Secondary infertility is the inability to conceive a child or carry a pregnancy to full term after previously giving birth. To classify as secondary infertility, the previous birth must have occurred without help from fertility medications or treatments, like in vitro fertilization. Secondary infertility typically is diagnosed after trying unsuccessfully to conceive for six months to a year. A related condition is recurrent pregnancy loss where patients and couples are able to conceive but are unable to carry to term.
Success rates for IVF depend on a number of factors, including the reason for infertility, where you're having the procedure done, and your age. The CDC compiles national statistics for all assisted reproductive technology (ART) procedures performed in the U.S., including IVF, GIFT, and ZIFT, although IVF is by far the most common; it accounts for 99% of the procedures. The most recent report from 2016 found:
However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the pelvic cavity for pelvic scarring and endometriosis. Laparoscopy surgery is no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to - leaving many more couples in the unexplained category.
A recent large population-based study collected data from almost 5000 European patients. According to preliminary results presented at the 2019 European Society of Human Reproduction and Embryology, there is no benefit from ICSI in non-male factor cases. Importantly, the study reported no benefit of using ICSI regardless of how many eggs are retrieved after ovarian stimulation. Therefore, having a low oocyte yield should not be a reason for choosing ICSI over IVF.

Intrauterine insemination (IUI) is one of the simpler, “low-tech” treatments for infertility and the starting point for many individuals and couples who are having difficulty with conception on their own. Patients who have been diagnosed with unexplained infertility, mild male factor infertility, a cervical factor, or irregular or absent ovulation are often good candidates for IUI.
^ GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
The cost of an IUI is almost certainly less on a per cycle basis, but because IVF has much higher success rates and IUI is a poor option for some, the higher per cycle cost of IVF can actually be more affordable in the long run – in terms of the cost to bring home a baby.  Because most successful IUIs happen in the first three or four-cycle, it eventually becomes very expensive to bring home a baby with an IUI.
 It is important for couples to maintain open and honest communication with each other, and to recognize that feelings can change over time. For single parents wishing to have additional children, it's also important that they try to develop a strong support system through friends and family. And, because children can pick up on their parents' stress, it is also important to pay attention to how their kids may be feeling. Children might not understand why their parents are feeling a certain way and attribute it to something they've done.  
How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
For any woman or couple facing infertility, the task of deciding on your next steps can feel very daunting. Of course, there’s no substitute for the advice of a fertility specialist, but a general idea of what to expect can help give you confidence. You might be wondering what is the difference between In Vitro Fertilization (IVF) and  IUI, or artificial insemination?
A doctor or WHNP takes a medical history and gives a physical examination. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy. If necessary, they refer patients to a fertility clinic or local hospital for more specialized tests. The results of these tests help determine the best fertility treatment.
If a physician believes infertility is a concern, a number of tests will be administered. For women, these may include ovulation testing, ovarian reserve testing, hormone testing, and hysterosalpingography (X-rays of the fallopian tubes) or other imaging tests. Assessing male infertility involves semen analysis, which examines the number of sperm, as well as their motility and morphology (shape). Other tests for men may include hormonal and genetic testing, testicular biopsy, and additional imaging.
The Fallopian tubes are the site for fertilization before the embryo makes its way to the uterine cavity for implantation. If the Fallopian tubes are damaged, fertilization may not occur. If one Fallopian tube is blocked, it may be due to inherent disease involving both Fallopian tubes; even if the other Fallopian tube is open, it may not be able to provide the appropriate nurturing environment for fertilization and early embryo growth to take place.
Treatment depends on the cause of infertility, but may include counselling, fertility treatments, which include in vitro fertilization. According to ESHRE recommendations, couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy.[63] Treatment methods for infertility may be grouped as medical or complementary and alternative treatments. Some methods may be used in concert with other methods. Drugs used for both women and men[64] include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) analogues, aromatase inhibitors, and metformin.
The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g. Britain, Belgium) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of less than 2,500 grams (5.5 lb).[35]
Deciding whether to undergo in vitro fertilization, and how to try if the first attempt is unsuccessful, is an incredibly complicated decision. The financial, physical, and emotional toll of this process can be difficult. Speak with your doctor extensively to determine what your best options are and if in vitro fertilization is the right path for you and your family. Seek a support group or counselor to help you and your partner through this process.
Most parents have a mental image of their ideal family, and if they find themselves unable to make that happen, it can be devastating. Infertility is heartbreaking and stressful, whether you have a child or not. In fact, being a parent adds a layer of complexity. For one thing, parents are immersed in the world of kids, so it's impossible to avoid all the babies and pregnant bellies that remind you of what you're missing. Plus, "parents with secondary infertility don't often get much sympathy, so they end up feeling as though they don't have a right to be sad," says Marie Davidson, Ph.D., a psychologist at Fertility Centers of Illinois. In fact, they're often told to appreciate the child they have (as if they don't). Finally, many parents feel guilt on two fronts: for not giving their child a sibling and for directing some of their focus and resources away from that child.
Spend quality time with your child. In the midst of your infertility problems, you may feel especially upset about shifting your focus from the child you already have to the child you’re longing to have in the future. You may even feel guilty about your inability to give your little one a sibling or about the sadness you are sure is spilling over into her life. The best thing you can do for your child in this situation is to keep life as normal as possible, and ideally, find some quality time to be together. Whether it’s a chat about her day before you tuck her into bed or an afternoon romp in the park, those rituals will go a long way toward keeping your tot’s world stable and happy — even if you sometimes feel your world is spinning out of control. (You might find that focusing on your child lets you live in the moment — at least for a little while — which can help you cope with secondary infertility.) If you’re in a particularly bad place and fear that you may have a hard time handling your true emotions in front of your child (say, your pregnancy test just came up negative for the zillionth time in a row), see if you can arrange to send her to a friend’s house, or enlist your partner or mother-in-law to take over for a bit. Allowing yourself the time to compose yourself can make it much easier to face your little pride and joy with a smile.
^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy. 

The treatment options for unexplained infertility are several and the treatment results are promising. Expectant management can be recommended if the woman is under 28-30 years of age and the infertility duration is less than 2-3 years. In vitro fertilization (IVF) has revolutionized the treatment of infertile couples, as well as profoundly increasing the basic understanding of human reproduction. IVF can be used as both a diagnostic and a therapeutic tool in couples with unexplained infertility. The pregnancy rates with IVF are good, at 40% per treatment cycle. In addition, the outcome of pregnancies among women with unexplained infertility is generally comparable to that of spontaneous and other pregnancies using assisted reproductive technologies.
Men will need to have sperm testing. This involves giving a semen sample, which a lab will analyze for the number, size, and shape of the sperm. If the sperm are weak or damaged, a procedure called intracytoplasmic sperm injection (ICSI) may be necessary. During ICSI, a technician injects sperm directly into the egg. ICSI can be part of the IVF process.

If you’re worried that you might be an infertile woman, don’t lose your hope. Be encouraged, and know that many women get pregnant even after being diagnosed with infertility. Know that there is a reason for what you’re going through. I trust God and I rely on His power, peace, and joy every day. I know there is a reason why we struggled with infertility – and perhaps the reason is so I could write about fertility and encourage couples like you to keep the faith.
Many women spend much of their early adult lives trying not to get pregnant. But when you finally do want to start a family and it doesn’t happen right away, it can leave you feeling frustrated. Not to mention, trying to get pregnant month after month unsuccessfully can be emotionally taxing. You should know that you are not alone, and that unexplained infertility is exactly that– unexplained– so no finger pointing as to who is at fault!

The common thing that happens once learning about the unexplained infertility diagnosis is shifting blame or incurring guilt. You may feel a sense of individual responsibility for the news, and be concerned about the effects that this will have on your relationship and your current partner. Perhaps you feel like you waited too long to start a family or have anxiety finding the right parenting partner that you associate now with your infertility. Remember, it’s no one’s fault.
While it’s always recommended to consult with a medical provider before making any treatment decisions, this article serves as a great jumping point for those looking to get pregnant using assisted reproductive technologies (ART). In it, we discuss everything you need to know about IUI and IVF.  We start things off with a high-level overview, then jump into the different types of each treatment, discuss treatment details, key decisions within each treatment, success rates, cost comparisons, risks, and who each treatment might be a good fit for.
An IUI procedure is the process of directly injecting sperm into the top of the uterus. This increases the odds of conception by reducing the distance the sperm must travel to meet the egg. That said, when most people talk about IUIs, they’re referring to the steps leading up to and after the actual procedure. An IUI treatment can be summarized into a few steps:
Gene mutations in men and obscure viruses in women can cause infertility. Here’s a basic list of the most commonly known reasons men and women can’t get pregnant, plus four research studies that describe lesser known causes of male and female fertility problems. If you’ve been trying to get pregnant for more than a year,… Read More »Causes of Infertility for Men and Women Who Can’t Get Pregnant
In July 1978, Louise Brown was the first child successfully born after her mother received IVF treatment. Brown was born as a result of natural-cycle IVF, where no stimulation was made. The procedure took place at Dr Kershaw's Cottage Hospital (now Dr Kershaw's Hospice) in Royton, Oldham, England. Robert G. Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010. The physiologist co-developed the treatment together with Patrick Steptoe and embryologist Jean Purdy but the latter two were not eligible for consideration as they had died and the Nobel Prize is not awarded posthumously.[1][2]

^ Hozyasz, K (March 2001). "Coeliac disease and problems associated with reproduction". Ginekol Pol. 72 (3): 173–9. PMID 11398587. Coeliac men may have reversible infertility, and as in women, if gastrointestinal symptoms are mild or absent the diagnosis may be missed. It is important to make diagnosis because the giving of gluten free diet may result in conception and favourable outcome of pregnancy.


Infertility may have psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction.[17] Marital discord often develops, especially when they are under pressure to make medical decisions. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.[18] Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[19]

Studies have indicated that IVF mothers show greater emotional involvement with their child, and they enjoy motherhood more than mothers by natural conception. Similarly, studies have indicated that IVF father's express more warmth and emotional involvement than fathers by adoption and natural conception and enjoy fatherhood more. Some IVF parents become overly involved with their children.[136]

Ovulation induction (in the sense of medical treatment aiming for the development of one or two ovulatory follicles) is an alternative for women with anovulation or oligoovulation, since it is less expensive and more easy to control.[7] It generally involves antiestrogens such as clomifene citrate or letrozole, and is followed by natural or artificial insemination.
If you're overweight or obese, losing weight can boost your chances of getting pregnant. A study found that women whose body mass index (BMI) was above normal took twice as long to get pregnant as those with a normal BMI. But a drop in weight of 5%-10% can dramatically improve ovulation and pregnancy rates. Obesity can also cause infertility and low testosterone in men. Being significantly underweight can also lead to infertility.
A surge in LH triggers your ovaries to release an egg. The surge usually happens 36 hours before the egg is released. Ovulation kits check LH levels in your urine to help you pinpoint the day of ovulation. These kits, which you can buy at the drugstore, are convenient and highly accurate. You may want to test 1-2 days before you expect the surge so you can note the rise in LH.
Nonmedicated cycle with IUI: Also known as natural cycle IUI, a non-medicated cycle with IUI is often used by single women or same-sex female couples who are not directly experiencing infertility, but rather a lack of sperm. This treatment involves tracking the development of the egg that is naturally recruited during a menstrual cycle and then introducing the donated sperm. You will come into the office for two to four monitoring appointments to track egg development and cycle timing.
With egg donation and IVF, women who are past their reproductive years, have infertile male partners, have idiopathic female-fertility issues, or have reached menopause can still become pregnant. After the IVF treatment, some couples get pregnant without any fertility treatments.[3] In 2018, it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.[4] However, a recent study that explores 10 adjuncts with IVF (screening hysteroscopy, DHEA, testosterone, GH, aspirin, heparin, antioxidants in males and females, seminal plasma, and PRP) suggests that until more evidence is done to show that these adjuncts are safe and effective, they should be avoided.[5]
Since most IVF cycles start with collecting a number of eggs after ovarian stimulation, you should have on average 12-15 eggs to use. This means that you do not need to use all of them for ICSI or conventional IVF. A Split-ICSI strategy incorporates both – some eggs are injected with selected sperms using ICSI, where the rest are incubated with sperm in the conventional way. Trying both provide a safety net against failed fertilization with either strategy.
In December 2015, the Ontario provincial government enacted the Ontario Fertility Program for patients with medical and non-medical infertility, regardless of sexual orientation, gender or family composition. Eligible patients for IVF treatment must be Ontario residents under the age of 43 and have a valid Ontario Health Insurance Plan card and have not already undergone any IVF cycles. Coverage is extensive, but not universal. Coverage extends to certain blood and urine tests, physician/nurse counselling and consultations, certain ultrasounds, up to two cycle monitorings, embryo thawing, freezing and culture, fertilisation and embryology services, single transfers of all embryos, and one surgical sperm retrieval using certain techniques only if necessary. Drugs and medications are not covered under this Program, along with psychologist or social worker counselling, storage and shipping of eggs, sperm or embryos, and the purchase of donor sperm or eggs.[151]
We’re not talking about that uncomfortable throb or dull ache that most women are cursed with during their periods—those cramps are your uterus’s way of telling you it’s contracting to expel its lining. For some women, the message comes through more loudly and clearly than others, but it doesn’t compare to the pelvic pain and severe cramping associated with endometriosis. This kind may begin before your period and extend several days into it, it may include your lower back and cause abdominal pain, and it can get worse over time. Endometriosis occurs when tissue that normally lines the inside of your uterus grows in other locations, such as your ovaries, bowel or pelvis. The extra tissue growth (and its’ surgical removal) can cause scarring, it can get in the way of an egg and sperm uniting, and it may also affect the lining of the uterus, disrupting implantation. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. Other symptoms include pain during intercourse, urination and bowel movements.  Here are other conditions that cause stomach pain.
Talk it out. Once you realize you’re entitled to your emotions, find an outlet for them. Talking about your feelings and your struggles can be a huge release and allow you to receive the support you need. If your family or friends don’t understand your sadness (or you find it hard to contain your baby envy around friends with more than one child), seek out people in your same situation. Find a support group for people with secondary infertility — online or in your area. And consider joining WTE's Trying to Conceive group to find moms who are also coping with secondary infertility.

Once the semen sample is ready, it'll be put through a special washing process, which separates the sperm from the other stuff that is found in semen. The embryologist will choose the “best-looking sperm," placing about 10,000 sperm in each culture dish with an oocyte. The culture dishes are kept in a special incubator, and after 12 to 24 hours, they are inspected for signs of fertilization.
There’s an intense emotional response to hearing, “There is no apparent reason for your infertility”. It can be difficult, maddening and equally frustrating for both you and your partner. People who do find out a specific cause find their situations difficult, too, of course, but knowing the “whys” makes it more bearable. In cases of unexplained infertility, couples feel that one reason, one cause is lurking in a shadowy corner. It just hasn’t been uncovered yet.

The Fallopian tubes are the site for fertilization before the embryo makes its way to the uterine cavity for implantation. If the Fallopian tubes are damaged, fertilization may not occur. If one Fallopian tube is blocked, it may be due to inherent disease involving both Fallopian tubes; even if the other Fallopian tube is open, it may not be able to provide the appropriate nurturing environment for fertilization and early embryo growth to take place.
At the same time, in older women, the IVF success rates can vary dramatically, and that’s why it’s so important to focus only on live births. For example, a clinic may have a very high pregnancy rate among older women, but a low live birth rate. Or, the rates may be quite high – 40% or even 50% – but only after four or five rounds. That makes a very big difference, especially in the overall cost of treatment!
How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
Oral drugs used to stimulate ovulation include clomiphene citrate and aromatase inhibitors. While taking these drugs, you will be monitored to see if and when ovulation occurs. This can be done by tracking your menstrual cycle or with an ovulation-predictor kit (an at-home urine test). You may be asked to visit your doctor for a blood test or ultrasound exam.
Preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) has been suggested to be able to be used in IVF to select an embryo that appears to have the greatest chances for successful pregnancy. However, a systematic review and meta-analysis of existing randomised controlled trials came to the result that there is no evidence of a beneficial effect of PGS with cleavage-stage biopsy as measured by live birth rate.[81] On the contrary, for women of advanced maternal age, PGS with cleavage-stage biopsy significantly lowers the live birth rate.[81] Technical drawbacks, such as the invasiveness of the biopsy, and non-representative samples because of mosaicism are the major underlying factors for inefficacy of PGS.[81]
Only 30 percent of patients who receive 100 mg of Clomiphene a day will produce more than three follicles. Patients that produce less than than three follicles have about half the chance of getting pregnant than those that produce greater than three follicles. Patients that receive fertility medications but do not do an insemination have only half the success rates compared to those who do.
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