From the Guidelines
Secondary infertility is primarily caused by age-related fertility decline, tubal damage, endometriosis, male factor issues, hormonal changes, weight fluctuations, lifestyle factors, and uterine factors, with approximately 20-30% of cases remaining unexplained. The causes of secondary infertility can be multifaceted, involving various factors that affect both men and women.
Key Factors
- Age-related fertility decline, particularly in women over 35, as egg quality and quantity diminish 1
- Tubal damage from infections like pelvic inflammatory disease, previous ectopic pregnancy, or surgery, which can block fallopian tubes and prevent egg and sperm from meeting 1
- Endometriosis, which may progress over time, causing scarring and inflammation that interferes with conception 1
- Male factor issues, such as declining sperm parameters due to lifestyle changes, medications, or health conditions, which can develop after a previous successful pregnancy 1
- Hormonal changes, including polycystic ovary syndrome, thyroid disorders, or premature ovarian insufficiency, which may emerge or worsen over time 1
- Weight fluctuations, significant gain or loss, which can disrupt hormonal balance and ovulation 1
- Lifestyle factors, such as increased stress, smoking, alcohol consumption, or poor diet, which can negatively impact fertility 1
- Uterine factors, such as fibroids, polyps, or adhesions that develop after a previous pregnancy or delivery, which may prevent implantation 1
Unexplained Secondary Subfertility
Unexplained secondary subfertility accounts for about 20-30% of cases, where no specific cause can be identified despite thorough investigation 1.
Treatment
Treatment depends on the identified cause and may include lifestyle modifications, medication to induce ovulation, surgical interventions, or assisted reproductive technologies 1. It is essential to note that the American College of Radiology Appropriateness Criteria provides evidence-based guidelines for specific clinical conditions, including female infertility, and recommends imaging and treatment procedures based on current medical literature and expert opinion 1.
From the Research
Causes of Secondary Infertility
- Ovulatory disorders, such as polycystic ovary syndrome (PCOS), are a major cause of secondary infertility 2, 3, 4, 5, 6
- Tubal disease, peritoneal adhesions, endometriosis, and uterine abnormalities can also contribute to secondary infertility 3, 4
- Abnormalities of sperm and advancing female age are additional factors that can affect fertility 3, 4
- Unexplained infertility, where the cause is unknown, accounts for about 5-10% of cases 3, 4
- Lifestyle factors, such as smoking, weight, and physical activity, can also impact fertility 2, 5
Specific Causes of Secondary Infertility in Women
- PCOS is a common cause of anovulatory infertility, affecting 7-15% of women of reproductive age 2, 5
- Hypothalamic amenorrhoea (HA) and premature ovarian insufficiency (POI) are other causes of anovulation 4
- Tubal patency can be affected by conditions such as endometriosis and pelvic adhesions 3, 4
Investigation and Management of Secondary Infertility
- Initial evaluation includes a complete medical history, physical examination, and laboratory tests to assess ovarian function, uterine cavity, and tubal patency 2, 3, 4
- Treatment options may include lifestyle modifications, medical therapy (e.g. clomiphene citrate, metformin), surgical techniques (e.g. ovarian drilling), and assisted reproductive technologies (e.g. in vitro fertilization) 2, 3, 4, 5, 6