Secondary infertility: Why are we struggling to get pregnant again?

Many people expect that once you’ve had a child, having another one should be straightforward. Secondary infertility can feel deeply frustrating when you had expected a second pregnancy to happen easily. It’s also surprisingly common, affecting approximately 5% of the UK population.

At Aria Fertility, we support many individuals and couples facing this situation.

What is secondary infertility?

Secondary infertility is described as difficulty conceiving or carrying a pregnancy after you have already had one or more pregnancies. As with primary infertility, the NHS defines secondary infertility as not getting pregnant after 12 months of regular unprotected intercourse, or after six months if you are over 35 or there are known risk factors.

Unfortunately, for many, secondary infertility carries a distinct, often overlooked social stigma, in which they feel their experience is minimised because they already have a child. It’s often accompanied by complex emotions, particularly guilt and shame.

Why does secondary infertility happen?

Age is one of the most important factors. As maternal age increases, egg number and quality decline, which reduces the chance of natural conception and increases the risk of miscarriage. In the UK, people are starting families later, and data show that those becoming parents at older ages are more likely to experience infertility.

Other causes often mirror those seen in primary infertility. Ovulatory disorders such as polycystic ovary syndrome, tubal damage after pelvic inflammatory disease or previous surgery, endometriosis, fibroids and uterine adhesions can all contribute.

Male factor issues, including reduced sperm count or motility, are present in a substantial proportion of couples and may have developed since the previous pregnancy.

Lifestyle factors such as obesity, smoking and excessive alcohol intake, as well as medical conditions that arise between pregnancies, can further increase the risk.

When to seek help

National guidance recommends referral for specialist fertility assessment if you have not conceived after one year of regular unprotected intercourse. Earlier referral is appropriate if you are 36 or over, have known conditions such as irregular ovulation, endometriosis or previous pelvic infection, or if your partner has known sperm problems.

If your menstrual cycle has changed significantly since your last pregnancy, if you have pelvic pain, very heavy or irregular periods, or a history of miscarriage, it is sensible to seek advice sooner.

We also encourage you to reach out early if the emotional toll is becoming overwhelming; psychological distress is common among those experiencing infertility.

How secondary infertility is assessed

A fertility workup for secondary infertility follows similar principles to assessment for primary infertility, but we will pay particular attention to any changes since your last pregnancy. We begin with a detailed medical, reproductive and lifestyle history for both partners, including information about your previous pregnancy, delivery and any complications.

Investigations typically include blood tests to assess ovulation and ovarian reserve, such as follicle-stimulating hormone, anti-Müllerian hormone and mid-luteal progesterone.

A pelvic ultrasound helps us evaluate the uterus and ovaries and can detect conditions such as fibroids or ovarian cysts, while further tests, such as hysteroscopy, may be used to treat polyps or adhesions if suspected.

For tubal assessment, procedures such as hysterosalpingography or HyCoSy can check whether the fallopian tubes are open. A semen analysis is essential to evaluate sperm count, motility and morphology and to guide treatment options.

Treatment options and next steps

Your treatment plan will be tailored to the underlying cause, your age and how long you have been trying to conceive. For some, targeted lifestyle changes, weight optimisation, smoking cessation and timed intercourse guided by ovulation tracking may be enough to improve the chances of conception. When ovulation is irregular, medications to induce or regulate ovulation can be highly effective, especially in conditions such as polycystic ovary syndrome.

If sperm parameters are mildly affected or there are unexplained factors, intrauterine insemination may be offered. A large UK observational study has shown that while IVF has higher live birth rates per cycle than IUI, the difference is smaller than previously thought, and IUI can be a cost-effective option in selected couples.

For many patients, particularly where tubal damage, more severe male factor issues or significant age-related decline are present, IVF provides the best chance of pregnancy. IVF success rates vary with age and diagnosis, and we will discuss realistic expectations for your specific situation.

Surgical treatment may be recommended for certain uterine or pelvic conditions, for example, removing fibroids, polyps or adhesions that are thought to be affecting implantation or increasing miscarriage risk. Throughout your journey, access to counselling and emotional support is an integral part of care, recognising the unique grief that can accompany struggling to conceive after having a child.

If you are worried about secondary infertility, please arrange an initial consultation with one of our fertility experts.