Trying to grow your family can be one of the most meaningful — and complicated — journeys of your life. For some people, getting pregnant seems to happen without much effort. For others, it takes time, support, and an emotional strength you didn’t know you had. If you’re struggling to conceive, whether it’s your first time trying or not, know that you’re not alone. Infertility is more common than most people think, and it comes in more than one form.

Understanding the difference between primary infertility (never having conceived) and secondary infertility (trouble conceiving again after a prior pregnancy) can help you feel more informed and empowered as you navigate your next steps. Whether you’re TTC for baby #1 or baby #2, your experience is real and valid.

distraught couple experiencing secondary infertility

Primary vs. secondary infertility: What’s the difference?

Primary infertility is when you’ve been having regular, unprotected sex for at least a year (or six months if you're over 35) and haven’t gotten pregnant. This is often the first major hurdle on the road to parenthood.

Secondary infertility, on the other hand, is when you’ve already had a child, whether through natural conception or fertility treatment, but now you're having trouble getting pregnant again. That past success can make this especially confusing or even shocking. It’s easy to assume that if you’ve gotten pregnant before, it should be easy again. But bodies change, and so can your fertility.

“One key difference with secondary infertility is that the person or couple has previously conceived,” says Dr. Maya Barsky, a double-board-certified Reproductive Endocrinologist at the Center for Advanced Reproductive Services. “So, we know that pregnancy was possible at one point. This often points to something having changed since then.”

What causes secondary infertility?

There’s no single reason why secondary infertility happens — and that’s part of what makes it so frustrating. Some of the most common causes include:

  • Age-related fertility decline (especially as more millennials delay childbearing into their 30s or early 40s)
  • Hormonal changes, including thyroid dysfunction or PCOS
  • Ovulation issues or irregular cycles
  • Scarring from previous childbirth, including from C-sections
  • Uterine abnormalities like fibroids, polyps, or retained placental tissue
  • Blocked or damaged fallopian tubes
  • Endometriosis
  • Male factor infertility, such as changes in sperm quality, count, or motility
  • Lifestyle changes like weight fluctuations, stress, or medication use

Dr. Barsky explains: “Sometimes, uterine changes such as scarring or retained placental tissue can develop after a prior pregnancy or delivery. These changes can interfere with implantation or make it harder to carry a pregnancy. Age is also an important factor. As time passes, age-related changes in egg quality and quantity can have a significant impact on fertility. And with age, it’s also common to develop additional health conditions (known as comorbidities), which can affect both the ability to conceive and the health of a future pregnancy. That said, it’s still essential to take a comprehensive look at all fertility factors — not just those related to age or uterine changes — to fully understand what may be contributing to the current challenges.”

woman with secondary infertility holding her baby and a negative pregnancy test

So, how is secondary infertility diagnosed?

First Fertility offers comprehensive, personalized fertility care, including fertility testing, IVF, IUI, third-party reproduction, genetic testing, fertility preservation, and LGBTQ+ family building. Our mission is to meet you wherever you are on your fertility journey, delivering the quality care you deserve and the individualized treatments that reflect your story. With 49 physicians across 54 locations in 15 states, we bring national resources and collaborative expertise to your local care team — ensuring your experience remains personal, connected, and consistent. As a patient, you matter — you’re supported, seen, and treated like the individual you are. States we serve include Alabama, California, Connecticut, Florida, Illinois, Louisiana, Maine, Massachusetts, Mississippi, Missouri, New Hampshire, New York, Oklahoma, Rhode Island, and Texas.

"Secondary infertility may be evaluated somewhat differently than primary infertility. Your medical history plays a key role,” explains Dr. Mira Aubuchon, MD, FACOG, a double-board-certified Reproductive Endocrinologist at MCRM Fertility. “For example, if infertility began after a C-section, imaging can help assess the uterus and fallopian tubes. A saline ultrasound may detect an isthmocele (a small pouch at the C-section scar) or show if the fallopian tubes are blocked. Otherwise, evaluations for both types of infertility are similar, including medical history and testing for both partners — even if previous results were normal, changes may have occurred over time.”

Typically, your fertility specialist will recommend:

  • A thorough medical and reproductive history
  • Hormone testing (like AMH, FSH, and thyroid levels)
  • Ovulation tracking
  • Imaging tests, such as an HSG or saline ultrasound
  • Semen analysis for your partner

The goal is to figure out whether something has shifted since your last pregnancy, and how that change might be impacting your ability to conceive now.

Fertility treatment for secondary infertility

Treatment options for secondary infertility typically mirror those used for primary infertility. These may include:

  • Ovulation-inducing medications (like Clomid or letrozole)
  • IUI (intrauterine insemination)
  • IVF (in vitro fertilization)
  • Corrective procedures for uterine issues or tubal blockages

If a clear cause is found — like retained tissue, a hormonal imbalance, or decreased sperm quality — addressing that issue directly can improve your chances. In other cases, assisted reproductive technologies, like those offered at First Fertility’s network of clinics, can help you work around whatever’s standing in the way.

Lifestyle support also matters. Managing stress, eating nutrient-dense foods, avoiding smoking or excessive alcohol, and syncing your cycles using apps or ovulation predictor kits are often part of the plan, too.

sad woman looking at a negative pregnancy test

The emotional toll of secondary infertility

Infertility of any kind can take a major toll on your mental health. But secondary infertility comes with its own set of emotional complexities. You might feel:

  • Guilty for wanting another child when you already have one
  • Isolated because friends, family, or even doctors assume you’re “done”
  • Frustrated by the lack of answers or support
  • Overwhelmed by juggling fertility treatments with work, parenting, and everyday life

“As someone who has also experienced infertility and delayed childbearing, I’m speaking as both a doctor and a mom: I recommend avoiding blanket assumptions. Many women struggling with secondary infertility are already doing everything they can to support their fertility — tracking cycles, managing stress, eating well, following medical advice. Being told to 'just relax' dismisses those efforts,” says Dr. Thanh Ha Luu, MD, a double-board-certified Reproductive Endocrinologist at InVia Fertility. “Dismissing concerns with comments like 'at least you have one child' or 'just give it time' can delay people from seeking help — and from getting the care they deserve.”

For parents, the emotional weight often intersects with busy careers, caretaking responsibilities, and an always-on culture that leaves little room to process grief or uncertainty. Add in baby showers, social media pregnancy announcements, and parenting groups filled with newborn talk, and it’s easy to feel like you’re caught in a loop of gratitude and grief.

couple struggling with infertility anxiously awaiting results from pregnancy test

Finding support that meets you where you are

Whether you’re trying for your first or your next child, it’s okay to acknowledge that this is hard. And it’s okay to want more for your family, even when you already feel incredibly blessed.

Connecting with a fertility specialist can help you get answers, explore your options, and take next steps with clarity. Mental health support — like therapy, journaling, or joining infertility support groups (especially those geared toward secondary infertility or parenting after infertility) — can offer space to process everything you’re carrying.

Fertility networks like First Fertility offer compassionate, personalized care and can connect you with clinics that specialize in diagnosing and treating secondary infertility. You don’t have to navigate this alone.

Your journey is valid. Your emotions are real. And your dreams for your family are worth pursuing — at every stage.

Dahlia Rimmon is a freelance writer, editor, and registered dietitian. She writes for various publications and family-focused brands, covering everything from food and supplements to overall health and wellness. Her experience spans private practice, consulting, and working in the baby food industry. She lives in St. Louis with her family.