Secondary Infertility
If you’re having difficulty getting pregnant or carrying a pregnancy after a previous birth, you may be experiencing secondary infertility. Even if you’ve conceived without difficulty in the past, fertility challenges can occur due to changes in age, health, ovulation or other factors. The fertility specialists at University Hospitals can help identify what may be contributing to your secondary infertility and guide your treatment options.
Schedule a Fertility Consultation
A fertility consultation can help determine which treatment options may be available for secondary infertility based on your unique circumstances.
To schedule, call 216-765-3352.
Quick Facts About Secondary Infertility
- Secondary infertility is difficulty getting pregnant or carrying a pregnancy to full term after a previous birth.
- It can happen even if a previous conception and pregnancy were successful without fertility treatment.
- Possible causes include changes in ovulation, ovarian reserve, uterine health, fallopian tube problems, endometriosis or sperm health in a partner.
- Evaluation includes a medical history review, hormone testing, ultrasound or other imaging, tubal evaluation and semen analysis.
- Treatment depends on the underlying cause and may include ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF), surgery or other fertility treatment options.
- A fertility specialist can help determine which evaluation and treatment options may be right for you.
What Is Secondary Infertility?
Secondary infertility is difficulty getting pregnant or carrying a pregnancy to full term after a previous birth. Even if your previous pregnancy occurred naturally without fertility treatment, secondary infertility can develop later due to changes in your health, age, fertility factors or your partner’s fertility.
A prior successful pregnancy does not mean future pregnancies will be equally easy to achieve. Fertility factors can change over time. For example, ovarian reserve may decline with age, ovulation patterns may shift, uterine or tubal health may change, endometriosis may develop or worsen, or sperm health may be affected by age or other factors. Additionally, new health conditions, medications or lifestyle changes since your previous pregnancy could affect fertility.
Secondary infertility is a recognized fertility condition, and evaluation by a fertility specialist can help identify what may be contributing to your difficulty conceiving or carrying a pregnancy. Even though you’ve had a successful pregnancy before, your current fertility situation may benefit from evaluation and possibly targeted treatment. Many couples experience secondary infertility and successfully conceive and have another baby with appropriate care and support.
Secondary Infertility vs. Primary Infertility
Primary infertility refers to difficulty conceiving for the first time, without a prior pregnancy. Secondary infertility is difficulty conceiving after a successful pregnancy and birth. Both are fertility conditions that benefit from evaluation and treatment.
Your prior pregnancy and birth demonstrate that you and your partner were able to conceive and carry a pregnancy to term. This information helps your fertility specialist understand your baseline fertility and guides evaluation. However, it’s important to recognize that fertility factors can change over time for either partner. Age, health changes, new medical conditions, previous pregnancies or other life circumstances may affect fertility.
When you see a fertility specialist for secondary infertility, sharing your prior pregnancy history, medical records, lab results and imaging from previous pregnancies can be helpful. This information may guide your initial consultation and help your care team understand what has changed since your previous pregnancy. However, even without complete prior records, your fertility specialist can conduct a comprehensive evaluation to assess your current fertility status and identify possible causes of secondary infertility.
What Causes Secondary Infertility?
Secondary infertility can be caused by several factors affecting one or both partners. Changes over time – in age, health, hormones or reproductive factors – can impact fertility. Understanding the possible causes of secondary infertility helps guide evaluation and treatment.
- Ovulation and Hormonal Changes
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Ovulation patterns or hormonal cycles may change over time, making it harder to conceive. Irregular or absent ovulation, cycle length changes or hormonal imbalances can develop even if you ovulated regularly before. These changes may be related to age, stress, weight changes, thyroid disorders or other health factors. Hormone testing and ovulation tracking help assess whether hormonal or ovulatory changes are affecting fertility.
- Diminished Ovarian Reserve
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Ovarian reserve, or egg supply, naturally declines with age as the number and quality of eggs decreases. Even if you had healthy ovarian reserve when you conceived previously, your reserve may have changed since then. Diminished ovarian reserve can make it more difficult to conceive. Evaluation includes hormone testing and ultrasound imaging to count follicles and assess current ovarian reserve.
- Uterine, Tubal or Structural Factors
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Changes in uterine or tubal health can develop after a prior pregnancy. Fibroids, polyps, scar tissue (adhesions) or fallopian tube damage can affect fertility and may not cause obvious symptoms. Pregnancy itself, childbirth or surgery can lead to scarring or structural changes.
Imaging can help identify these structural issues. Ultrasound visualizes the uterus and ovaries. Hysterosalpingography (HSG) is an imaging test that shows the shape of the uterus and whether the fallopian tubes are open. A saline-infusion sonohysterogram (SIS) is another method of assessing the uterine cavity. Hysteroscopy is a procedure that allows your doctor to look inside the uterus to identify – and sometimes simultaneously treat – problems like fibroids, polyps or scar tissue.
- Endometriosis or Pelvic Scarring
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Endometriosis – a condition where tissue that is similar to the uterine lining grows outside the uterus – can develop or worsen over time and may affect fertility. Pelvic scarring from childbirth, surgery or infection can also interfere with conception. These conditions may not have caused problems with your first pregnancy but can affect subsequent fertility. Evaluation and imaging can help identify endometriosis or scarring, and treatment options are available.
- Male Factor Changes
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Sperm count, movement (motility) or shape (morphology) can change over time due to age, health conditions, medications, environmental exposures or lifestyle factors. Even if your partner had normal sperm health when you conceived before, sperm count or quality may have changed. A complete fertility evaluation includes semen analysis to assess current sperm health and guide treatment decisions if needed.
- Unexplained Secondary Infertility
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In some cases, evaluation does not identify a clear cause for secondary infertility. This is called unexplained secondary infertility, and it doesn’t mean your fertility concern is not real or valid. It simply means the cause has not been identified through standard testing. Even without a clear diagnosis, treatment options are available. Your fertility specialist can discuss approaches that may help, such as ovulation induction, IUI or IVF.
When Should You See a Specialist for Secondary Infertility?
If you’ve been trying to conceive or maintain a pregnancy without success, a fertility specialist can help evaluate your situation and discuss next steps. The timing for seeking evaluation depends on your age and individual circumstances.
General guidelines for seeking evaluation include:
Earlier evaluation may be appropriate if:
- You have irregular or absent menstrual cycles.
- You have a history of recurrent pregnancy loss.
- You suspect you may have diminished ovarian reserve.
- You have a known uterine condition such as fibroids or endometriosis.
- There are concerns about male factor fertility (sperm health).
- You have other health conditions that may affect fertility.
- You or your partner are interested in understanding your fertility status sooner.
A fertility specialist can help you understand your fertility and determine which tests or treatments may be appropriate for your situation. Your primary care doctor or OB/GYN can provide a referral to a fertility specialist. You can also contact University Hospitals Fertility Center directly to discuss scheduling and insurance requirements.
How Is Secondary Infertility Evaluated?
Evaluation for secondary infertility involves a systematic approach to understand your current fertility and identify possible causes. Your fertility specialist will recommend appropriate testing based on your individual circumstances.
Step 1: Medical and Pregnancy History Review
Your fertility specialist will review your complete medical history including your prior pregnancy/birth history, how long you’ve been trying to conceive, your current menstrual cycle patterns and any prior fertility testing or treatment you’ve had. Understanding your fertility history and what has changed since your previous pregnancy provides important information that can inform your treatment plan.
Step 2: Ovulation and Hormone Testing
Blood tests measure key hormones that reflect ovulation and reproductive health. These tests help determine whether your ovulation patterns have changed and whether hormonal factors may be affecting fertility. Hormone testing is typically done at specific times during your menstrual cycle for accuracy.
Step 3: Ovarian Reserve Testing
Blood tests to assess your current ovarian reserve may include AMH (anti-Müllerian hormone) and FSH (follicle-stimulating hormone) levels. Transvaginal ultrasound is also used to count antral follicles, the small follicles visible in your ovaries, which provides information about ovarian reserve. These tests assess whether ovarian reserve has changed since your previous pregnancy.
Step 4: Uterine and Fallopian Tube Evaluation
Imaging such as transvaginal ultrasound helps assess the structure of your uterus and identify any fibroids, polyps or other abnormalities. Additional imaging such as hysterosalpingography (HSG), an X-ray test that shows the shape of the uterus and whether the fallopian tubes are open, may be recommended to evaluate tubal health and confirm that the tubes are unblocked.
Step 5: Semen Analysis
Sperm health should be assessed as part of a complete fertility evaluation. Sperm count, movement and shape can change over time, so even if your partner had normal semen analysis results before, retesting may be recommended. Semen analysis provides important information to guide treatment decisions.
Step 6: Diagnosis and Treatment Planning
After evaluation is complete, your fertility specialist will review all results with you and discuss findings. Based on what the evaluation reveals, your specialist will recommend a treatment plan. This may include fertility medications such as ovulation induction, IUI, IVF, surgical treatment for structural issues, endometriosis or other fertility options tailored to your specific situation.
Treatment Options for Secondary Infertility
Treatment for secondary infertility depends on what your evaluation reveals. Your fertility specialist will recommend an approach tailored to your specific diagnosis, age, medical history and fertility goals. Not all patients require the same treatments, so individualized care is essential.
- Ovulation Induction or Timed Intercourse
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If ovulation problems are contributing to secondary infertility, fertility medications may be recommended to stimulate or support ovulation. Combined with timed intercourse or monitoring, this approach may help increase chances of conception.
- Treatment Based on Identified Cause
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Your treatment plan is guided by evaluation findings. If an evaluation identifies a specific cause – such as ovulation problems, structural issues, hormonal issue, or problems with sperm count or quality – treatment will target that cause. If no single cause is identified, your specialist will discuss treatment options based on your age, ovarian reserve and overall fertility picture.
- Intrauterine Insemination (IUI)
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With IUI, sperm is placed directly into the uterus around the time of ovulation, which may improve chances of conception. IUI is often combined with ovulation induction medications. This approach may be considered for certain ovulation problems, unexplained infertility, or mild male factor concerns.
- In Vitro Fertilization (IVF)
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IVF may be considered for secondary infertility patients depending on your specific diagnosis, age, ovarian reserve, tubal health, sperm health and prior treatment response. During IVF, eggs are retrieved from the ovaries and fertilized in the laboratory with sperm, then a resulting embryo is transferred to the uterus. Even though you’ve had a successful pregnancy, your current fertility situation may benefit from IVF depending on the findings from your complete evaluation.
- Surgical Treatment for Uterine or Structural Factors
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When evaluation identifies structural issues such as fibroids, polyps, scar tissue or fallopian tube blockage, surgical treatment may be recommended. Minimally invasive procedures can often correct these issues and improve fertility. Your fertility specialist will discuss whether surgery is appropriate and what to expect from the procedure.
- Donor Eggs or Other Advanced Fertility Options
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Using donor eggs may be discussed as an option when egg quantity or quality is a significant factor. Donor egg IVF uses eggs from a woman with good egg quality, which can improve fertilization and pregnancy rates. Other advanced fertility options may also be appropriate depending on your evaluation and goals.
Secondary Infertility and Fertility Planning
When you meet with a fertility specialist for secondary infertility, your care team will take time to understand your complete fertility picture. Your specialist will review your medical history, prior pregnancy or birth history, current menstrual cycle patterns, any prior fertility testing and your partner’s health factors, if applicable.
Based on this review, your specialist may recommend additional testing to evaluate your current fertility status. Once the evaluation is complete, results will guide treatment decisions. Your care team will discuss whether options such as ovulation induction, IUI, IVF, surgery or other fertility treatments may be appropriate for your specific situation.
What to Bring to a Fertility Consultation
To make the most of your first fertility consultation, bring the following information if available:
- Prior pregnancy or birth history, including delivery date(s) and any complications.
- Details about your current menstrual cycle, including frequency, duration and any irregularities.
- Prior lab results related to fertility, such as AMH, FSH or estradiol levels.
- Prior imaging or ultrasound results from OB/GYN care or prior fertility evaluation.
- Semen analysis results if your partner has had prior testing.
- Notes about any prior diagnoses, treatments or pregnancy complications that may be relevant to your fertility.
Having this information available helps your fertility specialist understand your complete picture and can guide the evaluation process.
Emotional and Support Considerations
Secondary infertility can feel confusing, frustrating and isolating. Unlike primary infertility, you may feel that secondary infertility “shouldn’t” be happening — after all, you’ve been pregnant and given birth before. This confusion is valid. Secondary infertility is a real fertility condition, and the emotional impact can be significant.
You may also feel pressure around age, family planning expectations or from others who don’t understand why conceiving again is difficult. These pressures can add to the emotional weight of secondary infertility.
Seeking evaluation can help clarify what’s happening and provide a sense of direction. Understanding possible causes and exploring treatment options often brings relief and a sense of agency. Additionally, support is available. Many fertility centers, including University Hospitals, offer counseling and mental health services for patients navigating secondary infertility and fertility treatment.
Specialized Care for the LGBTQ+ Community
University Hospitals offers compassionate, collaborative care for the LGBTQ+ community, including fertility and reproductive health services for LGBTQ+ individuals and same-sex couples.
Learn More:
Frequently Asked Questions About Secondary Infertility
- What is secondary infertility?
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Secondary infertility is difficulty getting pregnant or carrying a pregnancy after a previous successful birth. Even though you’ve conceived and given birth before, fertility challenges can develop later due to changes in age, health, ovulation, ovarian reserve, uterine or tubal health, endometriosis, male factor fertility or other factors.
- What causes secondary infertility?
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Secondary infertility can be caused by several factors including changes in ovulation or hormonal patterns, diminished ovarian reserve due to age, fibroids or polyps in the uterus, fallopian tube damage or blockage, endometriosis or pelvic scarring, changes in male factor fertility (sperm count, movement or quality), or unexplained factors. Evaluation by a fertility specialist can help identify what may be contributing to your secondary infertility.
- Why is it hard to get pregnant the second time?
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Fertility factors can change over time for either partner. Even though you conceived successfully before, your current fertility picture may be different now. Age is a primary factor – ovarian reserve and egg quality naturally decline, accelerating after age 35. Additionally, physical changes from pregnancy and childbirth, new health conditions, medications, structural changes in the uterus or fallopian tubes, or changes in male fertility can all affect your ability to conceive a second time.
- When should I see a fertility specialist for secondary infertility?
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Evaluation is typically recommended after 12 months of trying to conceive if you’re under 35, or after six months if you’re 35 or older. If you’re 40 or older or you have irregular cycles, recurrent pregnancy loss, diminished ovarian reserve, uterine conditions or male factor concerns, earlier evaluation is recommended. You can also discuss with your primary care doctor or OB-GYN about whether a referral is appropriate for your situation.
- How is secondary infertility evaluated?
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Evaluation includes medical history review (including your prior pregnancy history), hormone testing to assess ovulation and reproductive health, ovarian reserve testing (AMH, FSH and follicle count), imaging to evaluate uterine and fallopian tube health, and semen analysis to assess sperm health. Your fertility specialist will recommend specific tests based on your individual circumstances. Results guide diagnosis and treatment planning.
- What treatments are available for secondary infertility?
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Treatment depends on what your evaluation reveals. Options may include ovulation induction or timed intercourse for ovulation problems, IUI for certain concerns, IVF depending on your diagnosis and age, surgical treatment for structural issues, or donor eggs if egg quality or quantity is significantly affected. Your fertility specialist will recommend an approach tailored to your specific situation.
- Does IVF work for secondary infertility?
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Yes, IVF can be an effective treatment option for secondary infertility depending on your specific diagnosis, age, ovarian reserve, tubal health, sperm health and prior treatment response. Even though you’ve had a successful pregnancy before, your current fertility situation may benefit from IVF if your evaluation indicates it’s appropriate.
What to Know About Fertility at Every Age
Trouble Conceiving? Some Possible Reasons Why
The Path to Parenthood: Support for Your Fertility Journey
Learn More and Next Steps
Your fertility care may involve additional treatments and services. Explore these resources to understand your full range of care options.
- Intrauterine Insemination (IUI) – IUI may be recommended when ovulation problems, unexplained infertility or mild male factor concerns contribute to secondary infertility. Learn about IUI.
- In Vitro Fertilization (IVF) – IVF may help retrieve and fertilize available eggs. Learn about IVF and how it works.
- Reproductive Surgery – If structural issues like fibroids, polyps or fallopian tube blockage are identified, surgical treatment may be an option. Learn about reproductive surgery.
- Fertility Center Hub – Access all fertility services and resources at UH.
Schedule a Fertility Consultation
Understanding your secondary infertility diagnosis and exploring treatment options is an important step in your fertility journey. UH Fertility Center provides comprehensive fertility care with experienced reproductive endocrinologists who can evaluate your individual situation and help you create a personalized treatment plan.
Ready to discuss secondary infertility and your fertility options?
A fertility consultation can help determine which treatment options may be available for secondary infertility based on your unique circumstances.
To schedule, call 216-765-3352.