Understanding Secondary Infertility
Secondary infertility refers to when woman or a couple have conceived before naturally, but struggle when they try to extend their family.
Secondary infertility refers to when woman or a couple have conceived before naturally, but struggle when they try to extend their family. They have been fertile in the past, but something is different. Something has changed.
Fertility is relative, existing on a spectrum. Both women and men are most fertile in our youth. Both male fertility and female fertility declines with the natural processes of ageing.
Female infertility is disproportionately affected by advancing female age, dropping radically from the age of 35 onwards. The effect of age alone, associated with radically poorer egg quality, can be responsible for many cases of secondary infertility.
Sperm problems can worsen with age also. Sperm that may have just made it over the line for natural conception in the past, may now be of inadequate quality for natural conception to occur. Sometimes a first natural pregnancy was a lucky break for a sub-fertile couple, as opposed to secondary infertility representing the loss of completely normal underlying fertility.
Many lifestyle factors and also many medical conditions can change over time. We can gain weight. Conditions such as endometriosis may worsen with time, impacting fertility. We can acquire hormonal imbalances and immune system problems that we did not have before. We may become diabetic. Pathologies of the uterus can develop or progress, such as growing fibroids or worsening adenomyosis. Fallopian tubes can be injured by infection or inflammation and and can become blocked.
Toxic exposures in our environment such as cigarette smoking, chemical exposures and ingesting endocrine disruptors through our diet can reduce both male and female fertility.
Some genetic causes of infertility are responsible for recurrent pregnancy losses, for example chromosome rearrangements. Both men and women can be the source of such abnormalities (known as chromosomal translocations or inversions), which have been found to be over represented amongst couples with secondary infertility compared to the background population. The only way to discover this important cause of infertility is a blood test called a karyotype that needs to be performed for both partners.
Many causes of secondary infertility can be modified or treated and for others, technologies like IVF and pre-implantation genetic testing of embryos (known as PGT) can help to find the right embryo that can successfully make a baby.
Whatever the cause, it’s important to seek a specialists help in a timely fashion. Technologies like IVF can be helpful where secondary infertility occurs due to poor egg and sperm quality, however IVF success rates are overall poorer for older couples.
The first step to overcoming secondary infertility is to be thoroughly investigated as a couple by a CREI qualified fertility specialist.
At Women’s Health Melbourne, we are experts at assisting both men and women to overcome both primary and secondary infertility to have healthy families.
Our practice is lead by Dr Raelia Lew, RANZCOG Board Certified CREI Fertility Specialist and Reproductive Endocrinologist
Written by Dr Raelia Lew
RANZCOG Board Certified CREI Fertility specialist, Gynaecologist and the Director of Women’s Health Melbourne.
Co-host of the Knocked Up Podcast, Co-founder of Ellechemy intimate wellness solutions. Raelia has a PhD in Preconception Health Promotion and Genetic Screening. Raelia is a leading Australian expert in IVF and egg freezing, pioneering a bespoke model of care.