Why Couples Sometimes Have Trouble Having a Second Child

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By Spencer Richlin, MD


Baby. Toddler. Repeat.

It sounds simple. But having a child is not easy for everyone, even for people who are already parents.

Secondary infertility is the inability to become pregnant or to carry a pregnancy to term, following the birth of one or more biological children. Like primary infertility, it is more common than most people are aware. According to the National Center for Health Statistics, more than three million women in the U.S. suffer from secondary infertility, which is about the same rate as primary infertility.

Why Secondary Infertility Happens

Infertility in general is defined as one year of well-timed sexual relations without conception. The causes vary and include age-related infertility, hormonal dysfunction such as Polycystic Ovarian Syndrome (PCOS), diminished ovarian reserve and physical conditions such as endometriosis or tubal disorders.

As we age, men and women’s bodies have physical and hormonal changes that contribute to secondary infertility. Otherwise healthy men and women may have diminishing reproductive health. There may be significant changes to a woman’s body since her last pregnancy. Even if they feel healthy and young, their reproductive health is affected by age.

One of the most significant effects of aging is on a woman’s oocytes (or eggs). Women are born with all the eggs that they will have in their lifetime. Each month, several eggs mature as part of her menstrual cycle. The quality and quantity of these eggs is affected by age, as well as lifestyle habits such as diet, sleep, stress management and vices such as smoking and alcohol.

What Patients Can Do 

Patients can play an important role in their fertility. First, women who are considering having another child can gain insights to their reproductive health by having a simple blood test called an anti-mullerian hormone (AMH) test. AMH levels are indicative of a woman’s ovarian reserve and her long-term fertility. This test can help a couple decide if they should try to have a child in the near future or if they have more time and flexibility.

Second, couples can improve their fertility in as little as 90 days through lifestyle changes to their diet choices, sleep habits, exercise routines and stress management. To help support couples while making these changes, RMACT has an Integrated Fertility & Wellness Program that includes yoga, acupuncture, support groups, counseling and a nutrition program.

In addition to these efforts, patients can seek help from a Board Certified reproductive endocrinologist, which is the type of doctor that focuses on infertility and reproductive function. These specialists perform advanced medical procedures and guide patients through infertility treatment.

We continue to learn more about the impact of lifestyle choices on fertility. Recent clinical research concludes that these factors affect mitochondria, which provide the energy that enables fertilized eggs to split cells and create an embryo. At RMACT, we have started recommending that women take the CoQ10 supplement to improve the quality of their oocytes and mitochondrial function.

Despite all of this, there is good news. The odds are in favor of couples who have had a previous spontaneous pregnancy and live birth. In part, this is because the patient has the physical ability to carry a baby to term. Working together, we can help a patient conceive and maintain a healthy pregnancy.

To learn more about secondary infertility and infertility intervention, please join us for Growing Your Family: Everything You Need to Know to Have Another, a live webinar on Wednesday, May 18 at 1:30 p.m. For more information, please go to or email



Dr. Richlin is a reproductive endocrinologist and the Surgical Director for Reproductive Medicine Associates of Connecticut (RMACT), as well as Division Director of Reproductive Endocrinology and Infertility (REI) in the Department of Obstetrics and Gynecology at Norwalk Hospital in Norwalk, CTHe is a Castle Connolly “Fairfield County Top Doctor,” has published several papers and is the coauthor of the fertility chapters in Avoiding Common Obstetrics and Gynecology Errors (Lippincott, Williams, and Wilkins, 2010). 


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