what is secondary infertility

What Is Secondary Infertility and How Is It Treated?

7 min read

Secondary infertility can come as a shock if getting pregnant the first time happened easily. Plus, there are the demands of dealing with this emotional and physical toll while also balancing the duties of parenting. Here, we dive into secondary fertility—what it is, what causes it and how it can be treated.

What is secondary infertility?

Infertility is defined as the inability to get pregnant after a year or more of having unprotected sex, for those 35 or younger. That timespan shrinks to six months if you’re over the age of 35. But what if you’ve been able to get pregnant before?

Primary vs secondary infertility

Under the umbrella of infertility, there are two types. For those who have never been pregnant, it’s called primary infertility, but if you’ve had a successful pregnancy in the past and are now having troubles, you’re considered to have secondary infertility.

How common is secondary infertility?

Infertility is said to affect about one out of every five to eight couples. Within that, the split between primary and secondary infertility varies by study, but a CDC survey reported that 19 percent of married women between 15 and 49 years old experience primary infertility and 6 percent experience secondary infertility. When it comes to treatment, about one third of IVF cycles is a case of secondary infertility.

What causes secondary infertility?

The causes of secondary infertility can be very similar to those behind primary infertility: egg and sperm quality (which decreases with age), STIs, conditions like PCOS and endometriosis, or certain lifestyle choices. Additionally, complications from a previous pregnancy or surgery can play a role.

Aging is a biggie that presents major challenges. Egg aging happens relatively quickly after the age of 35—by the time you reach your forties, your chance of conceiving on your own drops to five percent or less each cycle.

In part, the lower odds stem from the fact that aging contributes to poorer energy production in your eggs and a greater likelihood of chromosomal mishaps. Cell division and DNA replication become less efficient and accurate, so more mistakes get made. Plus, the batteries that your eggs run off don’t recharge as well as they used to, so their power and ability to provide that egg with energy takes a dip, especially over the age of 37. All of this means that not only does the quantity of eggs decrease (ICYMI: we’re born with all the follicles—think of these as pre-eggs—we’ll ever have), so does their quality compared to your 20- or 30-year-old eggs.

It doesn’t help that as we get older, our bodies’ abilities to repair DNA damage weakens. You may have noticed some differences in your body today compared to when you were in your twenties. Maybe you could deal with little sleep or lots of alcohol better. Maybe you’re noticing more fatigue or injuries from exercise. The body just doesn’t perform to the same degree and there’s more wear and tear. On a cellular level we call this oxidative stress, which is when an excess of free radicals causes damage to our cells. Free radicals are chemicals produced from our normal metabolism but can also be introduced through certain foods and beverages, air pollution, toxins and drugs that we ingest, inhale or absorb through our skin.

Free radicals can be dangerous because they are super reactive. They are desperate to cling onto other molecules and when they do so, they can create reactive oxygen species or reactive nitrogen species. These are what stress your cells out. Your body makes and uses antioxidants to help control the pest (free radical) population, but what you subject your body to over time can increase the amount of these free radicals hanging around. When the amount of free radicals overpowers the amount of antioxidants, those free radicals can start damaging cells (including egg and sperm), DNA, mitochondria (those energy producers or “batteries” of your cells). This is a major factor in both egg and sperm quality.

Can males also experience secondary infertility

Absolutely! Aging causes other changes that can affect the ability to conceive, such as poorer cardiovascular health. This is especially true for people with sperm: unhealthy diets and lifestyle choices affects penile blood flow and can cause erectile dysfunction. This occurs almost 20 percent more often in couples with secondary infertility versus primary. (P.S. This is also a wake-up call for your heart health. The arteries in the penis are incredibly small so when they stop functioning properly, it means your larger arteries (including those around the heart) could be next.) The most common cause of secondary infertility in males in the development of a varicocele (enlargement of the veins in the scrotum which happens when blood pools instead of circulating).

What can I do to improve egg and sperm quality?

Whether aging is a factor for you or not, there are proven ways to improve egg and sperm quality:

1. Take a prenatal with Vitamin B12 and Folic Acid.

Vitamin B12 and Folic Acid are used to make and control DNA. Getting these nutrients from a high-quality prenatal can provide the co-factors that are needed for proper cell and DNA division. Folic Acid and Vitamins B6 and B12 also all work together in a process called methylation. This is a process with multiple functions including turning genes on and off, and helping detoxify harmful chemicals. (Get the trio—and more—in bioavailable forms your body can absorb in both Bird&Be’s The Prenatal Essentials for Females and The Power Prenatal for Females.)

2. Avoid smoking and alcohol.

Cigarette smoke contains thousands of chemicals that stop you from getting pregnant in multiple ways. Smoking and nicotine increase oxidative stress, decrease egg quality, interfere with egg movement along the fallopian tubes and cause uterine changes that can prevent implantation.

For sperm the consequences of cigarettes are even higher as preconception smoking is linked to greater sperm DNA mutations and chromosomal abnormalities. These decrease the chances of getting pregnant, and in the event of conception, there’s an increased chance of childhood cancers, developmental malformations and infertility.

Wondering about booze? Alcohol is a toxic substance that your liver must process, detoxify and remove from your body, which requires enzymes and resources. Assigning this task to your liver takes those enzymes and resources away from your liver’s other tasks like metabolizing and detoxifying estrogens. Alcohol also affects other enzymes in your body that convert sex hormones. So consuming alcohol can affect estrogen, testosterone and progesterone levels. One study found that having three or more alcoholic drinks in the two weeks post-ovulation decreased the chance of pregnancy and that binge-drinking decreased the chance of implantation and pregnancy by 19 to 41 percent.

In testicular fertility, long-term drinking (at about six to seven drinks per day) has been linked to higher estrogen, low testosterone levels, low semen volume, poor sperm counts and decreased sperm motility.

3. Reduce or eliminate your intake of saturated fats and trans fats, processed and red meat, processed sugars and simple carbohydrates.

This means ditching the fried foods, margarines, candy and junk foods, fast foods, hot dogs and white breads. Avoid smoked or charred meats which can introduce more oxidative stress and need to be detoxified by your liver. Instead, load up on the top five foods for your fertility diet.

4. Eat more fruits and vegetables.

Fruits and vegetables are a great source of fiber and some, like berries, are high in free radical–fighting antioxidants. The anthocyanin pigment which gives berries their red to purple colour is a great antioxidant and can also be found in different varieties of vegetables too such as purple cauliflower and red cabbage.

5. Supplement with antioxidants

If you’re over the age of 35 or have been flagged with low-quality sperm or eggs, you’ll want to boost your antioxidant supply. CoQ10, L-Carnitine and Vitamin E are all mighty antioxidants that can improve egg and sperm quality—and you can find all three in each daily sachet of Bird&Be’s The Power Prenatal for Females and The Powers for Males.


CoQ10 works its magic directly in your mitochondria, those cellular batteries that take fuel and churn out cell energy. CoQ10 helps the mitochondria pump out more energy (eggs and sperm needs lots of energy to do their jobs), while also providing antioxidant protection to prevent mitochondria from getting damaged.


L-Carnitine is an antioxidant that helps shuttle the CoQ10 into the mitochondria so they can get to work. Preconception supplementation with L-Carnitine has been shown to improve egg development and egg quality.

Vitamin E

Vitamin E is a great antioxidant for eggs, sperm, uteruses, and penile blood flow. It helps protect against blood vessel damage and plaque buildup in the arteries. Better penile blood flow means more effective erections and ejaculation, and in the uterus, it means better conditions for implantation.

When to see a doctor for secondary infertility?

If you fall into the category of secondary infertility, it’s time for a fertility workup. Talk to your doctor and get referred to a fertility clinic that can give you a proper assessment. This will include full-profile hormonal testing on certain days of your cycle (usually cycle day 3 and cycle day 21), including a look at FSH (follicle-stimulating hormone) and AMH (anti-müllerian hormone), which are both used to estimate your egg reserve.

The person providing the sperm in this equation also needs to undergo testing. Sperm testing via a sperm analysis is a relatively non-invasive, easy test to screen for abnormal sperm counts and swimming ability (motility). An additional test called DNA fragmentation can be added on to check for breaks in the sperm’s DNA. (If you’re on a waitlist or want to check in sooner, our At-Home Sperm Test can flag if low motile sperm concentrations are lowering your odds of conception.)

You can also use ovulation tests (A.K.A. ovulation predictor test kits or OPKs) to keep an eye on your cycles. Red flags like irregular or very long cycles (like going more than 35 days without any menstrual bleeding) or a lack of LH (luteinizing hormone) surge are cues that you might want to talk with your doctor before hitting that one-year/six-month mark.