Imagine a couple who conceived their first child effortlessly, only to struggle for years when trying for a second. This situation, known as secondary infertility, is becoming increasingly common. According to the Indian Society of Assisted Reproduction (ISAR), infertility affects nearly 10-15 percent of couples in India, with secondary infertility comprising a significant portion of these cases.
Dr. Hrishikesh Pai, a leading fertility specialist and the president of ISAR, explains, “Many couples mistakenly believe that if they have conceived once, they will always be able to conceive naturally. However, fertility is dynamic and can change due to age, medical conditions, and lifestyle factors. Seeking early intervention is key.”
After having their first child without any complications, Meera and Raj never imagined they would struggle to conceive again. For two years, they tried everything—tracking ovulation, changing their diet, and even undergoing medical tests—only to face repeated disappointment. Like many couples, they assumed that since they had conceived naturally before, they would have no trouble doing so again. However, their doctor diagnosed them with secondary infertility, a condition that affects millions of couples worldwide but is rarely discussed.
Does having one child guarantee you can have another? Unfortunately, the answer is no. According to ISAR, one in six couples in India experiences infertility, with secondary infertility making up a significant percentage of cases. Changing lifestyles, increasing maternal age, stress, and environmental factors are contributing to this silent struggle.
So why does secondary infertility happen, and what can couples do about it? Let’s explore the causes, why cases are rising in India, and the best treatment options available today.
What is Secondary Infertility?
Secondary infertility refers to the inability to conceive or carry a pregnancy to term after having had one or more biological children without the use of fertility treatments. This differs from primary infertility, where a couple has never conceived.
While couples may assume that past conception guarantees future pregnancies, fertility specialists emphasize that factors like age, reproductive health, and environmental changes can impact fertility over time.
Causes of Secondary Infertility
Several factors contribute to secondary infertility, affecting either the woman, the man, or both partners.
Age-Related Decline in Fertility
One of the primary causes is increasing maternal age. Women are born with a finite number of eggs, and fertility declines significantly after the age of 30, with a sharp drop after 35. Studies suggest that by age 40, the chances of natural conception drop to 5 percent per cycle, according to the American College of Obstetricians and Gynecologists.
Men also experience fertility decline, with sperm quality and motility decreasing with age. A study published in the journal Human Reproduction found that men over 40 had 30 percent lower chances of successful conception compared to younger men.
Hormonal Imbalances
Hormonal conditions can interfere with ovulation and conception. Common disorders include:
- Polycystic ovary syndrome (PCOS), which affects nearly one in five women in India, making ovulation irregular, as reported in The Lancet.
- Thyroid disorders, where both hypothyroidism and hyperthyroidism can disrupt menstrual cycles.
- Irregular ovulation, where women with inconsistent cycles may have difficulty conceiving.
Dr. Firuza Parikh, a renowned fertility expert, states, “PCOS is one of the most underdiagnosed causes of infertility in India. Women should monitor their menstrual cycles and seek medical help if irregularities persist.”
Male Factor Infertility
Male infertility contributes to 40 to 50 percent of infertility cases, according to the World Health Organization. Common causes include:
- Low sperm count and motility
- Varicocele, a condition causing enlarged veins in the scrotum, affecting sperm production
- Environmental factors such as exposure to heat, toxins, and pollution, which lower sperm quality
Uterine or Fallopian Tube Issues
Certain conditions can impair a woman’s ability to conceive again, including:
- Blocked fallopian tubes resulting from infections, surgeries, or ectopic pregnancies
- Uterine fibroids and scarring, which were found in 25 to 30 percent of women experiencing infertility, according to a study published in Fertility and Sterility
Complications from Previous Pregnancy or Childbirth
Difficulties during or after the first pregnancy can contribute to infertility, such as:
- Scar tissue formation after a C-section
- Postpartum infections affecting reproductive organs
- Structural changes in the uterus
Lifestyle Factors Affecting Fertility
Modern lifestyle choices significantly impact fertility. Studies have shown:
- Obese women have a 66 percent lower chance of conception compared to women with a normal body mass index, according to the Harvard School of Public Health.
- High stress levels can disrupt ovulation and reduce sperm quality.
- Smoking has been linked to a 23 percent increase in infertility risk, while excessive alcohol reduces sperm count, according to the Journal of Human Reproduction.
Why is Secondary Infertility Increasing in India?
The rise in secondary infertility in India can be attributed to several key factors.
Delayed Pregnancies and Late Marriages
With career priorities and financial stability being major concerns, many couples delay childbearing. However, fertility naturally declines with age, making conception more challenging.
Increased Cases of PCOS and Lifestyle Disorders
PCOS is now one of the leading causes of infertility in Indian women. A 2021 study by AIIMS found that nearly 30 percent of Indian women in reproductive age suffer from PCOS.
Environmental Pollution and Toxin Exposure
A study in Delhi found that air pollution reduces sperm count and motility by 30 percent, according to the Indian Journal of Endocrinology and Metabolism.
Declining Sperm Quality in Indian Men
A study published in the Journal of Urology found that sperm count among Indian men has declined by 30 percent in the past two decades, largely due to stress, poor diet, and increased screen exposure.
Treatment Options for Secondary Infertility
The good news is that secondary infertility is treatable in most cases through medical intervention and lifestyle modifications.
Lifestyle Modifications
- A nutrient-rich diet, including leafy greens and lean proteins, improves fertility.
- Regular exercise helps maintain hormonal balance.
- Stress reduction through meditation, yoga, or therapy can enhance fertility.
- Avoiding smoking, alcohol, and excessive caffeine contributes to reproductive health.
Medical Treatments
Depending on the diagnosis, treatments may include:
- Ovulation induction medications such as Clomiphene Citrate
- Hormonal therapy for thyroid or testosterone imbalances
- Surgery for conditions like fibroids or varicoceles
Assisted Reproductive Technologies
For couples struggling to conceive naturally, options include:
- Intrauterine insemination (IUI), which has a success rate of 10 to 20 percent per cycle
- In vitro fertilization (IVF), where success rates range from 40 to 45 percent for women under 35 to 10 to 15 percent for women over 40, as reported by Sparsh Hospital
- Intracytoplasmic sperm injection (ICSI), which is used for severe male infertility cases
Dr. Nandita Palshetkar, an IVF expert, advises, “Couples struggling with secondary infertility should not wait too long before seeking help. Advances in fertility treatments have made conception possible for many.”
Secondary infertility can be a frustrating and emotional journey, but couples facing this challenge are not alone. Thousands of families have successfully expanded through early intervention and the right treatment.
If you have been trying to conceive again without success, seeking medical advice early can improve your chances. Advances in fertility treatments, lifestyle modifications, and expert guidance have helped countless couples, and they can help you too.
If you or someone you know is struggling with secondary infertility, take the first step today by consulting a fertility expert and exploring available options. Parenthood may be just around the corner.
