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Secondary Infertility

Secondary Infertility: When Conceiving Again Is Harder Than Expected

Perhaps your first pregnancy happened relatively easily.

You may not even remember exactly how many months it took. You started trying, and at some point there was a positive pregnancy test.

So when you decide to try again, it’s natural to expect that things will unfold in much the same way.

But month after month passes, and they don’t.

That can be surprisingly unsettling.

I often hear some version of: “But I got pregnant before. Why is it so much harder this time?”

The simple answer is that fertility can change.

A previous pregnancy tells us that conception happened at that point in your life, but several things may be different now for you, your partner, or both of you.

And there can be another layer to secondary infertility that isn’t always talked about.

You may feel guilty for being upset because you already have a child. You may compare yourself with friends who seem to be growing their families easily, or feel uncomfortable talking about how hard things are because other people assume you should simply be grateful for what you already have.

You can be deeply grateful for the child you have and still feel sadness about the baby you’re hoping for.

Those two feelings can exist at the same time.

What does secondary infertility mean?

Secondary infertility means having difficulty becoming pregnant after a previous pregnancy.

It’s different from primary infertility, where a pregnancy hasn’t happened before.

There isn’t always one clear reason why conception is taking longer. Sometimes investigations identify a female factor, sometimes a male factor, sometimes there’s more than one thing going on and sometimes no obvious cause is found.

That uncertainty can be one of the hardest parts.

When pregnancy happened before, it’s easy to assume there must be one obvious thing that has changed. Sometimes there is. Sometimes the answer is less straightforward.

Why can fertility change between pregnancies?

Pregnancy depends on quite a few things coming together.

An egg needs to develop and be released, sperm needs to reach and fertilise it, the fallopian tubes need to allow sperm and egg to meet, and the uterus needs to be ready to support implantation.

Any part of that picture can change over time.

Age may become more relevant

Female fertility gradually changes with age. The number of eggs remaining in the ovaries reduces over time, and chromosomal changes in eggs become more common.

That doesn’t mean there’s suddenly a fertility ‘cliff’ at a particular birthday, and age isn’t always the explanation. But if several years have passed since your last pregnancy, it may be more relevant now than it was before.

You may also hear about AMH – anti-Müllerian hormone – during fertility investigations.

AMH can help fertility specialists get a sense of ovarian reserve and how the ovaries may respond to medication used during treatments such as IVF. Current NICE guidance is clear that AMH shouldn’t be used on its own to predict whether you can or can’t conceive naturally.

That’s an important distinction, because AMH results can cause a lot of worry when they’re interpreted too simply.

Ovulation may have changed

Your menstrual cycle may also be different now.

Conditions such as PMOS/PCOS can affect how regularly ovulation happens. Changes in weight, some medical or hormonal conditions and very high levels of exercise can also affect cycles.

If your periods have become very irregular, much further apart or have stopped altogether, it’s worth discussing this with your GP rather than simply waiting and hoping things will settle.

There may be a pelvic or uterine factor

Conditions such as endometriosis, adenomyosis and fibroids may also affect fertility in some women.

There can also be problems involving the fallopian tubes, for example after a previous pelvic infection, ectopic pregnancy or certain types of surgery.

This doesn’t mean that painful or heavy periods automatically point to a fertility problem. But if your periods have become noticeably more painful or heavier, or you’re experiencing ongoing pelvic pain, it’s worth mentioning when you’re being assessed. You can also read more about the difference between these two conditions in our blog on adenomyosis vs endometriosis.

Sperm matters too

It’s very easy for fertility investigations to become focused mainly on the woman, but both partners matter.

Having fathered a pregnancy before doesn’t necessarily mean sperm will be exactly the same several years later.

A semen analysis looks at things such as how many sperm are present, how well they move and their shape. These can change over time for a number of reasons, including general health, some medications and certain lifestyle factors.

That’s why current NICE guidance recommends that both partners are assessed when a couple is having difficulty conceiving.

Ideally, this happens early rather than one partner going through months of tests before the other is considered.

When should you ask for help?

If pregnancy hasn’t happened after one year of regular unprotected intercourse, NICE recommends further fertility assessment.

But you don’t always need to wait that long.

If the woman trying to conceive is 36 or over, NICE recommends referral for specialist consultation at presentation rather than waiting for a full year.

It may also make sense to seek advice sooner if either partner already has a known or suspected fertility concern.

That may include:

  • very irregular or absent periods;
  • known endometriosis or another condition that may affect fertility;
  • previous pelvic infection, ectopic pregnancy or pelvic surgery;
  • significant pelvic pain or very heavy periods;
  • concerns about sperm or testicular health;
  • or previous pregnancy losses that need further medical discussion.

And this is one of the places where I think people with secondary infertility can sometimes hesitate.

There can be a feeling of, “Maybe I’m overreacting. I’ve already conceived once.”

But having conceived before shouldn’t stop you asking for help if something feels different this time. You don’t need to prove that the problem is serious enough before starting the conversation.

What might fertility investigations involve?

There isn’t one standard set of tests that everyone needs.

Your GP or fertility specialist will usually start by looking at the whole picture; how long you’ve been trying, your menstrual cycle, previous pregnancies, medical history, any symptoms you’ve noticed and your partner’s history too.

Depending on your circumstances, investigations may include:

  • blood tests to check whether ovulation is happening;
  • hormone tests where appropriate;
  • an ultrasound scan;
  • tests to check whether the fallopian tubes are open;
  • assessment of the uterus if there’s a reason to suspect a problem;
  • and a semen analysis.

If assisted conception is being considered, AMH or an ultrasound measurement called an antral follicle count may also be used to help predict how the ovaries might respond to fertility medication.

Sometimes these tests find a clear explanation. Sometimes they don’t.

Unexplained infertility simply means that standard investigations haven’t identified an obvious cause.

For some people, that brings relief. For others, it can feel frustrating because there isn’t one clear problem to fix. Both reactions are understandable.

Where might acupuncture fit?

Acupuncture can sit alongside fertility investigations and medical care as part of a broader, supportive approach.

When I see someone with secondary infertility, I’m interested in the whole picture rather than simply the fact that pregnancy hasn’t happened yet. I’ll usually look at their menstrual cycle, symptoms, general health, previous pregnancies and any fertility support or treatment they’ve already had.

For some patients, acupuncture is also a valuable source of support while they’re going through fertility treatment. That may include helping with symptoms, supporting general wellbeing and giving them some space during what can be a physically and emotionally demanding time.

Research into acupuncture and fertility is still developing.

There is some evidence suggesting that acupuncture may help with aspects of wellbeing and anxiety and stress relief during fertility treatment. The HFEA also describes acupuncture as a complementary therapy that some people use during fertility treatment, while noting that evidence for effects on fertility outcomes remains unclear. You can read more in our blog on the link between stress and infertility.

Evidence around pregnancy and live-birth outcomes is much less certain. Recent systematic review evidence has reported possible benefits in some outcomes, but study quality and certainty remain limited, so at the moment we can’t say reliably that acupuncture increases the chance of conception or live birth.

For me, that distinction is important.

Acupuncture can still have a meaningful supportive role without needing to make claims that the research doesn’t yet justify.

And one thing I’d particularly like to say about stress is this: looking after your emotional wellbeing matters because you matter, not because you need to somehow ‘relax enough’ to become pregnant.

A few common questions

Does having one child mean my fertility should still be normal?

It tells us that conception happened before, but fertility can change over time. Age, ovulation, reproductive conditions, tubal or uterine factors and sperm may all be different now.

I’m over 35. How long should I try before asking for help?

NICE recommends specialist referral at presentation from age 36 onwards, rather than waiting for 12 months. If you’re younger but already have a known or suspected fertility concern, earlier assessment may also be appropriate.

Should my partner be tested if we conceived naturally before?

Yes. Sperm parameters can change over time, so a previous pregnancy doesn’t rule out a male fertility factor now.

Can acupuncture help with secondary infertility?

Acupuncture may be used alongside fertility care to support wellbeing, symptoms and the experience of going through fertility treatment. Current evidence doesn’t allow us to say that acupuncture treats secondary infertility or reliably increases pregnancy or live-birth rates.

If things feel different this time

If you’ve been thinking, “I conceived before, so surely I should be able to again,” it may help to remember that fertility reflects what’s happening now, rather than what happened several years ago.

Sometimes there’s a clear reason why conception is taking longer. Sometimes several smaller factors are involved, and sometimes investigations don’t give one straightforward answer.

Either way, you don’t have to dismiss what you’re feeling because you already have a child.

You’re allowed to want another baby. You’re allowed to find the waiting difficult. And you’re allowed to ask for help without feeling that you need to justify why this matters to you.

Getting appropriate medical advice can help you understand what may have changed and what your options are. If you’re also considering acupuncture, it can sit alongside that wider care in a way that feels supportive, thoughtful and appropriate for you. At The Acupuncturists Ltd, we’re here to support you through this — book an appointment to talk through your options.

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Disclaimer

This article is for general information only and isn’t a substitute for individual medical advice, diagnosis or treatment. If you’re concerned about your fertility, menstrual cycle or reproductive health, speak to your GP or an appropriately qualified fertility specialist.