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What Is Secondary Infertility? 6 Ways to Manage

Melissa Wallace
Melissa Wallace

Secondary infertility refers to the inability to become pregnant or to carry a baby to term after previously giving birth. Here's what to know.

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Secondary infertility refers to the inability to become pregnant or to carry a baby to term after previously giving birth. Here's what to know.

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Secondary infertility refers to the inability to become pregnant or to carry a baby to term after previously giving birth. Here's what to know.

So, you’ve already had a baby and you’re ready for another — but things aren’t coming as easily the second time around. You might be experiencing a phenomenon called "secondary infertility."

If you’re having trouble conceiving a second time, you’re not alone. Secondary infertility is just as common as primary infertility, affecting about one in ten women. Yet unlike primarily fertility, it can be an emotionally difficult condition to navigate as you raise your first child. Here’s how to manage.

What it is     Causes     Diagnosis     Treatment   How to manage

What is secondary infertility?

According to the Mayo Clinic, secondary infertility is defined as the inability to become pregnant or to carry a baby to term after previously giving birth. The National Center for Health Statistics (NCHS) estimates that there are more than three million women in the US with one child that have had a difficult time getting pregnant again, or carrying another baby full-term.

But we need to talk beyond the statistics, because secondary infertility is emotionally difficult on both us and our partners. Because we already have a child, it’s difficult to not be immersed in a world where you’re constantly reminded of your inability to conceive.

“When my wife and I had our first child, we got pregnant pretty easily. Honestly, as I look back on it, it had to have been the very first or second cycle we were trying. Unfortunately, today, we are here two years into working on our second and no luck. We constantly talk about whether or not it's too late now. It's the single biggest strain on our relationship." - Jerome, CTO & Co-Founder at Oova  

>>RELATED: How Infertility Can Affect Your Relationship — And What To Do About It

Infertility vs. secondary infertility

What’s the difference between infertility and secondary infertility? Secondary infertility is a type of infertility that occurs when a person has trouble conceiving their second child. When someone has second infertility, they’ve already been able to become pregnant once. Primarily infertility is when someone hasn’t been able to conceive and carry a pregnancy to term.

Causes of secondary infertility

The causes of secondary infertility are often similar to the causes of primary infertility, with the main difference being that the couple has already been able to conceive once before. Partners of any gender can contribute to secondary infertility.

Some causes of secondary infertility include:

  • Increased age: It can be more difficult to conceive as you age — so if you’re a few years older than when you first conceived, age may be a factor. (Learn what to know if you’re trying to conceive after 35.)
  • Hormonal imbalances: Hormonal imbalances can disrupt your menstrual cycle and ovulation window, making it harder to conceive. Changes like irregular cycles, shorter or longer cycles, or heavier or lighter flow, can indicate that you may have hormonal imbalances that affect your cycle.
  • Changes in sexual health: Signs of secondary fertility can come from either partner! If you or your partner is having changes in sexual health like erectile dysfunction or difficulties with ejaculation, it can affect the ability to conceive and therefore increase chances of secondary infertility.
  • Lifestyle factors: Factors like excessive alcohol consumption, smoking, drug use, poor diet, and even stress can impact fertility in partners of any gender.
  • Reproductive disorders: Reproductive disorders like polycystic ovarian syndrome (PCOS) and endometriosis can affect ovulation and therefore make it more difficult to conceive.

How is secondary infertility diagnosed?

For a professional to give a secondary infertility diagnosis, they’ll need to evaluate both partners’ medical history and current physical state. Before diagnosis, a doctor will likely go through:

  • Medical history, including information about previous pregnancies, or changes in health and lifestyle
  • Physical examination, to assess overall health
  • Ovulation assessment, to assess if ovulation is occurring
  • Semen analysis, to assess a male partner’s sperm count, motility, and morphology
  • Hormone testing, to identify an hormone imbalances

Secondary infertility treatment

Is secondary infertility treatable? Just like primary infertility, secondary infertility can be navigated and there is hope for conceiving a second time. Some common secondary fertility options include addressing underlying health conditions, medication, assisted reproductive technology, and lifestyle modifications.

Addressing underlying health conditions

First, a doctor may recommend treating underlying health conditions like hormonal imbalances, infections, or inflammation that can be contributing to infertility. They may also help you manage conditions like endometriosis or work with you on PCOS treatments.

Medication

If you’re ovulating irregularly — or not at all — medications like clomiphene citrate or letrozole can help induce ovulation.

Assisted reproductive technology (ART)

Assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF) can help increase the chances of conception and help overcome fertility challenges like low sperm count and age-related decline in fertility.

Lifestyle modifications

Certain lifestyle changes can potentially have a positive impact on fertility in both partners. Both partners may aim to maintain a healthy weight, eat a balanced diet, reduce stress, get enough sleep, exercise regularly, and avoid smoking and excessive drinking.

>>RELATED: Oova 101: How to Reduce Stress

How to manage secondary infertility

Now that we know what causes secondary infertility and treatment options, we can start to try to manage it emotionally. When we begin to recognize the pain we're going through, understand it, deal with it, and get the support we need, we really can get through secondary infertility.

1. Make time for yourself.

It can seem absolutely impossible to find time for ourselves. And let’s not forget the guilt that comes with not dedicating every moment to our current child. But here’s what we need to remember — when we take care of ourselves, we're able to better take care of others.

Start with just 15 minutes a day. Each week, add a little more time to that. If your child is under three years old, it’s possible you are not getting a good night's sleep. It’s okay to accept that it’s going to be tough to get an hour at the gym if you're tired. So start with just enough time for some stretching, a brisk walk, meditation — time dedicated to you.

As we dedicate more time to ourselves, we can be more in tune with our bodies. Once we know what our stressors are, we're able to manage unexpected changes that come from them.

2. Identify what's changed.

Life moves so fast, and the stressors we had the first time we got pregnant are not the same as they were in the past. Factors ranging from age to diet can have an impact on fertility. We go back to work and things are never the same, especially now we’ve got a little one at home to get back to.

The best thing we can do is pinpoint the areas in our lives that are causing that stress. Here are a few things to consider.

  • Recent life changes
  • Surgery or new medications
  • Diet, exercise and routine
  • Lack of sleep

3. Have a plan.

Especially if getting pregnant the first time was easy, we may not know what's ahead for us as we manage through secondary infertility. Planning can help address things in advance and avoid stressful, last-minute decisions.

How can you get ahead? Try planning by:

  • Creating a fertility roadmap
  • Learning what treatments are available to you
  • Understanding which treatments are you willing to consider and when should you undergo them
  • Tracking your budget and how much are you willing to spend

>>RELATED: Infertility is Expensive. Here Are 7 Ways To Save Money When Trying to Conceive.

4. Ask for support.

We should never feel like we have to fight infertility alone. There are so many emotions we go through, like the feeling of inadequacy that seeps in, or the guilt you feel because you already have a beautiful child, while others struggle to have their first.

It can be so hard to discuss with your partner, family and friends about any and all of this. But it’s really important to talk about how we’re feeling and lean on the support of others to help us cope.

In addition to those close to you, seek a community to connect with on Facebook or through sites like RESOLVE. When we say “we are not alone,” just remember: three million women have faced secondary infertility. We can help one another.  

5. Reach out to your doctor or a fertility specialist.

It’s never too soon to get support from a medical professional, like a reproductive endocrinologist. There are a few guidelines to follow to determine when it’s time to call the doctor:

  • If you are under the age of 35, and have been trying to conceive for at least one year
  • If you are over 35 and you have been trying to conceive for at least six months without success
  • If you have ovulation concerns, have missed or irregular periods, have a history of pelvic infection or have tubal damage or endometriosis
  • If you have had two or more miscarriages

6. Track your ovulation cycle.

Tracking your fertile window through your ovulation cycle is a great way to understand your fertility. Oova’s test kit will not only show you if and when you’re ovulating, but also give you a personalized view of your luteinizing hormone and progesterone levels so you can identify any potential hormonal imbalances.

Managing secondary infertility: the bottom line

Secondary infertility is just as common as primary infertility, but it’s a uniquely difficult emotional experience to navigate as you take care of your first child. Secondary fertility can be caused by a variety of factors from partners of any gender, but there are numerous treatment options depending on your situation. When managing secondary infertility, know that you’re far from alone, and that the right support and medical knowledge can help you through your fertility journey.

About the author

Melissa Wallace

Sources

perimenopause-periods
Should I still see my gynecologist if my periods are just "weird" but not painful?
Yes. Annual visits remain important during perimenopause. Your provider can help determine if your "weird" periods are typical perimenopause changes or something requiring attention. They can also discuss management options to improve your quality of life.
perimenopause-periods
How long do irregular periods last before menopause?
Irregular perimenopause periods typically last 4 to 8 years before your final period, though this varies greatly. Some women experience irregularity for just a few months, while others have irregular periods for over a decade before reaching menopause.
perimenopause-periods
Is it normal to have two periods in one month during perimenopause?
Yes, this can happen, especially in early perimenopause when cycles shorten. You might have a 21 day cycle, meaning you could have a period at the beginning and end of the same calendar month. Track these patterns to distinguish between short cycles and abnormal bleeding.
perimenopause-periods
Why are my periods suddenly so heavy in my 40s?
Heavy perimenopause periods often result from estrogen dominance. When progesterone drops but estrogen remains high, your uterine lining builds up more than usual, causing heavier bleeding when it sheds. This is common in perimenopause but should be evaluated if it affects your daily life.
perimenopause-periods
Can I still get pregnant if my periods are irregular during perimenopause?
Yes. As long as you're having periods, even irregular ones, you may still be ovulating. Pregnancy is possible until you've gone 12 full months without any period. If you don't want to become pregnant, continue using contraception throughout perimenopause.
perimenopause-and-weight-gain
Can you prevent perimenopause weight gain completely?
While you may not prevent all weight changes during perimenopause, you can minimize gain through proactive strategies. Starting strength training before perimenopause, maintaining consistent sleep habits, and managing stress can help your body adapt to hormonal changes more smoothly. Remember, some body changes during this transition are normal and healthy.
perimenopause-and-weight-gain
At what age does perimenopause weight gain typically start?
Perimenopause weight gain can begin in your late 30s or early 40s, often coinciding with the first hormonal changes. Many women notice gradual changes starting 5 to 10 years before their final period. The timing varies greatly based on genetics, lifestyle, and overall health.
perimenopause-and-weight-gain
Does everyone gain the same amount during perimenopause?
No. Perimenopause weight gain varies significantly. Some women gain 5 pounds, others 20 or more, and some maintain their weight. Factors include genetics, starting weight, activity level, stress, sleep quality, and how dramatically hormones fluctuate. Your experience is unique to your body.
Is perimenopause weight gain different from regular aging weight gain?
Yes. While metabolism naturally slows with age, perimenopause weight gain has distinct characteristics. The hormonal shifts cause fat redistribution to the midsection, even if overall weight doesn't change dramatically. This abdominal weight gain pattern is specifically linked to declining estrogen and progesterone, not just aging.
perimenopause-and-weight-gain
Will the weight come off after menopause?
Perimenopause weight gain often stabilizes after menopause when hormones level out, but the weight doesn't automatically disappear. The metabolic and body composition changes that occur during perimenopause tend to persist. However, with consistent healthy habits, weight management becomes more predictable post menopause than during the fluctuating perimenopause years.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I take progesterone if I'm breastfeeding?
Yes, progesterone is generally safe while breastfeeding and doesn't significantly affect milk supply. However, always discuss with your healthcare provider before starting any hormone supplementation while nursing.
https://www.oova.life/blog/progesterone-supplementation-guide
Is it safe to take progesterone throughout pregnancy?
Yes, when prescribed by your healthcare provider. Progesterone supplementation in early pregnancy is safe and can reduce miscarriage risk in women with low progesterone or a history of pregnancy loss. Most providers continue supplementation through the first trimester (weeks 10-12) when the placenta takes over.
https://www.oova.life/blog/progesterone-supplementation-guide
Can progesterone supplementation cause weight gain?
Progesterone can cause temporary water retention and bloating, which may show up as a few pounds on the scale, but it doesn't cause true fat weight gain. Most women don't experience significant weight changes from progesterone supplementation.
https://www.oova.life/blog/progesterone-supplementation-guide
Can I switch from pills to suppositories or vice versa?
Yes, but only under your doctor's guidance. The dosing and timing may need adjustment when switching between forms since they're absorbed differently. Never switch on your own, especially if you're pregnant or undergoing fertility treatment.
https://www.oova.life/blog/progesterone-supplementation-guide
Will progesterone supplementation delay my period?
Yes, progesterone keeps the uterine lining intact, so if you're not pregnant and continue taking progesterone, your period will be delayed. Once you stop taking it, your period should start within 2-10 days. If you are pregnant, progesterone helps maintain the pregnancy and you won't get a period.
https://www.oova.life/blog/progesterone-supplementation-guide
Should I take progesterone pills orally or vaginally?
For fertility and pregnancy support, vaginal progesterone is usually preferred because it delivers higher concentrations directly to the uterus. For perimenopause or general hormone balance, oral progesterone often works well and is more convenient. Your doctor will recommend the best route based on your specific needs.
https://www.oova.life/blog/progesterone-supplementation-guide
When should I start taking progesterone after ovulation?
Typically, progesterone supplementation for luteal phase support starts 2-3 days after ovulation (confirmed by LH surge or temperature rise). Your doctor will give you specific timing based on your protocol. Some women start immediately after a positive ovulation test.
https://www.oova.life/blog/progesterone-supplementation-guide
What's better: progesterone cream or pills?
Pills (oral micronized progesterone) are generally more effective and reliable than creams because absorption from creams is inconsistent. For medical conditions like fertility issues, low progesterone, or HRT, prescription pills or suppositories are strongly recommended over over-the-counter creams.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
How can I tell if I have low or high progesterone?
The only definitive way to know is through hormone testing via blood tests or at-home urine tests that measure progesterone metabolites. However, symptom patterns can provide clues: anxiety and irregular periods suggest low progesterone, while bloating and extreme fatigue suggest high progesterone.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
When during my cycle should I test progesterone levels?
Test progesterone levels during the luteal phase, typically 7 days after ovulation or around day 21 of a 28-day cycle. This is when progesterone should be at its peak, making it easier to identify if levels are too low or too high.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
What are the main differences between low and high progesterone symptoms?
Low progesterone typically causes irregular or heavy periods, anxiety, hot flashes, and sleep issues. High progesterone causes bloating, fatigue, intense breast tenderness, and depression-like mood changes. Low progesterone symptoms persist throughout your cycle, while high progesterone symptoms are most intense during the luteal phase.
https://www.oova.life/blog/low-vs-high-progesterone-symptoms
Can you have symptoms of both low and high progesterone?
Some symptoms like breast tenderness and mood changes can occur with both low and high progesterone, making it confusing. However, the timing, intensity, and accompanying symptoms differ. Hormone testing is the best way to determine which imbalance you're experiencing.
https://www.oova.life/blog/10-dpo
Can stress affect 10 DPO symptoms?
Yes, stress can worsen or mimic 10 DPO symptoms. Stress increases cortisol, which can cause cramping, fatigue, and mood changes similar to both PMS and early pregnancy. During the two-week wait, try stress-reduction techniques like gentle exercise, meditation, or spending time with loved ones.
https://www.oova.life/blog/10-dpo
Is it better to test at 10 DPO or wait?
It's better to wait until 12–14 DPO for more accurate results. Testing at 10 DPO often leads to false negatives because hCG levels may still be too low. If you absolutely can't wait, use a sensitive early detection test with first morning urine, and be prepared to retest in 2–3 days if negative.
https://www.oova.life/blog/10-dpo
What does implantation bleeding look like at 10 DPO?
Implantation bleeding at 10 DPO is typically light pink or brown, much lighter than a period, and lasts 1–2 days. It's often just spotting when you wipe or a few drops on a panty liner. However, only 15–20% of pregnant women experience implantation bleeding—most don't have any bleeding at all.
https://www.oova.life/blog/10-dpo
Why am I cramping at 10 DPO?
Cramping at 10 DPO can be caused by elevated progesterone (whether you're pregnant or not), implantation (if you're pregnant), or premenstrual cramping. Unfortunately, cramping alone can't tell you if you're pregnant since progesterone causes similar symptoms in both scenarios.
https://www.oova.life/blog/10-dpo
What are the chances of a BFP at 10 DPO?
If you're pregnant, you have about a 50–60% chance of getting a positive test at 10 DPO. This means there's a 40–50% chance of a false negative even if you conceived. Chances improve significantly by 12–14 DPO.
https://www.oova.life/blog/10-dpo
What DPO is most accurate for pregnancy testing?
14 DPO (the day of your missed period) is the most accurate time to test, with 99% accuracy. 12 DPO offers 80–90% accuracy. 10 DPO has only 50–60% accuracy. For best results, wait as long as you can—ideally until 12–14 DPO.
https://www.oova.life/blog/10-dpo
Is 10 DPO too early to test?
10 DPO is considered early for pregnancy testing. While some women get positives at 10 DPO, accuracy is only 50–60% if you're pregnant. For best results, wait until 12 DPO (80–90% accuracy) or 14 DPO/missed period (99% accuracy).
https://www.oova.life/blog/10-dpo
Can you have implantation at 10 DPO?
Yes, implantation can still occur at 10 DPO, though 84% of women have already implanted by this point. Late implantation at 10–12 DPO is normal. If implantation happens at 10 DPO, you won't get a positive pregnancy test for another 2–3 days.
https://www.oova.life/blog/10-dpo
What does a negative test at 10 DPO mean?
A negative test at 10 DPO does not mean you're not pregnant. It's very common to get negatives at 10 DPO even if you conceived. Your hCG levels may still be too low, or implantation may have occurred later. Wait until 12–14 DPO to retest for more accurate results.
https://www.oova.life/blog/10-dpo
Can you get a positive pregnancy test at 10 DPO?
Yes, but only about 50–60% of pregnant women will get a positive at 10 DPO. The other 40–50% have hCG levels that are still too low to detect. If you test negative at 10 DPO, wait 2–3 days and test again.
https://www.oova.life/blog/high-progesterone-symptoms
Can high progesterone cause weight gain?
Yes, elevated progesterone can cause temporary weight gain through water retention and bloating. This is a normal part of the luteal phase and early pregnancy.
https://www.oova.life/blog/how-to-increase-estrogen
Does stress affect estrogen levels?
Yes, chronic stress elevates cortisol, which can suppress estrogen production and disrupt hormonal balance. Stress reduction through meditation, yoga, adequate sleep, and self-care practices helps maintain optimal estrogen levels.
https://www.oova.life/blog/how-to-increase-estrogen
When should I consider medical treatment for low estrogen?
Consider medical intervention if natural methods don't improve symptoms after 3 months, if symptoms severely impact quality of life, if you're experiencing early menopause (before 40), or if you have fertility concerns. Hormone replacement therapy may be appropriate in these cases.
https://www.oova.life/blog/how-to-increase-estrogen
What are the signs that my estrogen is increasing?
Signs of rising estrogen include more regular menstrual cycles, reduced hot flashes, improved vaginal lubrication, better mood stability, increased energy, and improved skin elasticity. You may also notice reduced symptoms that originally indicated low estrogen.
https://www.oova.life/blog/how-to-increase-estrogen
Can exercise increase estrogen levels?
Yes, moderate exercise stimulates estrogen release and helps maintain hormonal balance. Aim for 150 minutes of moderate cardio weekly plus strength training twice per week. However, excessive exercise can actually lower estrogen, so balance is key.
https://www.oova.life/blog/how-to-increase-estrogen
How long does it take to increase estrogen naturally?
With consistent dietary and lifestyle changes, you may notice improvements in symptoms within 4-8 weeks. However, significant hormonal changes typically take 2-3 months. Tracking your cycle and symptoms can help you monitor progress.
https://www.oova.life/blog/how-to-increase-estrogen
What foods increase estrogen levels naturally?
Foods high in phytoestrogens can help increase estrogen naturally. The best options include flax seeds (high in lignans), soy products (tofu, tempeh, edamame), lentils, chickpeas, whole grains (oats, quinoa, brown rice), and garlic. These plant compounds mimic estrogen's effects in the body.
https://www.oova.life/blog/perimenopause
What helps relieve hot flashes quickly?
Cool environments, layered clothing, herbal teas, and medical treatments like gabapentin or HRT may help—depending on severity. Lifestyle changes like reducing caffeine and alcohol can also provide relief.
https://www.oova.life/blog/perimenopause
Are there tests to confirm perimenopause?
Yes. Tests measuring estradiol, LH, and FSH levels can indicate hormonal shifts—but diagnosis is often symptom-based since hormone levels fluctuate widely during perimenopause.
https://www.oova.life/blog/perimenopause
How do I know it's perimenopause and not something else?
A doctor may recommend hormone testing (like LH, E3G, and PdG) and track symptom timing. Diagnosis is often based on symptoms combined with age and menstrual pattern changes.
https://www.oova.life/blog/perimenopause
What's the earliest age perimenopause can start?
Some women begin experiencing symptoms as early as their mid-30s, though perimenopause typically starts between ages 38-45.
https://www.oova.life/blog/perimenopause
Does perimenopause affect mental clarity?
Yes. Brain fog and difficulty concentrating are common during hormone fluctuations in perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What happens after the last sign of perimenopause?
After your final period, you enter postmenopause. You'll need 12 consecutive months without a period to confirm menopause. Many symptoms gradually improve, though some like vaginal dryness may persist without treatment.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
When do perimenopause symptoms finally stop?
Some symptoms like brain fog improve after menopause, while others like hot flashes may continue for up to 10 years post-menopause. Vaginal symptoms often persist or worsen without treatment. Each person's timeline is different.
https://www.oova.life/blog/high-progesterone-symptoms
Is high progesterone a sign of pregnancy?
Yes, high progesterone is one of the earliest indicators of pregnancy. Progesterone levels rise significantly after conception to support the developing embryo and reach their peak during the third trimester.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Can you still get pregnant in late perimenopause?
Yes, you can still get pregnant during perimenopause as long as you're having periods, even if they're infrequent. Continue using birth control until you've gone 12 consecutive months without a period and have officially reached menopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
Do symptoms get worse before perimenopause ends?
Yes, most perimenopause symptoms intensify in the final 1-2 years before menopause. Hot flashes peak around your final period, vaginal symptoms worsen, and mood changes increase. However, brain fog typically improves in late perimenopause.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
How long does late perimenopause last?
Late perimenopause typically lasts 1-3 years before your final period. However, the exact duration varies significantly from person to person. You've reached menopause after 12 consecutive months without a period.
https://www.oova.life/blog/high-progesterone-symptoms
What are the symptoms of high progesterone?
High progesterone symptoms include fatigue, bloating, breast tenderness, weight gain, anxiety, depression, headaches, and food cravings. During pregnancy, you may also experience increased nipple sensitivity and muscle aches.
https://www.oova.life/blog/TBD-10-symptoms-and-how-to-get-relief
What are the first signs that perimenopause is ending?
The earliest signs include longer gaps between periods (60+ days), intensifying hot flashes that peak around your final period, and worsening vaginal dryness. These symptoms typically increase in late perimenopause before you reach official menopause.
https://www.oova.life/blog/high-progesterone-symptoms
When should I be concerned about high progesterone?
Consult a healthcare provider if you experience high progesterone symptoms outside your luteal phase when not pregnant, or if symptoms include severe pelvic pain, abnormal vaginal bleeding, or rapid weight gain while on hormone therapy.
https://www.oova.life/blog/high-progesterone-symptoms
How do you test progesterone levels?
Progesterone can be measured through blood tests at your doctor's office or at-home urine tests that measure PdG (a progesterone metabolite). Testing is typically done during the luteal phase, about 7 days after ovulation.

About the Oova Blog:
‍Our content is developed with a commitment to high editorial standards and reliability. We prioritize referencing reputable sources and sharing where our insights come from. The Oova Blog is intended for informational purposes only and is never a substitute for professional medical advice. Always consult a healthcare provider before making any health decisions.

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