Primary vs Secondary Infertility: What’s the Difference?

Primary Infertility and Its Treatment

Many have a question in their mind about what is considered infertility. It is a medical condition when a male’s sperm or a female’s eggs are unable to fertilize. It is diagnosed when a couple has been unable to achieve pregnancy even after 12 or more months of unprotected sex. In simple words, when a couple cannot conceive a child through natural pregnancy, then that is diagnosed as infertility, or often known as primary infertility. Moreover, there are various treatments available nowadays to treat infertility, such as Assisted Reproductive Technology (ART), Medications, Surgery, and Lifestyle Changes. Now, let’s consider understanding these treatments in detail:

• Assisted Reproductive Technology (ART)

This method handles the eggs, sperm, or embryos through a combination of procedures to create a natural pregnancy and treat infertility. Some key techniques include embryo freezing, IVF, ICSI, etc.

• In Vitro Fertilization (IVF)

In this procedure, eggs are retrieved from the female, fertilized in a lab, and then safely transferred to the uterus for eventual formation of the fetus and treatment of both primary and secondary infertility.

• Intracytoplasmic Sperm Injection (ICSI)

This treatment is used when the male is infertile. In ICSI, a single donor sperm is injected into the female’s egg to further fertilize and cause a natural pregnancy in the woman’s womb.

• Intrauterine Insemination (IUI)

This method is only performed when the female is ovulating, as it requires healthy sperm to be placed directly inside the uterus of a woman in her ovulating days, to cause proper fertility and pregnancy.

• Third Party ART (TPART)

This method is often known as surrogacy, where a donor’s fertilization is needed, either in the form of sperm, embryos, or gestational carriers. Surrogacy offers donors for both genders and are later referred to as surrogate parents.

• Fertility Medications

In this form of treatment, medicines such as Clomiphene Citrate, Letrozole, or Gonadotropins serve as supporting pillars for egg or sperm fertilization by stimulating egg production or treating hormonal imbalances.

• Surgical Fertilization

These methods are used when the cause of infertility is a structural issue in either the male or female. In this procedure, these issues are corrected surgically by specialists. Some common structural issues include fallopian tube blockages, endometriosis, and uterine fibroids/polyps.

• Lifestyle Changes

One can be diagnosed with infertility if there is a lack of compatibility or an unhealthy diet. However, this method is the most suitable for this type of infertility. This involves counseling, dietary changes, education, and even optimizing ovulation timing for effective results.

Secondary Infertility & Its Treatment

After learning about infertility or primary infertility, one might ask, what is secondary infertility? So, when a couple has already given birth to a child through natural pregnancy, but fails to conceive again, it is diagnosed as secondary infertility. Moreover, secondary infertility treatments are the same as those of primary infertility, with options ranging from fertility medications and surgery to lifestyle changes or assisted reproductive technology. Some of the common causes of secondary infertility are age decline, problems with ovulation, uterine scarring, or blockage of the tubes. Furthermore, let’s understand these causes of secondary infertility in detail:

• Secondary Infertility in Females

Secondary issues can be an effect of either the male or female partner when it comes to various reasons that cause secondary infertility.

Age Decline – As women grow older, egg quality declines, and the number of eggs released decreases.

Hindrance in Ovulation – There are various conditions that affect the necessary ovulation required for natural pregnancy, such as thyroid and Polycystic Ovary Syndrome (PCOS).

Uterine Scarring – Asherman’s syndrome, also known as uterine scarring, is a barrier to natural pregnancy and can be caused by any previous Dilation and Curettage (D&C), C-section surgery, fibroids, or polyps.

Tubal Blockage – A major reason for secondary infertility is the blockage of fallopian tubes, further affecting the flow of eggs. This blockage is mostly caused either by infections or adhesions from previous surgeries.

• Secondary Infertility in Males

Often, the common reasons affecting a male’s fertility are low sperm count or impediment in the independent/spontaneous movement of the sperm. Moreover, these issues are caused by age-related decline or by swelling of the pampiniform plexus (a network of interconnected veins within the scrotum).

• Unhealthy Lifestyle

One of the most general causes of secondary infertility is an unhealthy lifestyle, or habits that affect your body, such as a sudden increase or decrease in weight, stress, anxiety, extreme alcohol consumption, chain puffing, etc. These habits certainly reduce fertility in anyone who follows them.

Differences Between Primary & Secondary Infertility

From the topics above, we already have a decent understanding of what primary and secondary infertility are. Now, let’s dive deep and look at the key differences between them. Both primary and secondary infertility are conditions where the chances of a natural pregnancy are none, even after continuous unprotected sex for 12 months. The major difference between these two forms of infertility is their history. Adding on, primary infertility means that there has been no prior pregnancy, while secondary infertility is diagnosed when there is a history of at least one natural pregnancy. Now, let’s have a look at some key differences amongst them in detail-

History of Prior Pregnancy

Primary infertile cases are the ones that have never achieved a pregnancy before. However, in secondary cases, there has been a history of one or more successful pregnancies.

Causes

There are different reasons for each to occur, such as primary infertility cases stemming from congenital, genetic, endometriosis, or developmental issues, while secondary cases are related to factors affected by the first pregnancy, such as age decline, complications from previous pregnancies (C-section scarring, adhesions), or significant weight changes.

Stress & Fear

During primary cases, there is a fear of what might happen or how it will feel, often referred to as fear of the unknown. However, in secondary cases, there is a sense of intense guilt, social isolation, and frustration, as society expects them to conceive again due to their prior successful pregnancy.

Common Factors Between Primary & Secondary Infertility

Along with many differences, there are many common factors, such as shared causes, diagnostic procedures, and treatments. Now, let’s elaborate on these factors in detail-

• Growing Age – Due to the decreasing quantity of eggs along with their dwindling quality, advancing age is considered a primary factor in both cases of infertility.
• Common Causes – In both cases, there are some common causes affecting the infertility, such as Polycystic Ovary Syndrome (PCOS), thyroid disorders, endometriosis, and other lifestyle factors (sudden weight gain or loss, anxiety, smoking, drinking, etc.).
• Diagnostic Process – Tests such as Hysteroscopy, Transvaginal Ultrasound (TVS), and Hormonal blood tests, including Anti-Mullerian Hormone (AMH), are common in both cases.
• Treatment – In both cases, the treatment options are similar, including Intracytoplasmic Sperm Injection (ICSI), In Vitro Fertilization (IVF), or medications to boost egg production.

Conclusion

There are times when one can’t conceive naturally, and thus is diagnosed with infertility. Moreover, there are two types of infertility, primary and secondary infertility. When one has primary infertility, they cannot conceive a child due to their medical condition. However, in secondary infertility, one has already gone through one or more successful pregnancies, but cannot further conceive a baby. This often happens due to the side effects of previous pregnancies or one’s advancing age. Furthermore, there are various treatments available in fertility clinics throughout the world for partners or parents wanting to conceive a baby.