Infertility is a stressful, painful, and frustrating condition, and it can become even more confusing when it happens after you’ve already given birth once. But it’s actually a relatively common story: you got pregnant fairly easily with your first child. It took a few months and a positive test popped up. But then when it comes time to try for another, it doesn’t happen so easily.
Secondary infertility is a term that is given to couples who have successfully given birth but are struggling to get or stay pregnant again. As with regular infertility, it’s diagnosed in women who are unable to conceive after trying for a year or more (if they’re under 35) or for six months or more (if they’re 35 or older). Approximately 3 million women in the United States are affected by secondary infertility each year. To put that number in context, compare it with 4 million births per year in the US - it’s a really significant number!
For many women, this can come as a total shock. After all, you had no trouble the first time around. What changed? Why now?
We’re hearing about secondary infertility more and more these days, and so we wanted to dig into the research to understand more about the causes so we can empower families with information and support them the best way possible.
Let’s look a little closer at some of the main causes of secondary infertility:
Thyroid dysfunction
Thyroid conditions, such as hypothyroidism or Hashimoto’s disease can shift hormone levels and interfere with the ovulation process, and we know that postpartum thyroid conditions are common. In fact studies have shown that up to 23% of all new mothers experience thyroid dysfunction postpartum - and often goes undiagnosed. We recommend all mamas get their thyroid checked before, during, and after pregnancy to help proactively manage any dysfunction before it causes further health challenges down the road.
Age
While we feel strongly that women are capable at all ages of carrying healthy babies, it’s true that women are born with a limited number of eggs. As you reach your mid- to late 30s, your eggs can start to decrease in quantity and quality, and they can be more difficult to fertilize than the eggs of a woman in her 20s.
You can support egg quality by avoiding cigarette smoking and limiting alcohol and caffeine. Certain vitamins and antioxidants like Coenzyme Q10, Folate, and Vitamins A and E may help with mitochondrial function of eggs, which is the energy source that helps with DNA replication.
In addition, multiple lines of research suggest that Omega-3 fatty acids play important roles in early reproductive events, and may promote egg quality and reproductive success. Several human and animal studies suggest that increasing EPA and DHA intake through diet or supplementation has the potential to prolong certain reproductive functions into advanced maternal age. Just another reason to keep taking that Prenatal Multi and Omega-3!
Nutrient status
A review of research published in Frontiers in Endocrinology concluded that nutritional factors may influence not only oocyte (immature egg cell) maturation, but also quality of embryos and efficiency of implantation. Factors such as deficient food intake, strong dietary restrictions, and a general lack of nutrients can result in lengthening of the postpartum interval to conception, lower gonadotropin secretion levels (these include sex hormones FSH and LH, necessary for ovulation) with alterations of the regular ovarian cycle, and increased infertility. The review of research concluded that poor intake of proteins, micronutrients, and vitamins is associated with reduction in reproductive performance. In other words, inadequate nutrition is closely linked to disrupted female reproduction.
We know that prior pregnancies and periods of breastfeeding can be quite depleting, and discuss this and the importance of keeping up with supplements between pregnancies in our blog on pregnancy spacing and whether or not it’s too soon to have another baby.
Weight
Variations of the body weight, whether overweight or underweight, are suspected to complicate ovulation. A study on weight and fertility reported that the time to conceive is longer in women with body mass index (BMI) greater than 25 or less than 19.
Another study found that women who are classified as overweight or obese based on BMI can experience hormonal shifts, which might disrupt their menstrual cycles and ovulation patterns. Women in these categories face higher rates of infertility and miscarriage.
Of course we know that BMI can be an unreliable measure of health, but we can still glean that staying at a healthy weight and body fat percentage for your height, lifestyle, and activity level supports fertility outcomes. Know that many women hold onto a bit of extra weight following a first pregnancy, so a higher weight when trying for a second pregnancy is not uncommon, and certainly nothing to be ashamed of.
Stress
When you already have one baby in your life, stress levels are likely more elevated than when you were trying for your first child. Plus, with a little one at home, you’re also less likely to take time for self care. But the reality is, stress can impact fertility. Chronic stress and elevated cortisol (the stress hormone) put your body in the sympathetic or “fight or flight” state. In this state, the body focuses efforts away from unnecessary body systems, like reproduction.
Stress is a tough one to address, since managing stress is important to fertility, but infertility often increases stress. Incorporating mindfulness and meditation exercises is beneficial to stress levels, as are adaptogens like ashwagandha, maca, and reishi. Note, if you do incorporate adaptogens, check with your provider on timing. As some aren’t well studied in pregnancy, they may recommend you discontinue use once you ovulate in case the egg was fertilized.
Liver health
You might not think about the liver as an organ important to fertility, but it is. The liver is responsible for metabolizing toxins and excess hormones, both of which are critical to fertility. It might not seem like liver health would change much between pregnancy, but it can be affected by alcohol consumption, diet changes (particularly a decrease in fiber or increase in refined grains and sugars), repeated use of non-steroidal anti-inflammatory drugs (e.g., Ibuprofen), antibiotics, and exposure to environmental toxins and chemicals.
Signs that your liver function might be less than optimal include fatigue, hormone imbalances, poor digestion (particularly after meals heavy in fats - even healthy fats), and skin issues (dryness, liver spots, acne). You can support liver health through regular exercise and diet. Focus on getting plenty of water, fiber, and greens, incorporating sulphur-rich foods (eggs, cruciferous veggies, garlic, and onions), and starting each day and meal with a glass of lemon water. Supplements to support liver health include milk thistle and dandelion.
Male factors
Women often assume the root cause must be related to their eggs or uterus, but impaired sperm production, function, or delivery is just as likely. Sperm can change with changes in lifestyle factors like weight, stress, age, medication use, exposure to environmental toxins, or other habits, like extreme temperature changes on the body (e.g., frequent hot tub use), or from the use of some steroid supplements. It’s always wise to check both sides of the conception equation if infertility arises, and remember, men can benefit from prenatals too!
Underlying medical conditions
While it might seem like not much has changed in the few years between your children, changes can happen in your body that can adversely affect reproductive health. These complications can be related to a prior pregnancy or surgery, infection, or even weight gain. Complications can include things like fallopian tube damage, ovulation disorders (including PCOS), endometriosis, pelvic adhesions, and uterine fibroids or polyps.
In fact, one study found that the natural fertility rate following delivery by caesarean section was 17% lower than the natural fertility rate following vaginal delivery, suggesting that complications from a C-section surgery could impact future fertility.
Microbiome imbalances
Studies have shown that gut imbalances and parasites and fungi can contribute to infertility in both men and women. If you’ve investigated most other means and if you have any other symptoms of parasites (bloating, abdominal pain, nausea, diarrhea or constipation) or fungal overgrowth (sugar cravings, bloating, skin or nail infections or rashes, vaginal or rectal itching), it might be worth investigating through a blood, urine, or stool analysis.
The health of the vaginal microbiome has also been linked to fertility, as an imbalance in good and bad bacteria (and a lack of Lactobacillus strains in particular) has been shown to create an inhospitable environment for sperm motility and fertility. Our Prenatal Pre/Probiotic contains the most well-studied strains for vaginal health.
Hang in there
Secondary infertility can be surprising and stressful. We hope you feel empowered with this information to ask questions and seek support not only from fertility specialists as needed, but also from your partner, family, friends, and counselors for emotional support.
We know that infertility comes with a tremendous amount of testing, tears, and uncertainties, and we’re here to support you through it all.
