You’ve been pregnant before, maybe you have a child already, so why isn’t it happening now? And why does everyone seem to think you shouldn’t mind? Here’s what secondary infertility is, and how to cope with it together.
Secondary infertility means struggling to conceive after a previous pregnancy. It’s the more common type in sub-Saharan Africa, and it can hurt as much as never having conceived. See a doctor after a year of trying, sooner if you’re 36 or over, and check both partners.
What secondary infertility is
Doctors call it secondary infertility when a couple can’t conceive after a year of trying, having had at least one pregnancy before. That earlier pregnancy may have led to a child, or ended in a miscarriage.
It’s common. Most women seen in Nigerian fertility clinics have secondary rather than primary infertility, though many of them have no living child: in one Delta State clinic, 59% had secondary infertility but only 17% had ever given birth. Across sub-Saharan Africa, about one in nine women who have had a child and want another can’t have one.
Why it happens
The cause is often something new since the last pregnancy, so it’s worth investigating afresh:
- Blocked or damaged tubes after an infection, including sexually transmitted infections, or after complications of childbirth, miscarriage or an unsafe procedure. In an Ilorin study, tubal damage was twice as common in secondary infertility as in primary.
- Scarring inside the womb, fibroids or polyps.
- Ovulation problems.
- Age: fertility falls as a woman gets older, and to a lesser extent a man too.
- A male factor. A man who has fathered a child before can still develop a problem, so he needs checking again. Our guide to male infertility explains the tests.
None of this is about blame. Many causes are medical events nobody chose.
It can hurt just as much
People often assume secondary infertility is easier. In an Ilorin study, women with secondary infertility had mental health problems as often as women who had never conceived, and far more often than other women.
- “At least you have one.” It’s meant kindly, but it can dismiss a real grief and leave you feeling ungrateful for wanting more.
- Family pressure. Nigerians’ ideal family size is large: around five or six children. In one Delta State community study, women with fewer children than expected, especially women with only daughters, faced more strain in their marriages.
- Guilt and worry, about your child growing up without siblings, or about not being fully present for them.
- Silence. People with secondary infertility often talk about it less, because they feel they have less right to be sad.
If pressure at home has turned into threats or violence, that’s abuse, and help is available. In immediate danger, call 112, or 767 in Lagos. In Lagos, the Domestic and Sexual Violence Agency’s toll-free line, 0-8000-333-333, is open 24 hours.
When to see a doctor
- After a year of trying, even if you conceived easily before.
- Sooner if the woman is 36 or over, or if either of you has a known risk: a past pelvic infection or STI, a difficult or infected delivery, a procedure to empty the womb, or a known sperm problem.
- A miscarriage during the year doesn’t restart the clock.
- Go together. Both partners should be assessed.
If treatment leads to IVF, our guide to the emotional side of IVF in Nigeria may help.
Looking after yourselves
- Talk as a couple about how you each feel and how far you want to go with tests and treatment.
- Agree what to tell family, and have a line ready for the questions. Our guide to handling family pressure about childlessness has ideas that apply here too.
- Protect time with your child that isn’t about the trying.
- Get support. A counsellor can help with grief, guilt and pressure. You can find a therapist for couples and relationships, by video, voice or chat.
If low mood ever turns into thoughts of ending your life, call Safe Place Nigeria on 0800 800 2000, free and open 24 hours. Read more about infertility and mental health in Nigeria and depression.
Suggested read: Losing a Spouse: Grief and What Comes After
Frequently asked questions
What is secondary infertility?
Difficulty conceiving after at least one previous pregnancy, whether or not that pregnancy led to a birth. It’s usually diagnosed after a year of trying.
Why can’t I get pregnant again after my first child?
The cause may be new: tube damage after an infection or complications, scarring in the womb, fibroids, ovulation problems, age, or a sperm problem in your partner. A doctor can check you both.
Is secondary infertility common?
Yes. It’s the more common type of infertility in sub-Saharan Africa and in most Nigerian clinic studies.
When should we see a doctor?
After a year of trying, or sooner if the woman is 36 or over or either of you has a known risk. Both partners should be checked.
Is it normal to feel this sad when I already have a child?
Yes. Research in Nigeria found women with secondary infertility had mental health problems as often as women who had never conceived. Your feelings are valid, and support helps.
This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
