For many couples who have had a child in the past, the thought of secondary infertility comes with strong feelings of denial. They often believe that because they have one child already, they must be fertile. However, there are many factors, including age, uterine abnormalities, or effects of reproductive surgery that can impact your ability to have another baby.

Here are a couple of questions you should ask yourself:

• Are you under the age of 35, trying to conceive for one year, and currently have one or more children?
•  Are you over the age of 35, trying to conceive for six months, and currently have one or more children?

If you answered “Yes” to either of these questions, you may have secondary infertility.

The diagnosis of secondary infertility is not different from primary infertility, though the causes may be different. Some of the causes of secondary infertility in women include tubal disease, which is subtle and silent and could happen after the birth of a child, infections, endometriosis that has worsened, or decreased fertility after a myomectomy (to remove fibroids). Male factor infertility is less common in secondary infertility as men do not have as big of a change with their fertility over time. However, they could have suffered a bilateral hernia or have a new problem like sexual or ejaculatory dysfunction.

Most often, the cause of secondary infertility is one of two problems related to ovulatory dysfunction:

1. The patient has good ovarian reserve and normal eggs, but is either not ovulating, not timing sex properly with ovulation, or has a problem with her luteal phase.
2. The patient has a perfect cycle, times sex properly, but has ovarian reserve issues (poor egg quality/quantity).

The biggest factor with secondary infertility is time and age. If a woman is 41, there is a big change in her ovarian reserve. She has a higher probability of poor ovarian reserve which is common amongst women who decide to space out the birth of their children. A woman may have birth and parenting plans like wanting to nurse her child for three years, but she does not have that luxury at 40.

Despite the fact that secondary infertility is less often the result of male factors, both partners should undergo testing for a complete assessment of their conception potential.

Once the results of a semen analysis, ovarian reserve, and uterine quality are in, your fertility doctor can devise a treatment plan to get you on your way to building your family. Keep in mind that just because you conceived quickly once before, does not necessarily mean you will see the same results the second time around.

Consult a fertility doctor sooner than later, have the complete workup done for both partners (it is better to rule out infertility than to waste time!), and accept that there could be negative news, but a skilled fertility doctor will help you have the baby you desire.