You’ve welcomed one baby into the world, and now you are ready to try again. But there’s just one problem: You and your partner are trying, yet those little blue lines aren’t revealing themselves with each month that passes by. The inability to get pregnant after previously giving birth to a baby is known as secondary infertility, and it affects many women in the United States and beyond. In addition to difficulty getting pregnant a second time, secondary infertility also refers to a woman experiencing recurrent miscarriages. In other words, she is able to get pregnant, but the baby is not carried to a live birth.
Although the causes of secondary infertility are often similar to the causes of infertility in a woman who’s never had a baby (known as primary infertility), there are some exceptions. Fortunately, there are treatments available for women who experience any type of infertility that can help a couple wishing to add to their family. Read on for more information and answers to the question “Why Can’t I Get Pregnant Again?”
Age is one of the greatest determinants of fertility, especially for a woman. A woman is at her most fertile between the ages of 15 and 30. However, more and more American women are waiting until their 30s to conceive. After age 35, a woman’s fertility is particularly affected. According to “Parents” magazine, an estimated one-fourth of women age 36 are infertile and cannot get pregnant (even if they have already given birth to one baby.
The problems with aging and a woman’s fertility is that the quality of her eggs are affected. A woman is born with all the eggs she will release in her lifetime. As she (and therefore, her eggs) age, they experience chromosomal damage that makes them less likely to be carried to a full-term pregnancy or fertilized. Although a woman is very young at age 35, unfortunately, her reproductive health is not at its height and pregnancy can be difficult to achieve.
To a certain degree, men are also affected by aging. Although the timeline is not as accelerated as a woman’s fertility, a man’s semen can carry less sperm and less high-quality sperm as he ages. As a result, a couple may also have difficulty conceiving due to male infertility as a result of advancing age as well.
However, being older than age 35 doesn’t mean a woman won’t get pregnant. However, a couple may have to wait longer to conceive than they did with previous pregnancies.
Complications Related to Prior Pregnancy or Uterine Surgery
Women who have had previous uterine surgery, such as a dilation and curettage (D and C) to remove abnormal tissue in the uterus, may experience unknown scarring and/or infections that could make a subsequent pregnancy more difficult. Many women may have this or other uterine procedures immediately after giving birth. As a result, they may not be able to recognize the symptoms associated with a postpartum uterine infection, such as bleeding or lower abdominal pain. A woman may attribute these symptoms to after-effects of pregnancy. While the body’s immune system may have healed the infection, there can be scar tissue and other after-effects associated with the infection.
Changes to You or Your Partner’s Health
A number of medical conditions are associated with greater risks to a person’s fertility. Examples can include high blood pressure and diabetes. This is true for both men and women. While there are many people who may have these conditions and successfully conceive, their effects on the body may make it more difficult to get pregnant again. The same is also true for drinking alcohol excessively and using illegal drugs.
As a general rule, the habits that keep a person healthy are also those that help them conceive. These include eating a healthy diet. Keeping stress levels low can also help. Other healthy habits that can promote conception include:
- Taking a folic acid supplement (usually of 400 micrograms/mcg) or introducing additional folic acid-containing foods into one’s diet. Examples include green vegetables, citrus fruits, and dried beans. Folic acid not only reduces the risks for neural tube defects, it also may help to improve ovulation. Men may also improve their sperm quality through folic acid intake.
- Limiting caffeine intake to no more than two caffeinated drinks a day. While studies are mixed on caffeine’s impact on fertility, some research has pointed to excess caffeine consumption as playing a role in affected fertility.
- Exercising at least 30 minutes a day for four to five times a week. Exercise relieves stress and also helps to maintain a healthy weight, which are two factors that promote fertility.
- Stopping smoking. Smoking more than 10 cigarettes a day greatly affects a woman’s egg release and overall fertility. A woman’s eggs are also more prone to genetic abnormalities that could result in miscarriage. Men who smoke are more likely to have lower sperm counts, affected motility, and abnormally shaped sperm.
Losing weight if one or more members of a couple are overweight can also impact a couple’s fertility. For women, the excess weight actually causes the overproduction of “male” hormones, known as androgens, that impact ovulation and egg quality. Losing about 5 percent of her excess weight can help a woman conceive. Very thin women may also have difficulty conceiving because their bodies delay ovulation. For a woman that is underweight, gaining even five pounds can help her conceive. If a man is overweight, losing weight could help to improve his sperm quality as well.
Healthy habits not only promote a more optimal environment for a couple to conceive, they also support a healthier pregnancy. Eating well, exercising, and keeping stress levels down are all tips that a doctor may advise a woman while she is pregnant.
Impaired Sperm Production in a Man
According to “Parents” magazine, an estimated 40 percent of infertility cases are attributed to male infertility. Examples of these issues and concerns can include a low sperm count or poor sperm motility (motion/movement). Each of these factors affects the sperm’s ability to reach the uterus and fertilize a waiting egg. Sperm have many factors that must be “just right” in order to fertilize an egg. Examples of sperm disorders that can affect a man’s fertility include:
- Improperly shaped sperm
- Sperm that lack motility or do not move in the appropriate motion
- Semen that contains very little sperm
Some men may also have ejaculate that does not contain sperm at all. This condition is known as azoospermia. Kidney failure and low testosterone hormone levels can also impact a man’s fertility. Sometimes, a man may develop a blockage or obstruction to the pathways that release sperm that mean as he ages, his semen no longer contains many active sperm.
In addition to these factors, taking testosterone supplements or exposing the testicles to excessive heat can also impact a man’s sperm count. This can include wearing too-tight underwear, heat exposure from exercise, or even using electronics that start to get hot on a man’s lap (such as a laptop computer). By avoiding these practices, a man may be able to improve his fertility.
Taking certain medications is also known to affect a man’s fertility. Medications used to treat the following conditions may affect a man’s sperm count/quality:
- Stomach problems
A man should review his medication listing with his doctor to ensure his medicines aren’t impacting fertility.
Damage to a Woman’s Reproductive Organs
There are a number of medical conditions that a women is vulnerable to, and over time, these can affect her fertility. A primary example is endometriosis. This is a condition that causes the muscular tissue associated with the uterine lining to start developing and attaching to other areas of the body. An example can be the Fallopian tubes. Untreated or long-standing endometriosis can cause damage to the Fallopian tubes that prevents an egg from traveling down the tube and to the uterus. Sometimes, if a woman conceives at all, it may be an ectopic pregnancy, where the fertilized egg does not implant itself in the uterus.
In addition to endometriosis, a woman may experience changes in hormone levels over time. She may enter early menopause, in which she no longer ovulates. Or, her hormone levels associated with pregnancy may simply decline, affecting her ability to get pregnant again. Another condition that affects fertility is polycystic ovary syndrome (PCOS). This condition disrupts ovulation, where a woman may not ovulate at all. A woman with PCOS has an excess of hormones traditionally associated with being “male” hormones, such as testosterone. In addition to irregular menstrual periods, PCOS symptoms include acne, obesity, unwanted hair growth, and diabetes.
When to Seek Help
If you are over age 35 and have had unprotected sex for six months without getting pregnant, talk to your OB/GYN, who may make a referral to a fertility specialist known as a reproductive endocrinologist. If you are under age 35, a doctor will usually recommend having unprotected sex for a year before seeking fertility evaluation and treatments.
A reproductive endocrinologist is a doctor who specializes in hormones associated with pregnancy, both from a male and female perspective. This doctor can evaluate you and your partner for the potential underlying causes of secondary infertility as mentioned above. Examples of these tests can include blood tests for hormone levels, evaluating a semen sample, and imaging studies to determine if a Fallopian tube is blocked or there are other uterine abnormalities that are affecting a person’s fertility.
Unfortunately, there is a large percentage of couples for whom a doctor may not be able to determine an explanation for infertility. This can be frustrating and stressful for couples hoping for another child.
Conclusions on Why Can’t I Get Pregnant Again
According to “Parents” magazine, an estimated one-fourth of couples who are seeking fertility treatments to conceive have one or more children. Sometimes, these couples had difficulty conceiving their first child. Others may have had no difficulty, but are facing infertility issues with subsequent pregnancies. According to Michael DiMattina, MD, and director of Dominion Fertility and Endocrinology in Arlington, Virginia, interviewed in “Parents,” “In fertility, past success is no guarantee of future success.”
While secondary infertility is a known medical concern, many couples are hesitant to seek fertility treatments due to misconceptions that these treatments will not benefit them if they have already had one child. However, waiting too long to seek fertility treatment options can mean that a couple is waiting until it’s too late to receive treatments. This is especially true if a woman is 35 and older or reaching this age.
Couples experiencing secondary infertility have feelings that are no less important than a couple who has been unable to conceive at all. Couples may have grief, sorrow, and misunderstanding as to why they could successfully conceive one baby, yet have such difficulty in having another child. They may also feel guilty for being so upset when they already have one child at home. Some couples may even express guilt they haven’t provided a brother or sister for their child. They may also find they don’t receive the same support for their infertility from family and friends because they have one or more children. However, the couple’s feeling and concerns over secondary infertility are very real and shouldn’t be ignored. A couple may wish to seek counseling as they struggle with infertility. RESOLVE, the National Infertility Association, also offers support specifically for those with secondary infertility by calling 866.NOT.ALONE (866.668.2566) and pressing extension 8.
Cleveland Clinic: 6 Reasons for Trouble Getting Pregnant a Second Time
Mayo Clinic: Secondary Infertility: Why Does It Happen?
The New York Times: Secondary Infertility: I Have One Child. Why Can’t I Get Pregnant Again?
Parents: We Can’t Get Pregnant Again
Resolve, The National Infertility Association: Secondary Infertility
Urology Care Foundation: What Is Male Infertility?