Over several generations, women have steadily redefined their aspirations — from seeking a well-settled husband and focusing on home-making to building careers, breaking boardroom barriers, excelling in sports, and taking charge of their own destinies. Yet, just when many decide to pause, embrace family life, and have children, they are sometimes faced with an unexpected and silent challenge: infertility.
While infertility can arise from various factors, one particularly perplexing form is secondary infertility — where women who previously conceived without assistance struggle to conceive again.
“Secondary infertility is the inability to conceive or carry a pregnancy to term after previously having a successful live birth, without using assisted reproductive technologies,” explains Dr Jyothi
C Budi, medical director at Ferty9 Fertility Centre. “It is typically diagnosed when a couple is unable to conceive after 12 months of regular, unprotected intercourse — or after six months if the woman is over 35,” she adds.
Although a prior pregnancy suggests a healthy reproductive system, fertility is not static. It can be influenced by changing physical, hormonal, or environmental factors over time. Dr Jyothi notes that cases of secondary infertility have been on the rise in recent years.
Dr Sarika Mudarapu, consultant infertility specialist at Kamineni Fertility, highlights that secondary infertility is often misunderstood or overlooked. “Many people are unaware of this condition and believe their struggles are unique. There’s also emotional and societal pressure — couples tend to prioritise parenting over their ongoing reproductive health, often feeling guilty or hesitant to seek help,” she reveals.
In India, studies show that secondary infertility affects around 28.6% of couples. According to Dr Jyothi, one of the leading causes is delayed childbearing; fertility naturally declines with age, particularly due to a decrease in egg quality and quantity. Other contributing factors include chronic stress, sedentary lifestyles, smoking, poor nutrition, and exposure to environmental toxins. Additionally, medical conditions like endometriosis, fibroids, polycystic ovary syndrome (PCOS), and thyroid dysfunction can develop or worsen over time, affecting fertility even after a successful first pregnancy.
Diagnosis typically involves hormone testing, ultrasounds, ovulation tracking, and semen analysis. “A thorough evaluation of both partners is crucial,” says Dr Jyothi. For women, this includes hormonal panels (FSH, LH, AMH, thyroid), pelvic ultrasound, and hysterosalpingography (HSG) to check for tubal blockages or uterine abnormalities.
Ovulation monitoring through blood tests or ultrasound is also essential. For men, a comprehensive semen analysis assesses sperm count, motility, and morphology. Depending on results, further assessments such as genetic testing, laparoscopy, or advanced imaging may be recommended.
Past pregnancy outcomes often offer important clinical clues. Treatment plans are customised based on factors such as delivery method, postpartum complications, or menstrual irregularities. “If there are existing concerns like irregular cycles, previous miscarriages, reproductive surgeries, or complications during an earlier pregnancy, it’s advisable to seek help sooner rather than later,” Dr Jyothi advises, adding, “Early evaluation can significantly improve the chances of successful treatment.”
Secondary infertility often comes as a painful surprise, but understanding that fertility is an evolving process, not a permanent state, is key. With timely medical intervention, lifestyle adjustments, and expert support, many couples can overcome secondary infertility and continue their parenting journey.
Myths & facts by Dr Sarika Mudarapu
Myth: If you’ve had a child before, you can’t be infertile
Fact: Fertility isn’t permanent — it can change over time. Secondary infertility is real and can be caused by factors like age, hormonal imbalances, lifestyle changes, complications from previous pregnancies, or infections such as endometritis and pelvic inflammatory disease (PID) that may lead to tubal blockages
Myth: Secondary infertility is always due to female health issues
Fact: Just like primary infertility, both male and female factors can contribute. In men, issues such as low sperm count, poor motility, erectile dysfunction, and lifestyle factors (like smoking, stress, or obesity) can play a significant role
Myth: If you just relax and wait, it will happen
Fact: While managing stress is important, waiting too long can reduce the chances of success. Fertility declines with age, and delaying evaluation or treatment can make it harder to conceive. Early intervention improves outcomes
Myth: Fertility treatments always work
Fact: While treatments like IUI or IVF significantly improve the chances, they are not guaranteed. Success depends on factors like age, the underlying cause, and overall health. Timely diagnosis and the right interventions greatly improve the likelihood of success