secondary infertility

Secondary infertility: What can you do?

Secondary infertility is more common than you think, but there’s also plenty of help available, says Sarah Breen.

For many Irish couples, conceiving a baby doesn’t require much thought. For others, it involves careful planning, meticulous timing and sometimes even medical help.

While primary infertility is the subject of countless books, TV storylines (like Charlotte’s case in Sex and the City) and movie plots, secondary infertility, which occurs after a woman has successfully conceived once, rarely gets a look in. But the reality is that secondary infertility is on the rise. And it doesn’t take into consideration whether that first pregnancy actually ended with a baby. A miscarriage still counts as a pregnancy.

“About six out of every 10 couples we see are suffering from secondary infertility,” says Dr Ahmed Omar, Medical Director at Beacon CARE Fertility Clinic ( “One of the main reasons why it’s on the increase is that women are trying for their first child a little bit later in their reproductive life. That makes it even more difficult to have a second child. Another factor is that couples are leaving longer gaps between children for reasons like schooling and careers.”

Many causes

“When you have primary infertility, there’s a whole host of different potential reasons for it,” explains Dr John Kennedy, a consultant at Sims IVF ( “If you’ve gotten pregnant before, we can rule out a lot of them. The most common thing that has changed since then is the passage of time. Maternal age is a huge factor.”

It’s no secret that a woman’s fertility peaks in her 20s and declines with age. From 31 it drops by about three per cent every year. After 35 that decline accelerates even faster. According to the CSO, in 2013 the average age of a first-time mum in Ireland was 32.

While the vast majority of women in their early 30s will have little trouble conceiving, the reality is that the older you are, the harder it can be. And a year or two later it can be harder still. Medically speaking, a pregnancy where the mother is 35 is known as geriatric. Slightly unbelievable in this day and age, but true nonetheless.

Other common causes of secondary infertility include an ovulation disorder, endometriosis, damage to the fallopian tubes and pelvic inflammatory disease as a result of contracting a sexually-transmitted infection.

“Pelvic inflammatory disease is largely asymptomatic,” says Dr Kennedy. “People don’t realise they have it. When I worked in a large maternity hospital, we screened a cross section of 20 to 35-year-old women who were attending the public gynaecology clinic for various different reasons. We found a rate of chlamydia of 25%. A lot of women who have chlamydia won’t have any problems getting pregnant, but it can block the tubes and cause infertility.”

Secondary infertility

The clock is ticking for men too

And although they have been known to father children well into their 70s – and beyond, men have ticking biological clocks too. The quality of their sperm starts to deteriorate as they get older and it can also be affected by changes in weight, which increases oestrogen.

“Sperm are very, very sensitive to change,” says Dr Kennedy. “And as we get older, we tend to gain weight. That’s not good for fertility.”

Help is out there

The good news about secondary infertility is if you’ve gotten pregnant once, there’s the assumption that you can do it again. Maintaining a healthy weight, eating a nutritious, balanced diet, controlling stress, not smoking and drinking conservatively can all help. However, some medical intervention may also be required to seal the deal.

“If you’re under 35, and you’ve been actively trying to get pregnant unsuccessfully for over a year, I would suggest going to see your GP or a fertility specialist,” advises Dr Omar. “If you’re 36 or older, you can reduce that time frame to six months.” For couples that are having difficulty conceiving the second time around, an investigation can shed some light on what might have changed.

“We would check the fallopian tubes, look at ovulation and do a semen analysis,” says Dr Omar. “Treatment would be based on the results of those tests. If the infertility is unexplained, maybe artificial insemination might be something to consider, or if there’s damage to the tubes or a problem with the sperm, IVF could be the way forward.”

Embarking on certain fertility treatments can be costly, however for many couples having another child is more than worth the expense and effort. And the good news is that techniques are evolving and improving all the time so, with a little help, the success rate for treating secondary infertility in many cases is excellent.

“The best indicator of future success is previous success,” says Dr Kennedy. “I’m always especially reassured to see people who have had children already, because I know they can do it. It’s just a question of getting them to do it again.”

It’s mentally draining

Dealing with secondary infertility can be very emotional, stressful and hard to accept for couples who feel their family is incomplete. After months of trying with no success, they’re exhausted and a bit shocked. As they watch their friends’ families grow, they can be confronted with regular reminders of their inability to conceive. If they already have a child, they can also feel guilty for not being able to provide a sibling.

Family members who jokingly tell them to hurry up and try for another certainly don’t help, nor do the people who say, “Just relax and it will happen when the time is right.” On the other hand, if they choose to reveal their struggle with infertility, there can be a perception that they should be satisfied just having one child. Couples feel that they’re not allowed to grieve the loss and it can be very painful to endure.

“The couples I meet often feel frustrated and irritated more than being upset or disappointed,” says Dr Kennedy. “Other people tend to demonstrate a lack of understanding, saying things like “oh, aren’t you happy with your lot?” and that’s a difficult thing to deal with.”

More like this:

Stress and fertility
Acupuncture and infertility
Infertility and relationships

Ask Tracey

Midwife Tracey Donegan answers your questions about pregnancy and birth

Q When should I have my first pregnancy scan? And how many scans should I get throughout my pregnancy?

Your first scan is known as your dating scan and is routine in all hospitals. Most mums will have this scan at their booking visit, which can be anywhere between 12-18 weeks. The earlier the scan the more accurate it will be. If you have experienced recurrent miscarriages some hospitals will scan you earlier. Contact your antenatal clinic for more information. In Ireland, most women will have two scans in a healthy pregnancy – a dating scan and an anomaly scan at around 20 weeks. However, some units provide a dating scan only. Private scans are also available in most cities and many parents use these services for additional reassurance and to find out the sex of their baby.



Q My son is 18 months old and has just started saying his first words. It is an extremely exciting time in our house and my husband and I are eager to encourage his speaking as much possible. What advice would you give us on how we can foster this without bombarding and confusing him?

AThere is nothing better than hearing your baby begin to talk. All the hard work you have put in over the last two years is coming back tenfold.
Toddlers will vary significantly with ability and speed of which they talk however a guide would be about 50 words by 2 years of age. The most important thing to watch for is that your baby/toddler is cooing and babbling and begins to string sounds together like “Mama/Dada” They should have a wide range of speech sounds and like to imitate you and things they hear.
There are many ways that you can promote Speech and Language development at home:
1. Slowing down your own speech and taking time over conversations with your little one. Every day is a new experience when you are 18 months, nappy changes, bath time, baking a cake brings endless opportunity for you to interact and offer new words for them to hear and repeat. Make eye contact, smile and use exaggerated tones to keep things interesting and fun for your tot.
2. Review the toys that you have on offer to your tot and ensure that they give plenty of open ended play opportunities. Role play is a wonderful way to allow children to take the lead. Kitchens with lots of plates, cups and pots. Fill the pots with dry pasta and allow your child to cook and serve you. Playdoh, painting, gardening and sandpits are also great for allowing your child to take the lead and babble about what they are doing. Read plenty of books together and point and allow them time to answer any questions that you ask.
3. Limit screen time. Overuse of televisions and iPads do not give your child opportunity to interact in a two way manner.
4. Ask your child lots of open ended questions “What’s that?” “Where are we?” Point at things they know the answer to for boosting confidence (Car/ Car, etc.) When they don’t know the answer, explain it to them. Limit baby talk and speak clearly with good pronunciation, remember you are the teacher and they will copy you.
If you are concerned about your child’s speech and language development, be sure to speak with your GP or developmental Health Nurse. They are very skilled at understanding the difference between speech delays and spotting something that may require professional attention.
Enjoy watching their little brains absorb the world around them and listen to what they have to say. It won’t be too long before they won’t stop talking to you, asking “Why Mummy/ Daddy?” every 5 minutes….