When the next pregnancy doesn’t happen

Most couples expect smooth sailing with conception after having birthed children, but this is not always the case. It could be that we’re looking at secondary infertility.

The heartache of secondary infertility

No matter the cause, there is no discounting the stress and anguish secondary infertility can bring for a couple. Often children are planned with a certain age gap in mind, and it can feel hopeless when this gap begins to widen with no subsequent pregnancy in sight. Some may feel sorrow for their first child, who may grow up without a sibling.

It might be that a couple gets together later in life after one or both have already had children, and will plan for another child. In these cases, it can be disheartening when the pregnancy doesn’t eventuate, especially if the previous children were conceived easily.

As if this private distress wasn’t enough, there is also a lack of understanding about secondary infertility. Comments such as ‘well, at least you have one’, while potentially well-meaning, point to a general sense that infertility is synonymous with childlessness. Of course, this is not the case, and secondary infertility or fertility delay are just as heartbreaking.

“We need to look at a couple’s general health but also the specific issues that might be important...including what has changed with their health and reviewing the circumstances of their previous fertility."

Dr Greg Philipson

The how and the why

There can be a variety of causes for delayed secondary fertility, ranging from ageing or health issues, to a change in partner or hormonal changes. In some cases, the initial pregnancy may have been a stroke of luck and underlying fertility complications may have existed from the outset.

The most common reason for this form of fertility delay is ageing. Up to age 35, 80% of women will achieve a pregnancy within a year, but this statistic drops to 40% after they turn 40 due to a reduction in viable eggs. For this reason, it is best to investigate cases of secondary infertility before the age of 40, particularly if wishing to access public funding.

There can also be pelvic health or injury related reasons for secondary infertility. Sometimes, women who experienced birth trauma or have suffered from an infection can experience delays with subsequent conceptions. Women who have had cysts removed or received treatment for endometriosis, or have experienced pelvic pain, may also find conception difficult.

Significant weight gain or loss can also affect fertility for both partners. If men are taking medications or have had significant health changes, undergoing chemotherapy for example, or if their health has suffered from any other reason, this can reduce their sperm count.

When does a fertility delay require investigation?

It is definitely worth investigating why pregnancy hasn’t occurred if a year has passed without conception, especially if the woman is under 40 and experiencing regular periods and both partners are in good health. A GP should be able to arrange testing for ovarian function and ovulation for the woman, as well as a sperm test for the man, to begin with.

Couples can request a pelvic ultrasound scan if there’s any chance of issues stemming from menstrual problems, pain, infection or surgeries. Both partners should be present to either be examined or discuss these findings, because sometimes results aren’t clear or more specialist tests are needed.

When it comes to IVF, the public health waiting list works on a score that places those who have already had children lower on the list. If there has been a significant change, such as one partner undergoing cancer treatment, and if previous children are under 12, the couple may be placed higher on the list. However, it’s worth noting that IVF may not be necessary or desired by everyone experienced fertility delay.

"It's about determining where to investigate, and where to just give people information about what they can expect, and what their options are."

- Dr Greg Phillipson

Where to go for more information

For good, accurate information on secondary infertility, have a look at this article from the British-based National Institute for Health and Care Excellence.

If you are experiencing delays with getting pregnant for a second (or third or fourth) time, book an appointment and have a chat with one of our doctors. We will be able to investigate any possible causes and suggest which treatments or lifestyle changes may help.