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Key Takeaways
- Secondary infertility means difficulty conceiving after a previous pregnancy, whether or not it resulted in a live birth.
- Doctors assess both partners and may check ovulation, the reproductive organs, and sperm count and function.
- Treatment depends on the assessment findings, your age, and how long you have been trying. Not everyone needs IVF.
Trying for another baby can bring unexpected challenges, even after a successful pregnancy. As time passes without a positive pregnancy test, you might start to worry and ask yourself why conceiving seems harder this time.
This article explains why conceiving again may become difficult, how doctors assess both partners, and which treatments they may consider.
What is secondary infertility?
Secondary infertility means difficulty conceiving after a previous pregnancy. It can occur whether or not that pregnancy resulted in a live birth. Infertility generally means not achieving pregnancy after 12 months of regular, unprotected sex, although doctors may recommend an assessment sooner depending on age and medical history.
Having conceived before does not mean that trying for another baby will follow the same path. Fertility can change over time, and the reasons for these difficulties may involve the female partner, male partner, or both.
Difficulty conceiving again may be the only sign. Some people also notice symptoms linked to an underlying fertility problem.
In women, missed or irregular periods may suggest polyendocrine metabolic ovarian syndrome (PMOS) or another condition affecting ovulation.
In men, difficulties with erections or changes in ejaculation may indicate a problem that needs assessment. These signs do not confirm infertility on their own, but they are worth discussing with a doctor.
Why can conceiving again be difficult?
Problems with ovulation, sperm, or the reproductive organs can make conceiving again more difficult. The causes may overlap, so doctors assess both partners.
Factors affecting female fertility
Several factors can affect female fertility, such as age-related changes, ovulation problems, previous infections, or surgery.
Possible contributing factors include:
- Age-related changes: The number and quality of eggs decline with age, particularly after 35. This can make fertilisation and a successful pregnancy less likely, even if you conceived without difficulty before.
- Ovulation problems: Conditions such as PMOS, previously called PCOS, can disrupt ovulation, so the ovaries may release eggs irregularly or not at all. Significant weight changes, certain medical conditions and medications can also interfere with ovulation.
- Uterine or tubal conditions: Blocked or damaged fallopian tubes can prevent sperm from reaching an egg. Some fibroids, particularly those that distort the uterine cavity, and uterine polyps may interfere with implantation. Adenomyosis may also affect fertility.
- Endometriosis: Tissue similar to the uterine lining grows outside the uterus, potentially causing inflammation and scarring around the reproductive organs. These changes can make conception more difficult, although not everyone with endometriosis experiences infertility.
- Previous infection: Untreated infections such as chlamydia or gonorrhoea can lead to pelvic inflammatory disease (PID). This may cause scarring or blockages in the fallopian tubes, affecting fertilisation.
- Surgery: Previous pelvic or uterine surgery can sometimes cause scarring. Some ovarian operations may reduce ovarian reserve, which refers to the remaining egg supply. Procedures such as dilatation and curettage (D&C) can sometimes cause scarring inside the uterus, which may interfere with implantation.
Factors affecting male fertility
Problems with sperm production or function can reduce the chances of fertilisation. These may include a low sperm count or sperm that do not move effectively. Possible causes include ageing, hormonal changes, infections, and enlarged veins around the testicles, known as varicocele.
Difficulty getting or maintaining an erection can make intercourse difficult. Ejaculation problems may prevent sperm from entering the vagina. Certain medications and previous pelvic or prostate surgery can contribute to these problems.
When no clear cause is found
Sometimes, a standard fertility assessment does not identify a cause. Doctors may diagnose unexplained infertility when the assessment indicates ovulation, at least one open fallopian tube, and adequate sperm numbers and movement.
These findings do not guarantee conception. Routine tests cannot fully assess every step, including egg quality and how sperm and egg interact during fertilisation.
How long should you try to conceive before seeking an assessment?
The female partner’s age can help determine when to seek advice for secondary infertility
The usual timing for a fertility assessment depends on the female partner’s age. If you have regular, unprotected sex without conceiving, seek an assessment:
- After 12 months of trying, if the female partner is under 35.
- After 6 months of trying, if she is aged 35-40.
- Without waiting six months if she is over 40, as doctors may recommend a more immediate assessment.
Seek advice sooner if either partner has a known or suspected fertility problem. This includes irregular or absent periods, endometriosis, a history of pelvic infection, or concerns about sperm health, erections or ejaculation.
If you are thinking about a fertility assessment, WhatsApp our Care Team, we will match you to one to three fertility specialists suited to your situation, including those who assess both partners, explain why each fits, and arrange the appointment.
How doctors investigate secondary infertility
An assessment usually involves both partners, even if you conceived without difficulty before. Your doctor will ask about previous pregnancies, how long you have been trying, and any changes in your health or medications. This helps them decide which tests you need.
Tests for women
Tests check whether you are ovulating and look for problems affecting the ovaries, uterus or fallopian tubes. Your doctor may recommend:
- Ovulation checks: Your menstrual history, and sometimes a blood test, can help establish whether you are releasing eggs regularly.
- Pelvic ultrasound: Your doctor uses a scan to assess the uterus and ovaries for abnormalities such as fibroids or ovarian cysts. Further tests may help identify problems inside the uterine cavity, such as polyps.
- Ovarian reserve tests: Blood tests and an ultrasound estimate ovarian reserve and help predict how your ovaries may respond to fertility medication.
- Fallopian tube checks: An X-ray or ultrasound using contrast fluid helps show whether the fallopian tubes are open.
Your doctor may recommend further tests based on your symptoms or initial results.
Tests for men
The initial assessment usually includes a semen analysis to check sperm count, movement and shape. If the result is abnormal, your doctor may repeat the test because results can vary between samples. Your doctor will also ask about difficulties with erections or ejaculation.
A specialist may examine the testicles to assess their size and firmness and check for lumps or a varicocele (enlarged veins in the scrotum). They may also examine the structures that carry sperm. These findings, together with the semen results, can help identify signs of a blockage.
If symptoms or semen results suggest a hormonal problem, your doctor may check testosterone and follicle-stimulating hormone (FSH), which are involved in sperm production.
What the results can tell you
Your test results may identify problems with ovulation, the fallopian tubes, the uterus or sperm. Your doctor will consider both partners’ findings together to explain what they mean and discuss the next steps.
However, the tests cannot assess every aspect of fertility. Ovarian reserve tests do not directly measure egg quality or reliably predict natural conception. Semen results alone cannot confirm or rule out a fertility problem.
How is secondary infertility treated?
A doctor will consider both partners’ test results before discussing treatment for secondary infertility
Your doctor will consider both partners’ results before discussing the options. If an assessment identifies a problem that can be treated, addressing it may come first. For example, medication may help if ovulation is irregular. Your doctor may recommend surgery for selected uterine or tubal conditions, or certain causes of male infertility, such as a varicocele. The choice depends on whether treatment is likely to improve your chances of pregnancy.
If no clear cause is found, or pregnancy does not occur after initial treatment, your doctor may discuss intrauterine insemination (IUI) or in vitro fertilisation (IVF).
IUI places prepared sperm directly into the uterus. For unexplained infertility, doctors may combine it with medication to stimulate the ovaries.
IVF involves fertilising eggs in a laboratory and transferring an embryo into the uterus. Your doctor may recommend it when other approaches have not worked or are unlikely to help.
Your age and previous treatment also influence whether to try a less intensive option or move to IVF sooner. Alongside treatment, your doctor may review medications and discuss lifestyle factors that could affect fertility.
How Health in Asia can help
If you are finding it difficult to conceive again, are unsure which specialist to see, or would like another opinion on a treatment plan, we can help you navigate the next step.
Tell the Care Team how long you have been trying, your age, and any concerns affecting either partner. If you have already had fertility tests or treatment, you can share the relevant reports.
The care team can help with:
- Finding a specialist who suits your needs and helping you check their insurance panel status and whether your policy covers the proposed care.
- Arranging a second opinion if you have questions about a diagnosis or treatment recommendation.
- Appointment booking and care coordination.
We do not diagnose or treat secondary infertility. Your clinician will assess your fertility concerns, explain the findings, and recommend appropriate care.
Disclaimer
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition. For decisions about your health or treatment, speak with a qualified doctor who knows your situation. An…
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