For people who have already given birth but can’t get pregnant later in life, a diagnosis of secondary infertility can be frustrating, upsetting, and stressful. It’s particularly difficult because of the emotional toll it takes on people, which we’ll go into detail about below.

‍A quick vocab note: We’ll use the terms “primary” and “secondary” infertility in this piece. Primary infertility means difficulty conceiving and giving birth to a first child. Secondary infertility means difficulty conceiving and giving birth to any child after a firstborn.

What is secondary infertility?

It’s when a person is unable to get, or stay, pregnant after previously giving birth without going through fertility treatment. Secondary infertility is as common as primary infertility — it impacts one in six people and is evenly split between men and women.

People are diagnosed with secondary infertility after they’ve tried to get pregnant through unprotected sex for a specific period of time. For people under 35, it’s when they’ve tried to get pregnant for a year. For people over 35, it’s when they’ve tried to get pregnant for 6 months.

What causes secondary infertility?

One major factor is that many people have children later in life than they used to. Advanced maternal age impacts egg quality, which can make it difficult to create healthy embryos. Men often also see changes as they age, particularly around erectile dysfunction or ability to ejaculate. 

Aside from age, factors that can impact a person’s ability to conceive include significant changes in weight, past surgeries, injuries to the groin, or a history of taking certain medications. Some conditions like polycystic ovary syndrome or endometriosis can impact your ability to get pregnant but don’t always cause infertility. For some people, it’s possible to get pregnant without treatment or without a diagnosis, but an underlying condition impacts your ability to get pregnant again.

How is secondary infertility diagnosed?

After six months or a year trying to conceive, you can meet with a fertility doctor to investigate the reason(s) why you haven’t been able to conceive. You and your partner will go through diagnostic tests and scans, which can include an ultrasound for women, a semen analysis for men, and blood tests for both of you. When the doctor can pinpoint the reason(s) they believe you haven’t been able to conceive, they can treat them. 

Sometimes, there aren’t any concerning findings in your test results that can give your doctor an idea of what’s going on. That’s called unexplained infertility, and it can be incredibly frustrating. 

What are your options if you’re experiencing secondary infertility?

It depends on the reason for your secondary infertility. If egg quality or quantity is the concern, a doctor might recommend a cycle of IVF to be able to create and select the best quality embryos that can lead to a healthy pregnancy. If sperm quality or quantity is a concern, your doctor might recommend adding a procedure called ICSI to your IVF cycle, where an embryologist will select and inject one high quality sperm into an egg to give it the best chance of fertilizing. It’s also possible to use a sperm donor or egg donor to create healthy embryos. 

Some people go through treatment for secondary infertility without success but get pregnant without assistance afterward. While your doctor will use their (many!) years of expertise to help you conceive, sometimes it happens on its own without intervention.

Quick plug: We have a piece about paths to parenthood for people ages 40+ if you’re considering becoming a parent for the first time or later in life.

The emotional toll

Now that we’ve covered the “what” of secondary infertility, let’s talk about the complicated emotional toll of secondary infertility and ways to handle hurtful comments. 

Beyond frustration, sadness, jealousy, and grief, many people feel guilty and ashamed when they’re experiencing secondary infertility because they already have a child. Well-meaning loved ones can also be hurtful unintentionally when they say things like “at least you have one already!” or “just keep trying!” You’ll decide how much you want to share, and with whom, but a good conversation diversion can be “I’ll let you know if there’s news to share” or “I need a break from talking about this. I’m sure you can understand.”

We know from our community that some people dealing with secondary infertility can find it harder to find their place in the fertility community when they share their stories. Remind yourself that everyone’s journey is different, and your feelings are valid. Your voice and your experience matters just as much as anyone else’s.

The bottom line (and good things to repeat to yourself!)

-If you're experiencing secondary infertility, it’s not your fault. Period.

-Wanting to grow a family beyond one child isn’t selfish.

-Being disappointed you’re having trouble conceiving a second child doesn’t mean you don’t love your first child.

-You don’t “owe” your child a sibling, even if you told them you wanted them to have one.

-You can share as much, as little, or none, of your experience as you want to.

-A family can be “complete” in any form.

-You’re not alone. 

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