What Is Secondary Infertility? Here’s What You Should Know About It, And How It Can Be Caused By Your C-Section

If you’ve previously had little to no trouble getting pregnant and even a successful pregnancy and a healthy child, infertility is likely the furthest thing from your mind. That is, until you start trying for baby number two and encounter many of the issues couples with infertility face.

By Gwen Farrell3 min read
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This can be a frustrating thing to experience if you’ve previously had no issues with conceiving. But the culprit at the heart of the matter might be secondary infertility, a condition which can (but not always) be caused by previously having a C-section. Here’s what you should know. 

Breaking Down Infertility

Infertility is a broad term with numerous causes and symptoms, but it’s most commonly defined as being unable to get pregnant after a year of trying to conceive for women under age 35, and six months of trying for women over 35. Approximately 1 in 10 women of childbearing age are struggling with infertility, though it’s a condition that can affect both men and women. Though we often think of infertility as affecting a couple’s ability and chances of conceiving at all (primary infertility), couples who have previously successfully conceived and had healthy pregnancies can also face infertility thereafter (secondary infertility). 

In women, factors like age, egg quality or quantity, conditions which contribute to hormonal imbalances like polycystic ovarian syndrome, endometriosis, and even lifestyle factors like eating disorders, stress, or excessive alcohol consumption can all contribute to infertility. It’s also possible that infertility in women is due to more complex medical reasons, like pelvic inflammatory disease (a complication from gonorrhea and chlamydia), ovarian cysts, sickle cell anemia, uterine conditions, thyroid disease, irregular ovulation and menstruation, and past ectopic pregnancy.

In women, factors like age, egg quality, and hormonal imbalances can all contribute to infertility.

Age, sperm health, and other lifestyle factors can negatively or positively affect male fertility. Male infertility can be a result of poor sperm motility, past testicular conditions like testicular cancer or undescended testicles, low testosterone, and use of anabolic steroids. It’s estimated that while as many as five million couples (or 1 in 6) in America struggle with infertility, male infertility is the significant contributing factor for half of those couples, meaning that 10% of men are facing infertility.

A change in lifestyle or environment, including weight loss, better sleep quality, and quitting smoking or alcohol consumption might be recommended as possible treatments for infertility. Treatment might also require more invasive methods, like genetic testing, sperm or egg retrieval, ovulation testing, or removal of uterine fibroids and endometrial polyps. Any treatment which directly handles either sperm or eggs is referred to as assisted reproductive technology, the most well-known method being in vitro fertilization. However, it should be noted that IVF, while often recommended by medical professionals, is not always a viable option for couples, whether for financial or ethical reasons. Fortunately, there are many tests and lifestyle factors to help find and resolve the underlying causes of which infertility is the symptom. 

Secondary Infertility

According to one doctor, secondary infertility shares many of the same symptoms and causes as primary infertility, but with one significant difference – the woman trying to conceive has previously achieved one or more pregnancies with no difficulty. For this reason, secondary infertility can often surprise individuals. We tend to view our fertility as something that’s static rather than dynamic, meaning that if we’ve successfully conceived before, it doesn’t follow logically that we’d have issues conceiving after having no issues at all.

But fertility can be a tricky thing, as many of us know, and it can change whether we think it will or not. As with primary infertility, factors like age, sperm health, female reproductive disorders, and infections can all contribute to secondary infertility, which affects an estimated 11% of couples. 

Secondary infertility affects an estimated 11% of couples.

An additional factor which may contribute to secondary infertility is possible uterine scarring, or isthmocele, which is a side effect of delivering via C-section. The formation of an isthmocele stimulates inflammation in the uterus which affects an embryo’s ability to implant successfully, a cause which doesn’t contribute to primary infertility. Isthmocele can be treated effectively with removal of the scar tissue through surgery.

Do We Have an Unhealthy Reliance on C-Sections?

For many women, it’s entirely possible that secondary infertility might have never been a feature of their fertility journey had it not been for their C-section. One mom shared that she had no difficulty conceiving her first son who was delivered via emergency C-section, and everyone was happy and healthy – until she began to try for another baby when her son was two, and was still not able to get pregnant by the time he was four. After many tests searching for answers, an MRI confirmed the presence of an isthmocele.

Uterine defects as a result of a C-section can be brought about by several factors, including the exact technique used to close the incision, the position of the uterus, going through labor before undergoing the surgery, and the exact number of C-sections the mom in question has had. Symptoms of possible defects, aside from secondary infertility, include discharge, painful periods, abnormal bleeding or menstruation, and even ectopic pregnancy in the C-section scar.

Uterine scarring, a side effect of C-sections, can contribute to secondary infertility. 

As terrifying as these possibilities sound, they don’t really seem to be widely known or disclosed to moms who may undergo C-sections, whether in the event of an emergency or electively. While the recovery process is rightfully the concern for many moms immediately following their surgery and delivery, it’s these consequences that could last far beyond that recovery and potentially impact their future fertility.

The number of C-sections globally has risen, and continues to. It’s predicted that by 2030, C-sections will account for a third of all births. Currently, that global number sits at 21%, or 1 in 5 births. In America, 31.8% of all live births in 2020 were via C-section. In contrast, the World Health Organization has recommended a target rate for C-section births to be between 10% and 15%. Dr. Ian Askew, a representative for the World Health Organization, acknowledges that while C-sections can be life-saving interventions in many cases, “unnecessary surgical procedures can be harmful, both for a woman and her baby.” Adequate prenatal preparation like educational programs and other health initiatives, including the use of midwives during labor, have all been shown to decrease both the need and reliance on C-sections. 

Closing Thoughts

Whether it’s after a pregnancy or not, infertility can be a frustrating, disheartening experience. It’s worth remembering that our fertility isn’t something we measure as a success or a failure or as a variable which never changes, but as something that can evolve over time, and being as aware and educated as we possibly can be is one of the most beneficial things we can do to help our childbearing journey.

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