Beyond baby one: The realities of secondary infertility

Many people believe having a first baby means it will be easy to fall pregnant again, but unfortunately that is not true. One in 10 people will struggle to fall pregnant with their second baby, despite having no fertility issues first time around.

WORDS: Merryn Porter

Known as secondary infertility, it is often misunderstood, and as a result, people may wait too long to seek help, reducing the chances of conceiving.

Genea Fertility SA’s Dr Victoria Nisenblat is educating people about the topic in a bid to increase awareness in the hope couples dealing with secondary infertility will seek help sooner.

Dr Victoria Nisenblat

What is secondary infertility?

Infertility refers to a person or couple who have been unable to conceive naturally after a year of trying, and secondary infertility occurs when it follows a previous pregnancy.

Dr Nisenblat said people were more likely to wait longer to seek help if they already had a child.

Secondary infertility occurs when couples or people struggle to conceive after they have been pregnant before

While in general, infertility affects one in six people or couples, she said secondary infertility affects one in 10 people.

While half will go on to conceive naturally, Dr Nisenblat said it was better to begin investigations early, especially if the woman is older than 35.

Dr Nisenblat said age was one of the biggest causes of infertility, and dictated how long you should wait to seek help.

“People who are younger than 35 are generally recommended to try for 12 months before they seek help, but for people who are older than 35 we really recommend they only wait six months so we can start investigating and excluding any major problems,” she said.

Causes of secondary infertility

Dr Nisenblat said age was the most common cause of secondary infertility, followed by lifestyle factors, including being overweight.

“Because these days people start their families later, by the time they start trying for their second they are two or three years older,” she said.

“So, they might have started trying for a family in their early thirties, but by the time they try again they might be over 35, which is when fertility really starts to drop.”

Dr Nisenblat said data now shows a man’s age also plays a role in fertility.

“The quality and quantity of sperm is age-related, and we are certainly starting to understand that more, and also seeing the [impact of] lifestyle factors for both men and women,” she said.

“Women after being pregnant may find it hard to lose weight and as we get older, hormone changes also cause weight gain.

“Carrying extra weight can affect the oestrogen levels in women and sperm production in men and can increase the risk of unplanned bleeding from the uterus.”

While obesity was a factor in fertility for both men and women, other environmental factors could also affect male fertility, including excessive heat, radiation, and poor air quality – an issue sometimes linked to the armed forces, submarines, or the mining industry.

There is now more understanding and data about the role of pollutants and occupations that are detrimental to male fertility

Another cause of secondary infertility was a previous caesarean, which could cause trauma to a womb lining. It is recommended women wait 12-18 months after a caesarean before trying to get pregnant to allow womb scar healing.

While she did not want to alarm women who had a previous caesarean, she said it was important they were aware of the risks and did not wait too long to start investigations if they had trouble conceiving.

“Of course, there are all the other factors, including endometriosis, polycystic ovarian syndrome (PCOS), blocked fallopian tubes, problems with ovulation and other hormone problems, as well as unexplained infertility, which can be a factor in secondary infertility as well.”

Dr Nisenblat said new couples could also have difficulty conceiving, even if one or both had children from past relationships.

Seeking help

She said anyone planning to fall pregnant, even if they had a child before, should have a preconception assessment with a GP, gynaecologist, or fertility expert to assess risk factors, start preconception vitamins and supplements, make lifestyle changes, and arm themselves with knowledge about secondary infertility and when to seek help.

“People who have had a baby before are not immune from struggling with fertility, but the earlier they seek help the better,” she said.

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