Beyond the First Child: Factors Affecting Secondary Fertility

Canada recorded its lowest fertility rate with 1.26 children per woman in 2023, according to Statistics Canada.

When trying to expand their family, many parents face a surprising struggle—becoming pregnant again proves harder than expected. Secondary infertility, a condition that affects couples who’ve successfully had one child but cannot conceive again, can be as emotionally and physically challenging as primary infertility. Despite the joy of already having a child, the inability to grow their family creates a complex emotional experience.

While infertility affects one in six Canadians, according to the CDC, about 11% of couples face secondary infertility.

This blog explores the factors contributing to secondary infertility, such as age, lifestyle, medical conditions, previous pregnancy complications, and steps toward prevention.

Age-Related Factors

One of the most significant contributors to secondary infertility is age. Fertility naturally declines as people grow older, especially for women, impacting egg quality and overall chances of getting pregnant.

• Diminished Ovarian Reserve: One of the most common secondary infertility causes relates to the decline of a woman’s ovarian reserve over time. After the age of 35, a woman’s eggs begin to naturally deteriorate in quality and quantity. The depletion of viable eggs can also be attributed to aggressive medical treatments or genetic defects.
• Increased Risk of Chromosomal Abnormalities: With age, the risk of chromosomal abnormalities in eggs increases, potentially leading to miscarriages or complications. Younger eggs are more likely to produce healthy embryos, while older eggs carry a greater risk of chromosomal issues. Genetic counselling can help families evaluate risks and decide on possible treatments.

Lifestyle Factors

Choices surrounding health and daily habits play a pivotal role in fertility. Some are linked directly to egg and sperm health, while others influence overall reproductive hormones.

• Smoking: Smoking reduces reproductive hormones in both men and women. For women, smoking can accelerate ovarian aging, while for men, it decreases sperm quality. Additionally, smoking increases the chances of miscarriage and premature birth.
• Excessive Alcohol Consumption: Regular consumption of alcohol can decrease LHRH, LH, testosterone, and progesterone levels and increase estradiol and FSH levels. This change in hormones can lead to reproductive disorders and infertility as ovulation and sperm production can be impaired.
• Drug Abuse: Recreational drug use, including cannabis, can interrupt hormone levels and damage the reproductive organs. Opioids and stimulants such as crystal meth and cocaine also impede ovulation by halting the production of pituitary and hypothalamus hormones.
• Poor Diet: Good reproductive health depends on a well-balanced diet that contains essential nutrients. Deficiencies in essential nutrients, such as folic acid, iron, and omega-3 fatty acids, can impair fertility. Focus on whole, nutrient-dense foods to promote optimal hormonal balance and egg/sperm quality.
• Stress: Physiological stress is linked to fertility issues as the full reproductive system depends largely on balanced hormone levels. Stress management techniques such as partner communication, deep breathing exercises, meditation, and progressive muscle relaxation (PMR) can lower stress levels.
• Lack of Sleep: Stress can also be present with sleep deprivation due to irregular hormone regulation. Lack of sleep increases the production of stress hormones and alters levels of reproductive hormones, including testosterone and estrogen.
• Obesity: Weight management is a key component in fertility treatments as obese individuals tend to have hormonal imbalances and insulin resistance. Gestational diabetes, high blood pressure, and congenital anomalies are more common for those diagnosed with obesity.

Medical Conditions

Underlying medical conditions may not only reduce fertility but often go undetected until couples struggle to conceive again.

• Endometriosis: Endometriosis occurs when uterine tissue grows outside the uterus, leading to inflammation, scarring, and obstructed reproductive organs. Treatments like surgery or medication can improve fertility in those with endometriosis.
• Polycystic Ovary Syndrome (PCOS): PCOS disrupts hormonal balance, causing irregular ovulation and poor egg quality. Treatments such as lifestyle changes, medications, and assisted reproductive technologies (ART) often help manage PCOS symptoms.
• Pelvic Inflammatory Disease (PID): PID is the inflammation of organs within the female reproductive system. Some women may experience symptoms such as an infection within the uterus, vagina, or fallopian tubes. Early diagnosis involves antibiotic treatment to prevent further damage that can lead to infertility.
• Uterine Fibroids: Commonly known as noncancerous tumors, uterine fibroids appear in or on the walls of the uterus, with or without symptoms. Treatments, including surgical removal or medication, improve fertility outcomes.
• Thyroid Disorders: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) negatively impact ovulation and menstrual cycles. Hormone-replacement therapies often regulate thyroid levels, restoring fertility.

Previous Pregnancy Complications

Unfortunately, even successful pregnancies can sometimes lead to complications that impact future fertility.

• Premature Birth: A preterm birth can lead to subsequent preterm births, so it is important to uncover any underlying health conditions that may be related to a preterm birth.
• C-Section: Scarring within the uterus from a previous c-section delivery can increase the risk of secondary infertility. The inflammation of the tissue can hinder a successful implantation.
• Miscarriage: Miscarriages have been linked to genetic factors, hormonal imbalances, and abnormalities in the uterus. Diagnostic tests for recurrent miscarriages can involve ultrasounds, genetic screening, hysterograms, a hysteroscopy, and an endometrial biopsy.

Prevention and Early Detection

Addressing risk factors and prioritizing early detection can improve success rates for secondary infertility.

• Regular Gynecological Check-ups: Routine check-ups enable early detection of conditions like PCOS, endometriosis, and thyroid disorders, preventing long-term complications.
• Maintaining a Healthy Lifestyle: Following a balanced diet and a regular exercise routine can address any infertility issues linked to lifestyle choices. Speak to a registered nutritionist and fertility specialist for a safe and comprehensive diet plan. Having a stress management plan can also help.
• Addressing Medical Conditions Promptly: Seeking treatment for reproductive health issues when they arise ensures better long-term outcomes. A multidisciplinary team can tackle issues holistically.

ONE Fertility Can Help You Assess and Manage Your Secondary Infertility Concerns

Secondary infertility is a deeply personal and emotional challenge, but understanding the contributing factors empowers families to seek solutions. At ONE Fertility Kitchener Waterloo, we understand how medical consultations, lifestyle changes, and fertility treatments can increase success rates for couples looking to grow their families.

Our team provides tailored solutions to help families explore their options. Don’t face this challenge alone—support and resources are available. Contact us today for more information or to schedule a consultation with one of our fertility specialists.