|So how different is primary infertility to secondary infertility?
If everything was straightforward conceiving the first time
around, it may come as a complete shock if you find that
it is taking a while to conceive this time around. However,
the emotional stress one feels with secondary infertility
is often just as great for those going through it for the
first time…. which is why primary and secondary infertility
cannot be compared with each other as they are the same
thing but just at different times in a person’s life.
Cruel comments of ‘…..you should be grateful
that you already have a child’ and ‘….just
be thankful for what you have’ hurts just as much
for a woman trying for a second baby as it does when someone
tells you to ‘just stop thinking about it and let
nature take its course’ when you are desperately trying
for a first!
Often the biggest step in deciding what to do if you suspect
that you have secondary infertility is when to start worrying.
The statistics show that even in a healthy couple without
any reproductive problems, it can take up to two years for
them to fall pregnant – 84% of them will conceive
with one year and half of the remainder will conceive within
two years resulting in 92% of couples conceiving overall.
Many couples will find it hard to wait two years before
consulting a doctor and since your chances of conceiving
decrease with age, it often makes sense to seek help sooner
rather than later. It has been suggested that if you suspect
that you may have secondary infertility and are over the
age of 35, that you seek help even after only six months
If you are convinced that you may have a problem you are
not alone – about 1 in 7 couples have a problem in
conceiving although the percentage of couples that experience
secondary infertility in particular, is not known. Some
couples do not seek help making it difficult to estimate
how many couples are actually affected by it.
Secondary infertility can happen at any time and the causes,
where they have been pinpointed, are almost identical to
those of primary infertility. The problem can lie with a
woman’s reproductive system; a man’s reproductive
system or with both partners as follows:
In 27% of cases, an ovulatory problem with the woman is
In 14% of cases, uterine/tubal damage (reproductive organs).
In 19% of cases, low sperm count or poor quality sperm is
involved and in 39% of cases, disorders in both the man
and women contribute.
This still leaves one third of cases in which the cause
of infertility is not identified.
The statistics are telling but in the cold light of day
are little comfort for the emotional stress it produces
on a couple who are battling to provide a sibling for their
However, in cases of unexplained infertility there is still
hope …….one to two thirds of couples with unexplained
infertility will conceive within three years if they keep
So, if you have not conceived after a year of regular intercourse,
without contraception, then make an appointment to see your
GP - infertility is a joint problem so, ideally, go to see
your GP as a couple. Early diagnosis and treatment of secondary
infertility are especially important in older couples, particularly
in the case of women over the age of 35 - in this case make
an appointment after six months of trying to get pregnant.
Where there is a history of amenorrhoea (no periods), oligomenorrhoea
(infrequent periods), pelvic inflammatory disease (PID),
or if either of you have had treatment for cancer, again
seek medical advice sooner rather than later as you will
need to be referred to a specialist
Depending on your case history, your GP may refer you to
a fertility specialist straight away, or may carry out initial
investigations before deciding whether to refer you or not.
The first stage will be an investigation of what the problem
might be. Your doctor will need to establish that you are
producing eggs, that your partner is producing sufficient
numbers of sperm, and that the sperm are sufficiently strong
and healthy to make the journey to meet your eggs.
Blood tests can be used to measure the levels of several
substances in your blood including:
Serum progesterone. If you are having regular periods,
a test done in the mid-luteal phase of your cycle (day 21
of a 28 day cycle) will confirm that you are ovulating.
If you have an irregular cycle you can still have this blood
test but it may be carried out later in your cycle, and
then weekly after that until your period starts. Don’t
forget that you could also try the at-home ovulation tests
and monitors to check to see if you are ovulating –
at time’s it helps to have some semblance of control
over the testing process and they also work out a lot cheaper
than having to go in for a scan every few
days to check for ovulation.
Serum gonadotrophins (FSH and LH). These levels can help
identify whether you may have polycystic ovary syndrome
or PCOS, or premature ovarian failure (i.e. early menopause).
There are also a number of excellent at-home tests that
can give you an early indication of whether you are peri-menopausal
or not – they are urine based tests and if your FSH
levels are elevated then your test result will be positive.
This is a hormone usually produced while you are breastfeeding
but your levels can be raised if there is an underlying
ovulatory disorder or a pituitary tumour. If you are not
feeding a baby or toddler but still producing breastmilk
this could be significant. A prolactin test may therefore
be carried out if there are symptoms to indicate this could
be the problem.
The next step is looking for blockages, damage and abnormalities
in your reproductive system. Before you have any uterine
investigations you will be screened for chlamydia and, if
the results are positive, referred for treatment and contact
A new product that has hit our shores is an indicative
panty-line called ‘Vianalyse’ – which
will indicate whether you have a bacterial infection or
a normal candida/yeast infection. The importance of knowing
which infection you have is imperative since one can be
treated over the counter and the other (a bacterial infection)
in most cases needs to be treated with antibiotics prescribed
by a Doctor. It is also extremely important for those undergoing
IVF treatment to ensure that they are free of vaginal infections
– bacterial or candida as it has been proven in clinical
studies that these can affect the outcome of fertility treatment.
If you have a history of pelvic inflammatory disease (PID),
have had a previous ectopic pregnancy or endometriosis you
may be offered laparoscopy, investigative surgery using
a telescopic viewing instrument, to see if your fallopian
tubes are damaged.
Depending on the results of the earlier blood tests, you
may be offered a hysterosalpingography (an X-ray that shows
the inside of the womb and fallopian tubes) or a hysterosalping-contrast-sonography
(using an ultrasound probe in the vagina to scan the fallopian
tubes) to check for blockages or growths. Both these tests
involve the injection of fluid into the womb, the flow of
which can be traced by X-ray or ultrasound to reveal any
Pelvic ultrasound is used to identify polycystic ovaries
or PCOS, so you may be offered one if your case history
points in this direction
Your partner will be offered a semen test and an examination
to check for swellings and blockages and other indications
of a problem. If the results of the semen analysis indicate
that there may be problems, then at least one if not more
repeat tests should be offered at three-month intervals,
to allow time for the production cycle to complete. One
abnormal semen analysis is not enough to reach any firm
For those men who are either too busy or too embarrassed
to go to the doctor to get checked out, there are also at-home
sperm tests that can be used to check for the WHO recommended
fertility standard sperm count (20mill per ml).
Sperm may die or be unable to swim in a straight line making
it impossible for them to get anywhere near to fertilising
an egg. Some men have an auto-immune response which means
they produce antibodies that kill their sperm, other men
may have ejaculatory problems.
Hormone disorders and tubal blockages also play their part
in causing male infertility. Your partner's sperm may also
fail in quantity or quality (motility, shape and normality)
as a result of illness, poor diet or lifestyle.
Men also become less fertile as they get older and again
some experts suggest that a general decline in fertility
starts from about age 35 in men too
Taking this first step in seeking medical help is stressful
and you may be surprised at how upsetting it can be to admit
that you have a problem and need help. Stress itself can
affect your libido and whether and how often you feel like
making love - for this reason you may be advised to contact
a fertility support group and/or you may be offered counselling.
NCCWCH 2004:1 (National Collaborating Centre
for Women's and Children's Health). 2004. Fertility: assessment
and treatment for people with fertility problems. RCOG (Royal
College of Obstetricians and Gynaecologists). www.rcog.org.uk
[Accessed: February 2005].
NCCWCH 2004: 51
(Ford et al 2000, Singh et al 2003).