Secondary Infertility

It may surprise you to know that there are more than one type of infertility; and I don't mean male and female infertility. One of the lesser known types of infertility (or subfertility) is secondary infertility. This is described as the inability to conceive after birthing one (or more) children.

The causes of secondary infertility are along the same lines as primary infertility:

1. Sperm quality

2. reproductive organ damage

3. Scar tissue or complications from previous surgery/pregnancies

4. Risk factors like advanced age, obesity, and other health issues in both partners.

The reasons of secondary infertility are not all that shocking, however, when a couple decides to try to achieve pregnancy for the second, third, or fourth time, and they find themselves trying for a year or more, not attaining pregnancy can be a bit of a shock.

This is a huge benefit of charting cycles with FAM or NFP. Regardless as to how one approaches trying to conceive, knowledge of ovulation and symptoms that are (or are not) present can be a blinking red indicator of where the dysfunction lies.

Another concern for this issue is self-diagnosis. Often times I hear of couples who may have been surprised with their first pregnancy. And then a few years down the road, when it is time for baby number two they are discouraged when in the first month they do not conceive. I am in no way insinuating that secondary infertility doesn't exist, but I think it is very important that we stick within the diagnostic characteristics of the disorder at hand. 

In my opinion, secondary infertility can be just as harmful emotionally as primary infertility. To have the want and love for a baby you haven't met yet, and to month after month be disappointed is challenging enough, and then if you express sadness over secondary fertility often times the retort is that, "You already have one baby, some people don't even have that!" This goes back to that nasty old parent-guilt business that I talk about all the time. 

Below are some of my personal thoughts on the causes of secondary infertility:

1. Stress. I say this ALL the time in person, but let's say it here too! 

         If you go in to your kitchen and you see a kitchen fire, what is the first thing you are going to do? You probably wont start to fold laundry. You are going to try to put that fire out and save your house! Your body works similarly. There are natural cycles happening all over the place inside of you, and that's how its supposed to be; FSH, serotonin, insulin, TSH, even daily poops work on a schedule and cycle. So if your body perceives a greater threat, the focus will move away from those "activities of daily living" (think chores and errands) and hone in on the crisis at hand (think kitchen fire or basement flood). Managing family, friends, work, and toddler is pretty stressful. Take that natural stress and then impose upon it the rampant parent-guilt of modern culture, and stress levels easily become unmanageable. Then, on top of that, add the stresses of disappointment of not conceiving as quickly or as easily as a couple did the first time around, and you have a recipe for cortisol soup.

           To all of this I say: Chiropractic. Chiropractic is the methodology of helping the body adapt to stress. Often times people will say, "Oh, my shoulders are so tight! It's just stress though." I entirely disagree. Stress is common. Stress is everywhere and we all feel it in different ways and places and manifestations, but it's always there. However, you should be able to work with the stress in your life. When you fail to adapt, dysfunction becomes a major factor. This is most evident in people with knee pain; almost always, knee pain comes from hip or foot dysfunction. The most significant take away from that metaphor is that it is simply a metaphor; these mal-adaptations happen in our brains, in our lungs, in our visceral organs, in our nerves, and because our spinal cord is the main communication device between our brain and our cells and tissues, it plays a major part in how we adapt to stress. Long story short: get your nervous system checked.

2. LAM. Lactation Amenorrhea Method.

       This is actually a form of NFP, sort of kind of.... Basically, if a woman ecologically breastfeeds, as in, no schedule, and feeding baby whenever baby is hungry (including night time), she can and most likely will delay the return of her menses. I live in a community that has a higher than average age for first births. Some may think of this as a negative thing, but I think its pretty beautiful. We also have a higher than average single earner family rate. I also think this is beautiful. Families on the Central Coast tend to be pretty crunchy, and we have a much higher than average "prolonged breastfeeding" statistic. It is not impossible to achieve pregnancy while breastfeeding, and despite some old wives tales, it is not harmful to breastfeed throughout pregnancy. However, the return of menses is also accompanied by a shortened luteal phase. The stunted luteal phase means that while a woman may be ovulating, her body is not providing a nice soft endometrial pillow for the fertilized egg to implant upon. The luteal phase should be at least 12 days so that the egg has time to make the trip from the Fallopian tube to the uterus, implant, and begin the division processes that will lead to a viable pregnancy. If the luteal phase is too short, the egg will simply be disposed of during the period, like every other non-fertilized egg of her menstrual cycle's history.

3. Shortened luteal phase due to other circumstances.

     Unfortunately our culture is soy, and otherwise xeno-estrogen happy. Our government subsidizes the growth of soy beans, so much like wheat and corn, it is in everything. Hormonal birth control is also widely popular in our country. These are a few factors that contribute to the over all estrogen rich ecosystems that we walk around in daily. Estrogen dominance is not simply, "too much estrogen." Though, "too much estrogen" is absolutely an issue of its own. The greater issue is the amount of estrogen in relationship to the amount of progesterone in the body. For about half of the menstrual cycle, it is meant for estrogen to be the dominant hormone. Estrogen is responsible for the thickening of the endometrial lining; so it is safe to say that estrogen creates the pillow for the fertilized egg to implant upon. However progesterone is the luteal phase dominant hormone. This means that within 36 hours of ovulation, estrogen drops and progesterone starts to ramp up. Progesterone is the dominant hormone after ovulation and only when progesterone starts to wane, will the menses begin. If a woman's progesterone is low, then the woman is more likely to have a quicker onset of menses; so her period will start again quicker than if she had more progesterone. When the menses returns quicker, say, less than 12 days, the environment of her uterus becomes less friendly to conception, or rather, implantation.


In short, secondary infertility is a heartbreaking experience. The best thing you can do is be an advocate for your own health and chart your fertility. Note cervical mucus, LH spike, and how many days after ovulation your period comes. These factors alone can make a world of difference. You are not alone and you are not broken. You are not wrong for wanting another baby. Just because you have one baby doesn't mean you should be satisfied or accepting. Fertility is a natural cycle in our lives to be respected. Please don't feel selfish or arrogant for wanting another baby. And please reach out for help if you have feelings of depression and futility.

Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-31.