Causes, statistics, treatment options, and more

Secondary infertility occurs when a person is unable to conceive or continue indefinitely after giving birth in the past. The cause may stem from factors involving one or both partners.

Secondary infertility affects approximately 11% of couples in the United States.

In females, the most common cause of secondary infertility is polycystic ovary syndrome (PCOS). However, endometriosis, genital infections and other conditions can also cause it. Some causes in men include hormone imbalances, aging and ejaculation disorders.

Treatment may include medication to improve fertility or surgery to manage an underlying condition. Doctors may also recommend assisted reproductive technology methods, such as intrauterine insemination (IUI) or in vitro fertilization (IVF).

This article examines the causes and diagnosis of secondary infertility, treatment options and more.

“Infertility” describes when a couple can not get pregnant after having a year of unprotected sex. There are two types of infertility: primary and secondary.

Primary infertility refers to a couple who have never become pregnant. In contrast, secondary infertility describes a couple who are unable to conceive or continue to term until they have had at least one successful conception in the past.

Conditions that affect females cause approx. a third of secondary infertility cases, while conditions affecting men cause another third. The remaining cases are unexplained and stem from conditions in which both partners are involved.

Primary infertility is relatively common and affects 19% of women in the US This is almost 1 in 5 people.

Secondary infertility is less common, affecting 11%or about 1 in 10 couples.

There are a number of causes of infertility in women. Some general causes include:

Polycystic ovary syndrome

The most common cause of female infertility, polycystic ovary syndrome (PCOS) is the inability to ovulate or ovulate regularly. Ovulation is the release of an egg and usually occurs once per menstrual cycle.

PCOS affects approx. 10% of women of childbearing age. This can lead to the formation of cysts, or fluid-filled sacs, in the ovaries.

Learn more about PCOS.


In people with endometriosis, tissue similar to the uterine lining grows outside the uterus.

Researchers do not know exactly what causes endometriosis, but we do know it can affect fertility in several ways. Endometriosis can cause inflammation, which can affect the quality of the eggs. It can also cause scar tissue to form, which can distort or change the reproductive anatomy and make it harder for the serum to reach the egg. Endometriosis can also affect implantation.

Learn more about endometriosis.

Genital infections

Chlamydia and gonorrhea are sexually transmitted infections (STIs) that can cause pelvic inflammatory disease (PID), an infection of the female reproductive system. Roughly 1 out of 8 women with a history of PID are struggling to conceive.

Learn more about PID.

Primary ovarian insufficiency

Primary ovarian insufficiency (POI) occurs when a person’s menstrual cycle becomes irregular before the age of 40. Approximately 5–10% of people with POI become pregnant and have a normal pregnancy, but many people with the condition struggle to conceive.

The cause is often not known, but chemotherapy, pelvic radiation and other conditions can cause it.

Learn more about PVB.

Hormonal disorders

Hormonal disorders occur when a dysfunction occurs in the hypothalamus and pituitary glands in the brain. It makes hormones that maintain the function of the ovaries, so problems with it can affect the reproductive system. An error here can cause a female not to ovulate.

Learn more about hormonal imbalances.

Fallopian tube obstruction

An older 2013 study indicates that obstruction of the fallopian tube occurs in 29% of females with secondary infertility. Chlamydia can cause an infection of the fallopian tubes, which can lead to permanent damage.

Learn more about blocked fallopian tubes.

Uterine conditions

Since the uterus is essential for getting pregnant, any condition that affects it can increase the risk of infertility. Such conditions may include:

  • fibroids, which are non-cancerous tumors
  • adhesions, accumulations of scar tissue
  • adenomyosis, a condition in which the lining of the uterus grows into the uterine wall
  • congenital anomalies present at birth that result in a person having an unusual uterus

The following are conditions that can cause secondary infertility in men.

Testicular or ejaculatory dysfunction

A variety of factors can cause this. They include:

  • trauma to the testes, which can reduce sperm production
  • varicocele, a condition involving large veins in the testicle that can affect the shape and number of sperm
  • lifestyle habits, such as excessive alcohol consumption and smoking
  • cancer treatment involving radiation, certain types of chemotherapy, or surgery to remove one or both testes

Hormonal imbalances

The hypothalamus and pituitary glands produce hormones that regulate testicular function. Various conditions that affect these structures can damage them and alter their hormone production. This can result in in a low sperm count or no sperm.


Some effects of aging may result to problems resulting in male infertility. Examples include:

  • prostate enlargement
  • reduced hormone production
  • complications of advanced diabetes
  • irritable bowel syndrome and other conditions affecting older men

Genetic conditions

Various genetic conditions can lead to a low sperm count or no sperm. This include:

  • Y chromosome microdeletion, a condition that affects sperm production
  • Klinefelter syndrome, a condition that causes small testicles and low testosterone production
  • myotonic dystrophy, a condition in which muscles progressively weaken

Most genetic causes contribute to primary infertility, but can still be a factor in secondary infertility.

Diagnosis of secondary infertility may involve the following:

A medical history

The doctor will ask for information on:

  • previous illnesses, STIs and surgeries
  • any previous pregnancies or births
  • a history of pregnancy loss
  • previous breastfeeding
  • current medication
  • exposure to harmful drugs or chemicals
  • the menstrual cycle
  • damage to the testes

An exam

This may involve a pelvic examination to check the reproductive organs. It can also include the following:

  • semen analysis to look at sperm count and characteristics
  • blood tests to detect hormone deficiency
  • ultrasound to look for structural abnormalities, such as tumors, enlarged veins, or a blockage in the tube that carries the sperm from the testes

Treatment may include the following:

Fertility medication

The main treatment for women with ovulation problems involves clomiphene (Clomid) as well as injections of follicle-stimulating hormone and luteinizing hormone. Clomid causes ovulation, while the injection eggs cause mature and ovulation.

Fertility medications such as clomiphene and other hormonal medications can also help men with fertility issues due to hormone imbalances.


Surgery for women can remove fibroids, endometrial growths, scars or uterine polyps. In some cases, doctors may consider surgery to open a clogged fallopian tube.

Surgery for men can involve the following:

  • repair of a blockage in the sperm transport system
  • reversal of a vasectomy
  • repair of enlarged veins in the spermatic cord, although it may not restore fertility

Supported reproduction technology

If other treatment options do not work, people may consider getting pregnant with assisted reproduction technology. Some options include:

  • the insertion of collected sperm into the uterus
  • squirting a single sperm into an egg
  • mix sperm with an egg outside the body and place it later in the uterus
  • frozen eggs

Experiencing infertility can be emotionally challenging for both partners. The National Fertility Association recommends the following coping strategies:

  • Encourage family members to educate themselves about fertility and let them know how they can help
  • give a spouse or partner permission to feel different
  • to give yourself permission to cry or mourn
  • to tell a spouse or partner how one wants help or support
  • obtaining information on infertility to have an idea of ​​what to expect
  • join an infertility support group

Secondary infertility refers to a couple who cannot become pregnant or continue to term until they have had at least one successful birth in the past. This is not the same as primary infertility, which refers to a couple who have never become pregnant.

Doctors base the diagnosis on a medical history, exams, blood tests and, in some cases, ultrasound. Treatment depends on the cause, but a variety of options are available.

Infertility can take a toll on emotions, but coping strategies, such as joining a support group, can help.


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