Despite being part and parcel of the human experience, pregnancy does not come easy to many. Despite the many tries, there is no guarantee that it will be successful – even for those who have had a successful first pregnancy. There is a hidden phenomenon that is often not talked about: secondary infertility.

If you are having trouble conceiving the second time and wondering what is wrong, take a look below to learn about secondary infertility and how you can navigate your way around it.

Secondary Infertility

Simply put, secondary infertility is a nebulous term for couples who have an inability to conceive despite having at least one child. To classify as secondary infertility, the previous birth must have occurred without any help from fertility medications or treatments, such as in vitro fertilisation. It is typically diagnosed after unsuccessfully trying to conceive for six months to a year.

According to a systematic analysis of national health surveys, approximately 10.5% and 2% of women worldwide have experienced secondary and primary infertility, respectively. This means that, whilst it is not common knowledge, secondary infertility is much more prevalent than primary infertility.

Causes of Secondary Infertility

Similar to primary infertility, secondary infertility can occur in both men and women. There can be several factors responsible for preventing another successful pregnancy, some of which are listed below:

Women’s Age

Women are most fertile in their 20s and early 30s. As they age, the ovarian reserve starts to deplete and the quality of the ova (egg cells) will decline in tandem. The decline in quality also translates into the increased chance of chromosomal abnormalities and congenital disabilities developing. If you are trying to conceive in your late 30s or early 40s, it is best to consult an infertility doctor and discuss your pregnancy options as soon as possible.

Health of the Uterus

For women who have undergone a caesarean birth, secondary infertility may arise if there are uterus adhesions or pelvic scarrings. These scarred tissues might affect the fertilisation process, making it significantly difficult for one to go through a healthy second pregnancy.

The pregnancy process does not stop at the fertilisation stage; any compromise to the other stages can also lead to a difficult pregnancy. Those who have developed conditions like a blockage in the fallopian tube or endometriosis may experience an ectopic pregnancy, where the embryo attaches itself to the lining of the fallopian tube instead of the uterus. Should there be a blockage or scar, the egg will not be able to reach the uterus and will instead be fertilised in the fallopian tube, which generally leads to a miscarriage.

Similar to one’s overall health, the health of the uterus is never linear. Women can develop PCOS at any age, effectively affecting ovulation, and by extension, the overall pregnancy. If you have been trying to conceive naturally for over six months and are not seeing any results, you may want to visit your gynaecologist for a routine fertility check up in Singapore.

Quality and Quantity of Sperm

Similarly, men are most fertile when they are in their 20s and early 30s. As they age, the quantity and quality of the sperm produced will drop, leading to a decreased likelihood of a successful pregnancy. Some of the common causes of male infertility include:

  • Oligospermia: a condition in which the sperm count is lower than 15 million sperm per ml.
  • Teratospermia: a condition where sperms are abnormally shaped, which affects the ability of the sperm to reach and penetrate the egg.
  • Asthenospermia: a condition that affects the motility of the sperm, giving rise to a lower chance of fertilisation.
  • Azoospermia: a condition wherein there is a complete absence of sperm in the testes.

For the aforementioned cases, fertility treatment may include extracting healthy sperms from the semen sample and performing an ICSI afterwards.

Treatments Available

Secondary infertility treatment plans will vary from case to case, and it will depend on the causes, the couple’s ages, how long they have been trying, financial availability, and more. Some possible treatment options include:

Medication: fertility drugs serve to correct any hormonal imbalances in both men and women, and can be taken orally or injected.

Surgery: conditions such as tube blockage, fibroids, varicoceles (varicose veins in the testicles hindering fertility), may be treated through different surgeries.

Intrauterine Insemination (IUI): otherwise known as artificial insemination, this procedure involves inserting sperm directly into the uterus using a syringe.

In Vitro Fertilisation:  this procedure involves fertilising the eggs with sperm in a lab, before it is inserted directly into the uterus.

Navigating Your Way Around Secondary Infertility

Infertility, no matter what kind, is physically taxing and emotionally draining – it may be even more so if you have experienced the joys of a successful pregnancy. At The O&G Specialist Clinic, we wish to aid you in this difficult process and offer you a higher chance at fulfilling your dreams of having a bigger family. Our clinic offers various fertility treatments and infertility management services to better cater to your needs and specific circumstances, allowing you to better navigate your way around your infertility issues. Our team of specialists will be right there with you, supporting you every step of the way.

With years of experience and training in employing fertility treatments, Dr Loh is an infertility doctor in Singapore that believes in providing holistic care and customised treatments based on each individual. In addition to having founded the The O&G Specialist Clinic, Dr Loh also helps infertile couples as the current Medical Director of Thomson Fertility Center. A highly-esteemed figure in the infertility management scene, he is often sought out for his opinions regarding matters surrounding infertility. Discover Dr Loh’s recent feature on CNA.

If you wish to receive insight into your infertility, we are more than happy to give you a helping hand.


Katib, A. A., Al–Hawsawi, K., Motair, W., & Bawa, A. M. (2014). Secondary infertility and the aging male, overview. Central European journal of urology, 67(2), 184.

Olpin, J. D., & Kennedy, A. (2011). Secondary infertility in women: Radiologic evaluation. Reports in Medical Imaging, 4, 1-14.

Raque-Bogdan, T. L., & Hoffman, M. A. (2015). The relationship among infertility, self-compassion, and well-being for women with primary or secondary infertility. Psychology of women quarterly, 39(4), 484-496.

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