Thrive by IU Health

June 14, 2019

What Parents Need to Know About Secondary Infertility

What Parents Need to Know About Secondary Infertility

Is adding to your family taking longer than expected? Nicole Scott, MD, a physician in the obstetrics and gynecology at Indiana University Health, explains why you might be struggling to conceive.

Secondary infertility takes many people by surprise. “It’s not an issue on many people’s radar,” Dr. Scott says. If you didn’t have trouble conceiving before, you may not anticipate any problems getting pregnant again. And if you’re a generally healthy person, you might assume that your reproductive health is fine, too. Even women who are trying to have another child in their mid- to late thirties or beyond may not consider their age to be an issue, says Dr. Scott: “So often we see celebrities getting pregnant later in life and they didn’t seem to have any trouble doing so, but that may not be the case.”

To meet the definition of secondary infertility, couples have to have successfully conceived at least once but are now unable to conceive or carry another pregnancy to term in a set amount of time—one year for women under 35, six months for women over 35. But don’t feel you have to wait that long to seek help, says Dr. Scott: “It’s never too early to see your ob-gyn to discuss any worries you may have about conceiving and to get an evaluation.”

Here, she explains some of the most common causes of secondary infertility:

Age. Once a woman is over the age of 37, her chances of becoming pregnant decrease. “While any woman who gives birth when she’s over 35 is considered to be of advanced maternal age, we don’t really see an age-related decline in fertility until 37,” Dr. Scott explains. But if you’re older than that, don’t panic: it’s a gradual decline, not a sudden plunge. “You could still be fertile—it may just take longer for you to get pregnant now than it did when you were younger,” Dr. Scott says.

Age is less of an issue for men (there’s not even an accepted definition of advanced paternal age), but it does sometimes play role in secondary infertility because the quality and quantity of a man’s sperm decrease with age.

Obesity. Carrying too many extra pounds can make it harder for both women and men to add to their family. “Being obese raises estrogen levels because fat cells make estrogen,” Dr. Scott explains. In men, too much estrogen can limit sperm production, while women with excess estrogen may ovulate less often.

Certain medical problems. Conditions such as endometriosis and polycystic ovarian syndrome may have worsened since your last pregnancy and could now be interfering with your ability conceive. (Fibroids can also be a culprit, though Dr. Scott says they would have to be quite large to have an effect.) Health problems such diabetes, high blood pressure, and thyroid diseases can affect fertility in both women and men.

Medications. Steroids, cancer treatments such as chemotherapy and radiation, and some blood pressure medications can interfere with conception for men and women. Men who use testosterone replacement therapy or antidepressants may struggle with fertility issues due to decreased sperm production or impaired sperm motility, respectively.

Complications from previous pregnancies. Injuries or infections from previous deliveries (or gynecological surgeries) may have produced scarring (adhesions) inside the uterus. This condition, known as Asherman’s Syndrome, can make it more difficult to conceive and maintain a pregnancy.

Smoking cigarettes or marijuana. Lighting up can lower sperm count in men and cause premature menopause in women.

Alcohol. Heavy drinking is known to affect sperm quality and is associated with an increased risk of ovulation disorders.

-- By Jessica Brown