What to Know About Secondary Infertility

Jun 28, 2023


Alto Pharmacy

There’s a spectrum of infertility experiences. The 11% of US couples affected by secondary infertility first have difficulty conceiving after previously giving birth without fertility treatment.

Infertility can be overwhelming to navigate regardless of when it occurs in the family building journey. And secondary infertility can bring unique challenges of its own. Fortunately, the condition is just as treatable as primary infertility, or difficulty becoming pregnant for the first time.

Here’s what to know about causes, treatment options, and support resources for secondary infertility.

What causes secondary infertility?

Like primary infertility, secondary infertility can be caused by female reproductive factors, male reproductive factors, a combination of both, or unknown causes.

Causes of secondary infertility in women and people assigned female at birth

Problems with egg quantity or quality

Women become less fertile as they age, with a significant decline in the quantity and quality of their eggs from the mid 30s until they eventually reach menopause. Lower-quality eggs are more likely to have chromosomal abnormalities, which increases the chance of miscarriage and reduces the chance of a successful pregnancy.

Structural issues with reproductive organs

Blocked or damaged reproductive organs, specifically the fallopian tubes or uterus, can result in secondary infertility. There are several potential reasons for damage to the female reproductive organs.

  • Complications related to sexually transmitted infections (STIs) like pelvic inflammatory disease (PID), chlamydia, or gonorrhea can block the fallopian tubes.

  • Procedures such as dilation and curettage (D&C) or a c-section delivery can cause scarring in the uterus.

  • Benign polyps or fibroids may block fallopian tubes or interfere with the implantation of a fertilized egg, or embryo.

Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is characterized by a hormone imbalance that impacts ovulation. It is a leading cause of female infertility.


Endometriosis occurs when tissue that should only grow in the uterus implants and grows elsewhere. The abnormal tissue growth — as well as surgical procedures to remove it — can block the fallopian tubes, preventing the fertilization of an egg. Endometriosis can also interfere with embryo implantation.

Changes in weight or other lifestyle factors

Being underweight or overweight can both impact a woman’s fertility. So can behavioral or lifestyle factors including smoking and substance use.

Causes of secondary infertility in men and people assigned male at birth

Male infertility most often stems from issues with sperm production, including sperm quality, motility, or quantity. Contributing factors may include the following.

  • Reduced testosterone levels

  • Decline in the quality of semen, the fluid that carries sperm

  • Low sperm count

  • Health conditions including hormone, pituitary gland, or immune system problems and genetic conditions like cystic fibrosis

  • Certain medications and medical treatments, including some blood pressure and arthritis medications and treatment for cancer, urinary tract infections, and more

Why is it different this time around?

If you are experiencing secondary infertility, you may be wondering why it’s more difficult to conceive than before. Here are some reasons why a fertility issue may develop later in life.


Both male and female fertility change over time. The quantity and quality of a woman’s eggs decline with age. There is a similar, though not as severe, relationship between age and sperm quantity and quality. It’s also possible that a fertility issue has become more severe over time. 

New health issues or habits

Physical changes, new health issues, or lifestyle factors can influence a male or female partner’s fertility. Weight gain or loss or shifts in habits like smoking or substance use may lead to more difficulty conceiving.

A new diagnosis of pelvic inflammatory disease, chlamydia, or gonorrhea is another potential factor in secondary infertility.

Taking a new medication could also change a person’s fertility. For example, common treatments for high blood pressure, arthritis, seizures, or ulcerative colitis can impact sperm quality. And treatment for certain types of cancer can also affect both male and female fertility.

Fertility issues caused by a previous pregnancy or birth

Structural issues with the fallopian tubes or uterus can develop as the result of a complication from a previous miscarriage, pregnancy, or birth.

When to seek treatment

The timeline for seeking treatment for secondary infertility is the same as that for primary infertility and depends on your age. 

  • If you are under 35, most health experts suggest consulting a reproductive specialist after a year of trying to conceive.

  • If you are between 35 and 40, you may want to pursue testing or treatment after six months of trying to become pregnant.

  • If you are over 40, you may want to pursue testing or treatment before you start trying to conceive.

It’s important to be proactive about seeking treatment for secondary infertility. To increase your chances of success with treatment, don’t wait to pursue a consultation with a fertility specialist based on your past experience(s) conceiving.

It is also recommended to pursue testing or treatment before trying to conceive if you or your partner have any of the following risk factors for secondary infertility:

  • A history of a sexually transmitted infection such as pelvic inflammatory disease

  • Irregular periods

  • A history of one or more miscarriages

  • Low sperm count

Common treatment options for secondary infertility

There are many treatment options that can help increase your chances of conception. The most effective course of treatment depends on the underlying cause of your or your partner’s fertility issues. These are some common treatments for secondary infertility.

  • In vitro fertilization (IVF) is a form of assisted reproductive technology (ART) in which eggs and sperm are fertilized in a laboratory and then placed into the uterus with the potential outcome of a pregnancy. In addition to treating female infertility, IVF can also be used when male infertility is a factor.

  • Intrauterine insemination (IUI) is a type of artificial insemination in which sperm that have been washed and concentrated are placed directly into a woman’s uterus during ovulation.

  • Injectable fertility medications like gonadotropins and oral fertility medications such as Clomid® and Femara® can treat fertility-related hormonal imbalances in women.

  • Oral fertility medications such as Clomid®, letrozole (Femara®), and anastrozole (Arimidex®) and injectable gonadotropin therapy are common treatments for male infertility.

The importance of support

Secondary infertility can be a difficult and emotionally complex diagnosis to process. The need for support is just as great as it is for primary infertility. It’s often helpful to connect with others who have faced similar challenges. RESOLVE: The National Infertility Association offers virtual and in-person support groups specifically for secondary infertility.

To learn more, search their directory of support groups by topic.

Choose the right fertility pharmacy

Fertility treatment can be a challenging journey, but Alto is with you every step of the way. We offer reliable same-day delivery of your medications and fertility resources like personalized injection guide videos and access to fertility-trained pharmacists.

Interested in learning more about how Alto can support your treatment? Request a price quote online or reach out through secure in-app messaging.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

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