Secondary infertility is the inability to conceive a second child, granted that your first child was conceived naturally without the assistance of reproductive technology or fertility medications. The diagnosis is the same as primary infertility:

  • The inability to conceive after 1 year, if the woman is under 35, or
  • The inability to conceive after 6 months, if the woman is over 35

secondary infertility

Secondary infertility is very common – in fact, according to ‘Resolve,’ the National Infertility Association, 12% of women in the United States are dealing with secondary infertility. In addition, the National Center for Health Statistics released a report in 2013 estimating that approximately 3 million women of childbearing age in the US are experiencing secondary infertility.

What Causes Secondary Infertility?

The cause of secondary infertility is twofold. The first is the increase in age between your first child and your second attempt at pregnancy; the second is the same list of risk factors and conditions associated with primary infertility.


As women age, their ovarian reserve diminishes. The finite number of eggs that women are born with decrease in number and quality (in general), leading to an increased chance of miscarriage. In other words, the number of antral follicles (AF) – the follicles that can potentially grow to maturity during menstruation – decreases with age.


secondary infertility


From a TCM perspective, aging also has a lot to do with energy levels and how much of that energy is devoted to developing healthy eggs. Qi, our primordial energy, endowed at birth through our parents, gets depleted as we age. Chinese medicine views birthing and delivery as one of the most energy-draining experiences in a woman’s life – therefore, going through it twice is highly demanding for the body. However, that does not preclude you from having a second child.

From a TCM perspective, it’s more efficient to harness the energy you have to focus naturally on that one leading follicle, rather than trying to divide your energy in the hope of developing more than one egg through treatment or medication. Try conserving and enhancing your energy so it can go toward the quality of eggs, rather than quantity. However, if you are at a fertility clinic using hormonal drugs to increase the quantity of eggs, think about eating whole foods, taking prenatal vitamins and antioxidants to provide a healthy environment for your eggs to grow. I equate this to a bike. It’s difficult to take a 40 year old bike for a ride unless you de-rust and tune it up.

Primary & Secondary Infertility

“If we can conceive once, we can definitely conceive again.”

This is a commonly held belief among couples, but unfortunately, is factually untrue.

It’s important to consult your physician and get an update on how prone you are to certain conditions and risk factors at the time you are trying to conceive. It’s unlikely that your health is identical to what it was at the time you had your first child. Check for conditions like PCOS, endometriosis, pelvic/tubal factors, as well as your partner’s sperm count & quality. Reflect on any changes in your lifestyle including excessive drinking, smoking, stress, diet, and sleep.


secondary infertility


As I discuss in my book, Pathways to Pregnancy, tThe philosophy in Chinese medicine is that you are most likely to conceive naturally when you are more balanced physically, mentally, and emotionally. Yet, this can be challenging for many as you find yourself doing double duty- working full time and taking care of your child and family when you get home; you lack sleep and have more on your plate than ever leaving little room for self-care. What you really need is to harness your energy with a healthy diet and lifestyle that reduces your stress levels, an environment that is more conducive to making healthy eggs and babies. So instead of feeling guilty such as, you have to ‘do it all’, enlist your partner, friends, or family to help lessen your load and give your permission to have a little ‘me time’ even if it’s 20 minutes a day.

Final Thoughts

The statistics paint a very different reality than what couples believe about secondary infertility. It’s common, but there are surprisingly few conversations about it. Couples often feel shame and guilt while seeking help for secondary infertility, knowing that many others struggling with fertility do not have a child at all. But in reality, we can’t forget that the hope of having a second child carries as much anticipation and longing as it does for a woman hoping to become pregnant for the first time.

Let’s be inclusive and start the conversation.