Although there is no regular effort to collect data about secondary infertility, surveys of American couples in 1995 and 2006 suggest that right now about 3.3 million couples, or 6.6 million people in the USA alone, want to have another child and can’t. The most common situation for secondary infertility is remarriage after divorce.

After the end of the first marriage, the new couple wants to have their own children. The problems leading to secondary infertility may lay in the health of the woman, the health of the man, or both.

The very most common cause of secondary infertility is age. People wait longer and longer to have babies, and more couples want to have children in their second marriage.

By age 45, a woman has only a 6 per cent chance of conceiving a child even if sexual intercourse is perfectly timed with her menstrual cycle. The chances of a woman being able to become pregnant peak around the age of 25 and diminish every year afterwards.

Men, too, become less fertile with age, and more prone to various conditions that prevent fatherhood. Especially with men work in trades that require constant exposure to solvents, plasticizers, putties, or gasoline, the cumulative effects of this kind of environmental pollution reduce sperm counts and sperm viability. And most men who want to become fathers again are in a second marriage, according to a scientific survey of 578 male infertility patients sponsored by the American Society for Reproductive Medicine.

About a third of women affected by secondary infertility suffer pelvic adhesions. A pelvic adhesion is scar tissue that forms when the uterus is injured, either during childbirth, or during abortion or uterine surgery. Sometimes scar tissue can stretch over the ovaries preventing the ovulation and thereby preventing pregnancy.

Other causes of secondary infertility are much less common. These include failure of the ovaries before menopause, PCOS, secondary effects of chlamydia and gonorrhea, and “hostile mucus” lining the cervix. Endometriosis alone accounts for another 30 per cent of all cases of infertility. It is a significant factor in secondary fertility.

And if one or both partners has become “fat and happy,” or fat and unhappy, excess weight contributes to a variety of hormonal imbalances that increase estrogen in men and testosterone in women-in some cases, losing weight is what is really needed to treat secondary infertility.

The good news about secondary infertility is that there are many different fertility treatments. Just don’t wait longer than six months of trying before you see a doctor who may have the right treatment for you.

Elena and Frank welcomed a bouncing baby boy named Frederick into their home in August of 2008. Both having grown up as only children, Elena and her husband very much wanted a second child. They started trying again just as soon as Frederick finished breastfeeding. Elena had mostly normal periods, but at the end of 2009 Elena was still not pregnant.

In January 2010 Elena had a complete workup at her gynecologist’s office. The medical exam found no evidence of any kind of structural problem, but her estrogen levels from her first pregnancy were still so high that she was not ovulating. High estrogen levels essentially made her ovaries act as if she were still pregnant and it was not time to ovulate. But within just 28 days of taking the fertility drug Clomid (clomidene sulfate, also known as Serophene), Elena was pregnant with their second child.

Fortunately for Elena and Frank, Elena did not suffer any form of cervical or fallopian overgrowth that would interfere with reception of the sperm or release of the egg. And the doctor hit on just the right dose of Clomid on the first try. Some women trying to get pregnant have to wait longer.

In March 2005 Anne delivered a healthy baby girl. She used birth control pills in late 2005 through 2007, when she and her partner decided they wanted to try for a second pregnancy.

Anne stopped taking oral contraceptives in January 2008 but didn’t get pregnant for six months. Her doctor told her that it wasn’t unusual not to get pregnant right away after stopping the Pill, but at the end of a year, Anne and her partner started getting concerned. It didn’t help Anne feel good about the situation that her sister had delivered two children during the same time.

Anne’s doctor put her on a 100 mg dose of Clomid. The first month there was no response. The second month there was no response. The third month Anne didn’t have her period-but it wasn’t because she was pregnant. After 60 days, the doctor gave Anne progesterone to induce a period, and it was 14 days later, nearly at the end of the maximum allowable Clomid treatment, that Anne was able to conceive a greatly desired second child.

In some cases, however, the problem is not estrogen. This was the case for Susan.

Susan and her husband Sam had always wanted to have four children. Susan bore three children with ease, but she grew heavier and heavier with each child. After the birth of her third child, Susan had gained a total of 88 pounds (40 kg). Susan and Sam continued to try to make another baby, but she simply did not get pregnant.

Since Susan and Sam were both over 40, they went to see their doctor after just six months of trying. The doctor offered a very simple approach to restoring fertility: Eat less, and lose weight.

After losing just 16 pounds (7 kg), Susan was pregnant again. The change in her weight led to a change in insulin sensitivity which led to a change in testosterone levels which led to a change in luteinizing hormone that made ovulation possible. But Susan and Sam didn’t care about the chemistry. They rejoiced that there was a way to conceive another child.

Even though not being able to conceive may cause intense emotional pain to mother and father alike, doctors may tell the couple just to “keep on trying.” The fact is, for many parents, the biological clock is ticking. It’s never a good idea to keep on trying for more than six months if either parent is over 35, or for more than a year if both parents are under 35. After 40, the need for medical intervention is even greater.

Secondary infertility is usually something that can’t be treated with a pill. There will be physical exams for both partners, and most women find the pelvic exam and palpation extremely invasive. There will blood draws and ultrasounds and possibly laparoscopic surgery. Adding to the frustration and sheer difficulty of keeping everything going can be the necessity of the female partner’s following a PCOS diet. All of these interventions are intensely stressful. They make feelings of anger, isolation, grief, depression, jealously, and self-blame all that much worse.

Couples suffering secondary infertility tend to get at best limited social support. If there is one child, friends and family will assume the second will be coming right away or the parents have decided to have only one child. Some friends and family may even just the couple dealing with secondary infertility to be “selfish” for having only one child! They may receive moral lectures on the “burden” each new human being brings to the environment or told that they lack a moral compass because they want to have more than one child.

Well-intentioned or not, the treatment of many couples only makes their suffering worse. The irony is that the best parents and the parents who enjoy their child the most are the most likely to feel great emotional pain from secondary infertility.

Finding resolution of the depression caused by secondary infertility requires a frank assessment of the time, resources, and money that fertility treatment will require. Parents must consider whether they can continue to be good parents to the child they now have if they invest time and money into conceiving a sibling and bringing that child to term. These are intensely personal decisions that require knowledgeable, objective, accurate factual information-not unsolicited lectures by laypeople.

Whatever the decision, whether to grieve the loss of an opportunity to have a second child, to embrace alternative methods of expanding the family, or to focus on having a family of three, resolution brings relief. If depression continues for month than six months, then it is a good idea to seek out a counselor with expertise in reproductive issues to bring back good feeling and enjoyment of life. Treating depression can be just what is needed to use the power of the mind to conceive.

The causes of secondary infertility are often the same as the causes of primary infertility. However, since couples usually wait few years before conceiving second child, the most common cause for secondary infertility could be age-related. Quality of a woman’s eggs as well as man’s sperm declines as they grow older. It’s suggested that women over 35 years who are trying to conceive for six months without success, consult their doctor.
Other possible reasons for secondary infertility include various diseases in the man or woman, both diagnosed and underlying. Possible reasons for secondary infertility could be decreased sperm count in men due to age, lifestyle, poor diet, smoking, etc. Woman could suffer from ovulation problems, polycystic ovarian syndrome (PCOS), hormonal disorders, endometriosis, pelvic inflammatory disease or previous ectopic pregnancy that all could be reasons for secondary infertility. Large weight gain or loss in both men and women could be major reason for inability to conceive second child, especially in women because weight gain and obesity could postpone ovulatory cycles. Sexually transmitted diseases such as Chlamydia could also cause secondary infertility.

Diagnosing infertility requires a few tests, which is the first step in treatment. Even if you conceived your first child without delay, that doesn’t mean that you won’t have problems with second infertility. That’s why you shouldn’t delay visit to your doctor. With age being a main factor for infertility, the earlier partners begin treatment, the better chance they have of becoming pregnant. If partners are not able to conceive after having a year of unprotected sex, your first step should be to consult with your doctor. But if you are over the age of 35, you should wait only six months before talking to your doctor.

This form of infertility can be very difficult to deal with emotionally. It causes a lot of stress, since many couples don’t expect to have difficulty conceiving again, especially if the first pregnancy went well without any problems or obstacles. Parents unable to have second child might feel as they are letting down their first child by not providing a sister or brother. At the same time, they can feel guilty that the first child is somehow not enough, being the constant reminder of the loss. Also the time and emotional commitment that parents involve in infertility treatment, can make them think they’re not as committed to their first child as they would like. Infertility can destroy your relationship and relationship with your first child if you allow it. Parents shouldn’t waste their time feeling unhappy and desperate. They should dedicate all time they have to their first child.