By Dr Verónica Corona García (Gynaecologist – Reg. No. 280866947). Article updated and medically reviewed on 09/09/2026 by Dr Latifa Aboulmajd (Gynaecologist – Reg. No. 03-0311750).
Secondary infertility may be an unfamiliar concept to many, but for those experiencing it, it can bring a range of mixed emotions. Secondary infertility occurs when, after having achieved at least one previous pregnancy, difficulties arise in achieving another pregnancy. This can happen whether the previous pregnancy resulted in a live birth or had another outcome.
It can also occur regardless of whether the previous pregnancy was achieved naturally or through assisted reproduction. Fertility can change over time. Having achieved a pregnancy in the past does not necessarily mean that reproductive conditions will remain the same years later. In both women and men, fertility may be affected by age, health conditions, medical treatments or lifestyle factors.
The causes of secondary infertility are practically the same as those of primary infertility. Secondary infertility can affect women, men, or even both partners. It is important not to delay seeking medical advice in cases of secondary infertility, particularly if the woman is over 35.
After one year of trying to conceive without success, it is advisable to consult a specialist. For women over 35, this assessment may be brought forward to six months because of the impact age can have on fertility.
It may also be advisable to seek advice earlier when certain risk factors or medical history are present, such as irregular menstrual cycles, endometriosis, previous gynaecological or pelvic surgery, previously known fertility problems, or when the previous pregnancy required assisted reproduction treatment.
The specialist can assess the reproductive health of both partners and recommend the most appropriate fertility tests in each case.
Primary infertility occurs when a pregnancy has never been achieved despite one year of regular unprotected intercourse. To diagnose primary infertility, fertility tests are required to determine specific causes. Once the results are obtained, treatment can range from addressing underlying conditions to using assisted reproductive technologies to achieve pregnancy.
The main causes of secondary infertility in women include:
Age also plays an important role in secondary infertility, particularly in women. Several years may pass between one pregnancy and the next and, during that time, ovarian reserve gradually declines and changes in oocyte quality may also occur. This can reduce the chances of achieving a spontaneous pregnancy and increase the risk of chromosomal abnormalities in embryos.
The main causes of secondary infertility in men include:
Semen quality can also change over time and may be affected by illnesses, surgical procedures, certain medical treatments or lifestyle factors. For this reason, in cases of secondary infertility, it is important to reassess both partners.
Secondary infertility is diagnosed in much the same way as primary infertility, with the main difference being that there has already been at least one previous pregnancy. Generally, the specialist will gather information about the couple's medical, reproductive, and general health history, including a review of previous pregnancies, births, and miscarriages, as well as any history of illnesses, surgeries, or previous treatments.
The assessment may include ovarian reserve testing using hormone tests and ultrasound, evaluation of ovulation, a gynaecological ultrasound scan, assessment of fallopian tube patency when indicated, and a semen analysis to evaluate semen quality. Depending on the results, the specialist will perform other tests that may be genetic or related to external factors (such as lifestyle and environmental factors).
It is important to note that secondary infertility does not always have a clear or single cause. In some cases, factors that affect fertility may develop over time, even after a previous pregnancy without difficulties.
After experiencing the happiness of a natural pregnancy, Ruslán and Claudia’s plans to expand their family were met with the reality of secondary infertility. With determination and courage, they decided to undergo in vitro fertilisation.
When Ruslán and Claudia decided to conceive again, they anticipated joyful moments and a smooth process. However, medical tests revealed a blockage in Claudia’s fallopian tubes, requiring a laparoscopic intervention. Faced with this challenge, they chose to move forward and opted for IVF-Life Alicante.
Treatments for secondary infertility are similar to those used for primary infertility and are chosen based on specific causes in each case. Some treatments include:
When the patient’s ovarian reserve is low or there are ovulation problems, specialists may resort to ovarian stimulation. The aim is to support the maturation of the follicles recruited during the cycle rather than allowing them to undergo atresia, thereby improving the chances of pregnancy.
Artificial insemination (AI) involves placing sperm, previously prepared in the laboratory, into the uterus at the time of ovulation. Artificial insemination may be considered in certain cases, depending on factors such as the woman’s age, ovarian reserve, fallopian tube patency and the characteristics of the semen sample.
In vitro fertilisation (IVF) involves retrieving oocytes following ovarian stimulation and follicular puncture and subsequently fertilising them in the laboratory. It may be considered, among other situations, in cases involving blocked fallopian tubes, low ovarian reserve or unexplained infertility.
In cases where the problem is the quality of the eggs or semen, the fertility specialist may consider treatment with double gamete donation.
In certain cases, surgery may be necessary to repair blocked fallopian tubes or remove cysts or fibroids affecting fertility.
Depending on the cause, specialists may prescribe medication to treat ovulation problems or conditions like polycystic ovary syndrome (PCOS). At IVF-Life we offer a wide variety of assisted reproduction treatments to address both primary and secondary infertility cases. Depending on the causes of infertility, specialists will provide you with a fully personalised treatment plan tailored to your case.
After the age of 35, female fertility declines more noticeably. Therefore, if pregnancy is being planned for a later stage, fertility preservation may be considered. Egg freezing allows eggs to be preserved at the age at which they are collected, helping to maintain their reproductive potential for future use.
Secondary infertility is more common than many people think and, although it can often come as a surprise, it does not necessarily mean that pregnancy will not happen. Today, reproductive medicine offers diagnostic tools and treatments that allow us to address many of the causes involved and provide treatments adapted to each case.
Having achieved a pregnancy in the past is part of a couple’s reproductive medical history, but it does not necessarily determine how the next chapter will unfold.
Mascarenhas MN., Flaxman SR., Boerma T., Vanderpoel S., Stevens GA.
National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.
PLoS Medicine.
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Global analysis of the prevalence of infertility since 1990:
https://doi.org/10.1371/journal.pmed.1001356
World Health Organization.
Infertility prevalence estimates, 1990–2021.
World Health Organization (WHO).
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Global estimates of infertility prevalence between 1990 and 2021:
https://www.who.int/publications/i/item/978920068315
Carson SA., Kallen AN.
Diagnosis and Management of Infertility: A Review.
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Review on the diagnosis and management of infertility:
https://doi.org/10.1001/jama.2021.4788
Practice Committee of the American Society for Reproductive Medicine.
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American Society for Reproductive Medicine (ASRM).
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Recommendations for the evaluation of female fertility:
https://doi.org/10.1016/j.fertnstert.2021.08.038
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