Overview
Things change between pregnancies, for both partners. A fertility check for both of you usually finds a clear direction.
Common causes
- Age: egg quality and number fall over time
- Tubal damage after infection, a previous ectopic pregnancy or pelvic surgery
- Changes after a caesarean section, such as adhesions or a scar defect in the uterus
- Uterine problems such as fibroids, polyps or scar tissue after a previous procedure
- Changes in sperm quality with age, illness, weight or medicines
- Weight change, thyroid problems or PCOS
When to see a specialist
After 12 months of trying, or after 6 months if the woman is 35 or older. Come sooner if periods have become irregular or there has been a pelvic infection or surgery since the last pregnancy.
Tests and treatment
The tests are the same as for any couple: egg reserve, ovulation, the tubes and uterus, and a semen analysis. Treatment then follows the cause, from ovulation induction or IUI to hysteroscopy, laparoscopy or IVF.
Questions about secondary infertility
Why can't we conceive when our first child came easily?
Fertility can change with age, health, weight, infections, surgery such as a caesarean, and changes in sperm quality. A check for both partners usually finds the reason.
Can a caesarean section affect fertility?
Sometimes. It can lead to adhesions or a small scar defect in the uterus. An ultrasound or hysteroscopy can check for this.
Does the male partner need testing again?
Yes. Sperm quality can change over the years, so a new semen analysis is part of the check.
Is treatment for secondary infertility different?
The tests and treatment options are the same as for a first pregnancy. The plan depends on what the tests find.
