If you have been pregnant before, you know the immense joy and sometimes struggle being a parent can be. The first smile, the first tantrum, the giggling, the screaming – parenting is an adventure and nothing quite like it.

But you love it. And so, you decide to try for another baby.

But the months pass, and every pregnancy test you take returns negative. What's going on? You didn't struggle to conceive naturally the first time.

What is secondary infertility?

If you struggle to conceive the second time, you may have secondary infertility. Although it may be confusing and frustrating, secondary infertility is surprisingly common. Approximately 11% of couples experience secondary infertility.

What causes secondary infertility?

There are numerous reasons why couples may be struggling to conceive again. It could be an underlying problem that has worsened over time, or perhaps you had an infection or operation since your last child that has affected your fertility. At Tamara, we will do everything possible to discover the problem and help you conceive again.

Some of the most common causes of secondary infertility include:

• Your age: Fertility declines with age in women.
• Scarring to the womb or fallopian tubes from previous surgery
• Low sperm count, sperm production, sperm quality, or poor sperm motility
• Ovulation problems caused by polycystic ovary syndrome (PCOS)
• Blockages or problems with your womb caused by fibroids
• Certain treatments or medications, such as chemotherapy

If you are struggling with any of the above, or your partner could be, it is worth making an appointment with your doctor sooner rather than later.

When should you seek help?

Your doctor is unlikely to offer you tests or treatment for secondary infertility unless you have been trying to conceive through regular, unprotected intercourse for at least a year. However, there are some circumstances when it is best to see your doctor soon rather than later:

• If you have an existing medical condition that may affect your fertility
• You've had multiple miscarriages.
• You have been diagnosed with endometriosis or pelvic inflammatory disease.
• You have known fertility problems.
• You have undergone treatment for cancer.
• You are over 35 years old and have been trying to conceive naturally for six months.
• Your periods are very painful.
• You have pain during intercourse.
• You menstruate irregularly or not at all.

Infertility affects men and women equally, with 40% of cases having an issue with the man and the woman. Male secondary infertility affects men as commonly as female secondary infertility.

So, you must see your doctor as a couple.

How your doctor can help with secondary infertility

During your appointment, your doctor will ask you and your partner some questions to check whether there are any obvious reasons you aren't conceiving naturally. These questions could include any number of the following:

• Information about any previous pregnancies and or births
• How often do you have unprotected intercourse, and whether there any complications (such as painful sex)
• The type of contraception you used in the past and when you stopped taking it
• Personal and family medical history
• Any medication you may be taking for your lifestyle, including exercise habits, stress levels, weight, and whether you drink, smoke, or take any recreational drugs.

Your doctor may also carry out a physical health check. This can include checking the pelvic area for any signs of infection. For men, this may mean assessing the penis and testicles for any abnormalities. Depending on these results, your doctor may offer further tests or refer you to a fertility specialist.

If you're seeing your doctor because you are concerned about your fertility, it's natural to feel a bit nervous about having tests or answering awkward questions. But it's important to remember that your doctor is there to help, not to judge.

What happens if you can't find out what's wrong

Unfortunately, there are some unexplained cases of infertility where a cause cannot be found. An unexplained diagnosis can be confusing and upsetting for many couples as they don't know their next steps. However, the good news is that most couples struggling with unexplained infertility do eventually conceive, either naturally or with the help of assisted reproductive technologies.

Secondary infertility treatments available

If you struggle to conceive naturally, you may need fertility treatments to have another baby. Depending on your situation and medical requirements, treatments will vary. Below is a list of the secondary fertility treatment options available to anyone struggling to conceive naturally:

Artificial insemination: This treatment consists of depositing a semen sample inside the woman's womb to help improve the chances of egg fertilization.

In vitro fertilization (IVF): This reproduction treatment consists of fertilizing the eggs with the sperm in the laboratory and then transferring these healthy fertilized embryos into the woman's womb. The fertilization of the egg can be carried out this way or by Intracytoplasmic Sperm Injection (ICSI), where the sperm is injected directly into the egg.

Sperm donation: This treatment is considered by couples struggling with male infertility and the quality of sperm production.

Egg donation: This treatment is for female infertility patients who cannot conceive using their own eggs. This is an option for older women, women with ovarian failure, and women who have had repeated miscarriages or failed to become pregnant through IVF.

At Tamara, we will work closely to ensure you receive the fertility treatment you need. As infertility experts, we know the heartbreak secondary infertility can cause. We are dedicated to supporting you and your partner throughout your infertility journey.