Secondary Infertility

This was something my body was just supposed to know how to do, says Amy M., a mother of three who faced secondary infertility following a more typical first pregnancy.

“I was confused,” she says. “Was there something wrong with me? Was it my husband? How could it work the first time and not now? Would we ever have another child?” The experience left her feeling frustrated, sad and angry, says Amy.
This situation is not uncommon. According to Dr. Sherif G. Awadalla, Medical Director at the Institute for Reproductive Health, overall infertility affects 10 to 15 percent of couples. Of this figure, 40 percent of infertility is secondary, a “failure to conceive within one year of a prior pregnancy or prior miscarriage.” He says an estimated three million women in the United States face secondary infertility.

Awadalla attributes several factors as potential causes for secondary infertility: tubal blockage, ovulation difficulties, endometriosis and cervical issues. Male factors typically involve issues with sperm count and quality.
Allyson S., mother of two, dealt with a metabolic issue. Her endocrinologist described her pituitary system as “all out of whack” and said it could be difficult for her to conceive or maintain a healthy pregnancy. In fact, Allyson would experience two miscarriages before experiencing a successful pregnancy.
Fortunately, a myriad of fertility treatment options are available. Awadalla cites oral medications like Clomid and Femara as a common place to start. Injectable medications are sometimes used to address ovulation difficulties. More complex treatments include intrauterine insemination (IUI) and surgery. Surgical options can include minimally invasive laparoscopy techniques. Awadalla says surgery is sometimes recommended to repair fallopian tubes and to treat endometriosis. He points to in vitro fertilization (IVF) as another promising treatment.

Amy and her husband tried several options. “I went through seven inseminations. The first three were with Clomid. Then I had laparoscopy to clean out scar tissue. I had my final four IUI’s with injectables,” she explains. For Allyson, getting her metabolic issue under control was a major factor. For both women, these subsequent pregnancies felt a little different from their firsts.

“You can’t help but feel different after experiencing fertility issues,” Amy says. Once the OB confirmed her twin pregnancy, she remembers, “I was paranoid it could all be taken away. Every appointment I was panicked we would not hear the heartbeats. I was sure that every worst case scenario was going to happen to me.”
But, she adds, “I was more present.” She says she took time to sit and feel her babies move. “When I could quiet the doomsday voices in my head, I allowed myself to enjoy this pregnancy because I knew it could be my last. I didn’t complain as much. I slept in a chair for the final six weeks, but I woke up each day happy.”
Allyson describes feeling more anxious compared to her first, “easy” pregnancy. “After two miscarriages, there was lots of worry,” she explains. “Being told my condition could make it difficult to carry to term was scary.” Allyson says the worry from her latest pregnancy has lingered even after the birth. “I was very laid back with my first child,” she says. “But with this one I am much more cautious.”

Both moms would assure other women facing secondary infertility that they are not alone. “A lot of people don’t realize that secondary infertility is a thing,” says Allyson, “but it is, and there are a multitude of reasons it might occur.”
For women concerned about secondary infertility, Awadalla suggests starting with an OB/GYN followed by a referral to a reproductive endocrinologist. These specialists are trained to evaluate and treat infertility. Also, check out the resources at the American Society for Reproductive Medicine ( and The National Infertility Association (, where patients can get a list of questions to ask their fertility specialist.

Finally, consider Amy’s advice: “You are not alone,” she says. “Do not be afraid to open up about your difficulties to friends, family and neighbors. You will be shocked how many others have experienced this. If a baby is something your heart desires, get a little pushy, and don’t let anyone tell you just to wait and see. The only timeline you need to follow is the one you are personally comfortable with.”

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