Secondary Infertility: Causes and Treatment

If growing your family is proving difficult, you are certainly not alone. The National Center for Health Statistics estimates that as many as three million women have a hard time falling pregnant or carrying a pregnancy to term after they’ve already had a child. Secondary infertility is a reality to many.

Dreaming of Baby speaks with Dr. Sunny Jun, a board-certified Reproductive Endocrinology and Infertility Specialist at CCRM San Francisco on the causes and treatment of secondary infertility.

CJ DeGuara: Hello and welcome to Dreaming of Baby! Today we have with us Dr. Sunny Jun with whom we shall be discussing secondary infertility. Dr. Jun would you be so kind as to tell our readers a little about yourself and what you do?

Dr. Sunny Jun: I’m a board certified Reproductive Endocrinology and Infertility specialist at CCRM San Francisco. Secondary infertility is fairly common in our practice. Thank you for the opportunity to discuss this topic with you today.

What is secondary infertility?

CJ DeGuara: It is always a pleasure to have you with us. To get us started, what is secondary infertility?

Dr. Sunny Jun: Secondary infertility is defined as the inability to conceive or carry a pregnancy to term after the birth of one or more children without utilizing fertility treatments.

Why can’t I get pregnant again?

CJ DeGuara: Are there any specific reasons or causes for secondary infertility?

Dr. Sunny Jun: There can be a variety of reasons or causes including advanced maternal age, male factor, lifestyle changes, endometriosis, uterine and tubal factors and more.

CJ DeGuara: With that in mind, what is unique from a fertility treatment standpoint when it comes to secondary infertility; how is it diagnosed and what should one expect?

Dr. Sunny Jun: In terms of fertility treatment, the options are still the same. After undergoing a work up and identifying the potential cause of their secondary infertility, women will proceed with the treatment that would be most optimal for them. If women under 35 years of age have been actively trying to conceive for up to a year or women over 35 years of age for up to 6 months without success, then it’s time for them to seek help.

CJ DeGuara: From an emotional standpoint, is there any major difference you find in people seeking treatment?

Dr. Sunny Jun: Yes, definitely. Women dealing with secondary infertility are sometimes more frustrated than women with primary infertility as they were able to conceive without assistance in the past. Also, they sometimes feel more alone during this whole process as they do not receive the emotional support they need from family and friends. They may feel guilty and sad because they already have a healthy child or children yet they desire more. Everyone’s sense of an ideal family size is different and if that dream is not met, there will be disappointment, frustration, and emptiness. Family and friends including partners may not understand that as well. In addition, undergoing fertility treatment while juggling with childcare and work can be quite stressful.

CJ DeGuara: I would also imagine that in certain instances they take longer to seek help, especially for older couples. How problematic is this and how can we help get people to a fertility specialist sooner?

Dr. Sunny Jun: You are right about taking longer to seek help. We see couples in their 40s having tried naturally for a year before seeing a fertility specialist for their second or third child. They believe that if it worked for them in the past, that it will happen again. However, the ovaries will continue to age with time which will make it more and more difficult to conceive. The earlier the intervention, the better the chances of success.

CJ DeGuara: I believe that it is common practice that one year is the guideline for couples trying to conceive to be considered infertile. Is this true or does it vary by age and other factors?

Dr. Sunny Jun: In general, women who are younger than 35 years of age can try up to a year and women approximately 35 to 38 try up to 6 months. Women older than 38-40 should at least see an OB/GYN or fertility specialist for consultation soon to undergo some evaluation. Ovarian reserve can vary from person to person even at the same age. Therefore, this will not apply to all women but most women.

CJ DeGuara: Dr. Jun, you have been a wonderful guest today, for patients suffering from secondary infertility or who believe that they might be; what advice would you give them? What do they need to know right now that we did not quite cover?

Dr. Sunny Jun: There are other factors such as complications from prior deliveries affecting future pregnancies (i.e. scar tissue in the uterus or fallopian tubes), changes in lifestyle affecting sperm and egg quality, or development of potential signs of endometriosis that can prompt an earlier visit to their OB/GYN or fertility specialist. We need to understand that women with secondary infertility are truly undergoing the same level of stress and anxiety as women with primary infertility. They should seek help sooner than later to achieve a successful outcome. Their history of having had a child or children is one of the reassuring factors for us physicians. However, we would evaluate and recommend individualized fertility treatment based on the potential cause or reason for their secondary infertility.

CJ DeGuara: You have helped us put a light on this important subject, Dr. Sunny Jun. Thank you for your time today!

Dr. Sunny Jun: Thank you so much for the opportunity! It was my pleasure!