We Need to Talk About Secondary Infertility
With reproductive medicine under political attack, this long-overdue conversation is more necessary than ever.
November 13, 2024
Written By: Christen A. Johnson
Danielle always thought she’d have her ideal number of kids—three, to be exact—by the time she turned 35. But as it does, life happened, and she and her husband didn’t welcome their first child until Danielle was 36. That was more than two years ago.
For the past eight months, the couple has been actively working on having a second baby. Danielle had an ectopic pregnancy (when a fertilized egg implants anywhere other than the uterus, often in a fallopian tube) last October. “That and the fact that we’ve been trying for more than six months means our doctors are now advising IVF,” she says. She always knew that getting older could affect her chances, but still: They’d conceived their first baby naturally; this felt like a surprise.
“People assume that since they’ve been pregnant before, it’s going to be easy again,” says reproductive endocrinologist Amanda Adeleye, MD, founding partner and medical director of CCRM Fertility Chicago. “That’s not necessarily the case. Secondary infertility can happen to anyone.”
And it does. While almost all of us are aware of infertility as a concept (it may impact up to 15 percent of couples, according to the National Institutes of Health), many have never even heard the phrase “secondary infertility”—even though it affects some 11 percent of hetero partners trying for more kids.
What Is This Really About?
The simplest way to think of secondary infertility is as an umbrella term. Rather than a hard-and-fast diagnosis, it’s more of a category for a collection of separate (but sometimes linked) causes that prevent someone from conceiving (after trying for six months to a year) or carrying a pregnancy to term after already having given birth at least once without fertility treatments.
Yeah, it’s a mouthful, but that’s because this situation can be complex. Things like ovulation issues, hormonal disorders (such as polycystic ovary syndrome), fibroids, and endometriosis—all medical conditions in their own rights—can lead to secondary infertility in women (low sperm count can do the same for men).
A prior C-section could also be at play, explains Hey Joo Kang, MD, a reproductive endocrinologist and infertility specialist at Weill Cornell Medicine’s Center for Reproductive Medicine. It can be easy to forget this is a major surgery that cuts your uterus open. Sometimes that incision heals poorly, resulting in scarring that can cause inflammation, make embryo implantation harder, or block the fallopian tubes. In a 2023 study, women who’d had a C-section had a 10 percent decreased chance of getting pregnant again compared with those who’d delivered vaginally. And with C-section rates on the rise globally, the procedure may contribute to even higher rates of secondary infertility.
“People assume that since they’ve been pregnant before, it’s going to be easy again.”
Then, of course, there’s the aforementioned—and biggest, most common— factor: “Egg quality and quantity decline as women get older,” says Shelby Neal, MD, medical director at Duke Fertility Center. Meaning, even if you’ve successfully already had one or more kids, aging alone could cause secondary infertility.
Why Patients Are Losing Patience
That last point may have you thinking, Well, obviously. It’s not like our culture ever misses a chance to mention our proverbial biological clocks or remind us that “older” women may struggle to have children. But why the cognitive dissonance then? Why is secondary infertility not a just-as-well-known phenomenon as first-time infertility? It might come down to the way some doctors think and talk about all this.
“When I’m going through diagnoses with patients, I don’t usually say, ‘You have secondary infertility.’ I try to focus on the why and how to fix it,” says Dr. Adeleye. As in, she zeroes in on the potential root cause, which could take time to pinpoint, versus a more general label. That approach isn’t wrong, of course—women do want and deserve those specifics—but getting a sense of the bigger picture sooner can also be immeasurably useful. Having a name for what’s happening to you, even if it represents a broad category of complications, can help with processing a situation and, importantly, finding a community of other people in your same position.
Danielle and her husband didn’t even know that secondary infertility was a thing—or that she had it—when they were struggling to conceive their second. That is, until she did her own research, she says. “It’s not like a doctor was telling me. I asked, ‘So is this secondary infertility?’ And my doctor nodded and was just like, ‘Yeah.’”
Jennifer, 37, also went through a lot before she found out. After having one child naturally, she had two miscarriages, all while dealing with an MD who questioned whether she’d actually been pregnant at all. A new ob-gyn eventually told Jennifer that she might need to start thinking about fertility treatments if this happened again. But although his bedside manner was an upgrade, he didn’t tell her directly that she may be experiencing secondary infertility. “He only alluded to it, but I came to that conclusion on my own,” says Jennifer, who works in the fertility industry as a nutritionist. “You’re, like, in limbo by yourself.”
Networks have slowly started to form around women like Danielle and Jennifer. Resolve: The National Infertility Association runs more than 10 free virtual and in-person secondary infertility groups nationwide. And more than 10,000 women have joined secondary infertility Facebook groups for comfort and support. These communities are raising awareness, a key factor in getting women the information they need from the start and later helping them understand their options without losing even more time—something that’s become downright crucial as lawmakers propose bills that aim to limit access to both reproductive freedoms and fertility medicine.
Luckily, there are currently secondary infertility treatments out there, including IVF and IUI, the use of egg or sperm donors, surrogates, and more. Fertility science has come a long way and has become super targeted, says Dr. Adeleye. “It’s not that all of a sudden, you’re 35 and you can’t get pregnant anymore, but someone who is 36 might not have the same kind of needs as someone who is 41, and I’d have very different conversations with those people.”
Entering those conversations armed with knowledge around issues like secondary infertility will help you stay in charge of your reproductive future and get what you really need: answers.
