Medical Conditions > Secondary infertility
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Secondary infertility

All you need to know

If you’ve been trying for another baby for a while without success, you could be experiencing something called secondary infertility.

There are two types of infertility: primary and secondary. Primary infertility is when a couple who has not previously had a child has been trying for a year without success, while secondary infertility is when a woman or AFAB person  has had a child before but is now struggling to conceive again. 

It's normal to assume that you’ll get pregnant again if you've already had a child before, but there are a lot of factors that can make it more challenging the next time around — like age, for instance. If you’ve been trying to have another child for over a year without success, it’s a good idea to speak to your GP.

Struggling to conceive is overwhelming and confusing, especially when you’ve already had one or more children, but know you’re not alone. Secondary infertility affects around 5% of the population, and it’s the most common form of infertility

Plenty of options are available if you're having difficulty conceiving after pregnancy. Read on for information on secondary infertility causes and treatments

What are the common causes of secondary infertility?

The same issues that cause primary infertility also cause secondary infertility. Conception is a pretty complex process. It relies not only on ovulation (the monthly process of releasing an egg from the ovaries) but also on successful fertilisation, and an embryo attaching to the uterine wall. Anything that affects those stages may result in infertility. Some causes of infertility include:

Advanced maternal age

Fertility naturally declines as you get older (on average after 35), making age one of the most common reasons a woman can't get pregnant. As you age, so do your ovaries and eggs.

Early menopause

This happens when a woman's periods stop naturally before the age of 45 due to a decrease in normal hormone levels (particularly estrogen) produced by the ovaries. This is sometimes referred to as premature ovarian insufficiency (POI).

Impaired sperm production or low sperm count

Poor sperm quality is one of the most common reasons for male infertility.

Blocked or damaged fallopian tubes

This may prevent fertilisation or implantation. Damage to the fallopian tubes can happen because of endometriosis, pelvic inflammatory disease (PID), a previous ectopic pregnancy, sexually transmitted infections (STIs) or complications from surgery. 

Uterine conditions

Such as fibroids might prevent a fertilised egg from attaching to the womb's lining or even prevent sperm from reaching the egg.

Polycystic Ovary Syndrome (PCOS)

This causes a hormone imbalance that can affect a woman’s reproductive cycle and make ovulation infrequent or irregular. PCOS is one of the most common causes of infertility in women.

Excessive weight gain or weight loss

This may be a risk factor for infertility in both men and women. A body mass index (BMI) of over 30 or under 19 can make it harder to conceive.

Lifestyle factors

Sometimes, secondary infertility has no identifiable cause. This is known as unexplained secondary infertility, which affects around one in five couples

It might be a good idea to see your GP if you've been trying to get pregnant for a year without success. If you've had fertility issues in the past or a known condition, or if you're over 35 and have been trying for six months or more, it's especially important to seek medical advice.

Your healthcare provider will offer you advice and support, and if necessary, run some tests to see if there are any underlying issues.

How is secondary infertility diagnosed?

The main sign of secondary infertility is the inability to conceive after having one or more pregnancies. Your healthcare provider may suspect secondary infertility if you’re under 35 and have been trying to conceive for 12 months or if you’re over 35 and have been trying for six months.

Your doctor may perform tests to determine the cause of infertility in both partners.

Some of these tests include:  

  • A semen analysis to check the volume and quality of sperm

  • Blood tests to look at hormone levels

  • Ovulation tests

  • A transvaginal ultrasound

  • An X-ray of the uterus and fallopian tubes.

 A fertility specialist will provide information about potential secondary infertility treatments.

What treatments are there for secondary infertility?

If you're having trouble getting pregnant for the second time, know that there are treatments that can help. 

Solutions for secondary infertility include medication, surgery, artificial insemination, assisted reproductive technology (ART), and surrogacy. The type of treatment you receive will depend on the specific cause of your infertility. Sometimes, your doctor might recommend a combination of these methods to increase the chances of success. Below are some of the treatments your doctor or fertility specialist might recommend.


Certain medications can be a helpful solution by stimulating ovulation, which is necessary for conception. The two types of drugs commonly used for this purpose are clomifene (known as Clomid) and letrozole. Gonadotropins (hormones that regulate how the ovaries and testicles work) may be recommended for those who have already tried clomiphene and letrozole without success. 

If you have PCOS, your doctor might suggest a drug called metformin. While metformin isn’t a fertility treatment, it can help regulate hormones and restore regular ovulation by treating insulin resistance. 

It's important to note that drugs to help with ovulation are not recommended for women with unexplained infertility because they might ovulate normally, so these drugs wouldn’t help.


Surgery can treat some conditions that affect your fertility, such as scarring or blockages in your reproductive system. 

Surgery can also treat scarring in the uterus or remove large uterine fibroids, which are non-cancerous growths that can sometimes prevent a fertilised egg from attaching to the wall of the uterus.

If you have endometriosis, your doctor might recommend a laparoscopy, which is a type of keyhole surgery to remove any endometriosis lesions.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) may be a viable treatment option if you're struggling with infertility. During the procedure, viable sperm are separated from weaker ones and inserted directly into the uterus during ovulation. 

IUI can be carried out during a natural ovulation cycle or with hormones to stimulate egg production. IUI is a less invasive option than IVF and is often used in conjunction with donor sperm.

In vitro fertilisation (IVF)

If you're looking into expanding your  family, you might have heard of a type of assisted reproductive technology called in vitro fertilisation (IVF)

During IVF, the ovaries are stimulated using medication to produce more eggs than usual. The eggs are then removed and mixed with sperm in a lab dish. The resulting embryos are returned to the womb to grow and develop.

It’s worth noting that in the UK, IVF isn’t available on the NHS for secondary infertility.

Intracytoplasmic sperm injection (ICSI)

If a couple struggles to conceive due to low sperm count or poor quality sperm, there is a treatment called intracytoplasmic sperm injection (ICSI) that can help. It's part of the IVF process, but instead of just mixing the sperm and egg, a single sperm is directly injected into each harvested egg. 

This process increases the chances of conception because the sperm doesn't have to penetrate the egg by itself. The process is the same as standard IVF from the couple's perspective, with the only difference being the laboratory process used to fertilise the egg.

Egg and sperm donation

People who face infertility issues also have the option to use donor eggs, sperm, or embryos. Using a donor is a major decision, and it might not be suitable for you, but it can be an excellent option for: 

  • single people

  • same-sex couples

  • people who can’t produce sperm or eggs

  • people with a high risk of passing on an inherited or genetic disease

  • people for whom other fertility treatments have not been successful

In cases where the intended parents are not carrying the child themselves — such as for same-sex male couples, single men, transgender people, or women who had a hysterectomy — you might consider a gestational carrier or surrogate. 

Can I have treatment on the NHS?

Trying to access fertility treatment on the NHS can be very frustrating. The waiting lists and eligibility criteria can vary across the UK, making it hard to know where to start. 

The best thing to do is chat with your GP or contact your local integrated care board (ICB). They can provide you with all the information you need about NHS-funded treatment in your area, and advise about your eligibility. 

When it comes to secondary infertility, however, your best bet is usually to seek private fertility treatment. 

If you're struggling with secondary infertility and aren't able to access NHS-funded treatment, get in touch for a free consultation with an Apricity advisor today. Apricity offers all-inclusive, transparent pricing for various fertility treatments and is the only clinic to offer IVF insurance plans with affordable instalments for fertility treatment.

Support for secondary infertility

Secondary infertility can be particularly hard, as often people offer unhelpful advice like "well, at least you have one child already." 

Infertility can take a real toll on your well-being and your relationship, and just because you have a child already doesn't make your feelings any less valid — so don't be afraid to reach out for support.

Talk to your GP about counselling on the NHS, or if you'd prefer to go private, the British Infertility Counselling Association has a directory of accredited therapists.

Fertility Network UK also offers fertility groups (in person and online) and free webinars that will allow you to share your story and get advice from others struggling to conceive. 

If you're seeking fertility treatment, it's a good idea to ask clinics whether they offer mental health support (and whether they charge for it) before picking one. If you're undergoing treatment with Apricity, you'll receive free supportive counselling as part of your package, with access to your care team seven days a week through extended hours.

We understand that  secondary infertility can be a confusing, overwhelming diagnosis to receive. Just know that  different treatment options are available, and it’s absolutely possible to grow your family. 


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