines with age, impacting fertility. 
Sperm quality changes Even if a man has previously fathered a child, sperm health can be affected by lifestyle, environmental exposures, or medical conditions. Issues like DNA fragmentation, oxidative stress, and hormonal imbalances can all reduce fertility. 
Complications from previous pregnancies or deliveries

Prior pregnancies or childbirth experiences may leave lasting effects on fertility, including: 

  • Asherman’s syndrome – Uterine scarring that can impact implantation. 
  • C-section scarring – Scar tissue from a caesarean delivery may affect the uterus or fallopian tubes. 
  • Postpartum infections – Infections after childbirth can cause damage to the reproductive system. 
Hormonal imbalances

Hormones play a critical role in ovulation and sperm production. Secondary infertility can be caused by conditions like: 

  • Thyroid disorders (hypothyroidism or hyperthyroidism) 
  • Elevated prolactin levels 
  • Low testosterone or other hormonal deficiencies in men 
Weight fluctuations and lifestyle changes

Significant changes in weight, diet, or stress levels since a previous pregnancy can influence fertility. Being overweight or underweight can disrupt ovulation and hormone levels and may lead to irregular menstrual cycles. 
Medical conditions and medications

New health conditions or medications since your last pregnancy can influence fertility. Common issues include: 

  • Endometriosis – A progressive condition that can cause scarring and tubal blockages. 
  • Uterine fibroids – Lesions in the uterus that may interfere with implantation. 
  • Autoimmune disorders – Conditions like lupus or rheumatoid arthritis can impact reproductive health. 
  • Medications – Some medications, including antidepressants, blood pressure medications, and chemotherapy, can affect fertility. 

How common is secondary infertility?

Secondary infertility is more common than many realise and affects millions of couples worldwide. While known male and female infertility factors account for many cases, up to 30% of secondary infertility cases remain unexplained. 

It’s important to remember that even without a clear diagnosis, many couples go on to have successful pregnancies with the right treatment and support. 

What are the next steps?

If you’ve been diagnosed with unexplained infertility, there are several options to help you move forward: 

Lifestyle optimisation

Certain lifestyle changes can boost sperm health and improve fertility outcomes, including: 

  • A diet rich in antioxidants, healthy fats, and essential vitamins. 
  • Reducing alcohol and quitting smoking. 
  • Managing stress through relaxation techniques. 
  • Avoiding excess heat exposure (such as hot tubs and tight clothing) 
Advanced fertility testing

Beyond standard semen analysis, advanced tests can provide deeper insights, including: 

  • Sperm DNA fragmentation test – Assesses sperm DNA integrity. 
  • Oxidative stress test – Measures free radical damage in sperm. 
  • Comprehensive hormone panels – Identifies subtle hormonal imbalances. 
  • Immune function testing – Assesses potential immune-related fertility issues. 
Fertility treatments

If lifestyle changes and advanced testing still don’t provide a clear answer, assisted fertility treatments may offer the best route forward: 

  • Sperm freezing – If sperm quality fluctuates, freezing a sample for future use can be beneficial. 

Each treatment is tailored to your specific needs, ensuring the best possible chance of success.