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Secondary Infertility

What is the Difference Between Primary and Secondary Infertility?

May 26th, 2022 | 11 min. read

By Lisa Rosenthal

For decades, patients have come to fertility clinics for help growing their families, whether it be their first child or their next child. The terms "primary infertility" and "secondary infertility" are often thrown around in the fertility world, but what do those with primary and secondary infertility have in common and where do the similarities end?

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What do primary infertility & secondary infertility mean?

According to the World Health Organization (WHO), “Infertility can be primary or secondary. Primary infertility is when a pregnancy has never been achieved by a person, and secondary infertility is when at least one prior pregnancy has been achieved.”

Expanding on this definition, secondary infertility does not always follow primary infertility. There are those who conceive with no need for fertility treatment, but who do need it to achieve subsequent pregnancies and babies. 

Breaking this down even further, secondary infertility can either follow primary infertility or occur after a child has been conceived without assisted reproductive technology (ART).

Put simply, just because you needed fertility treatment to have one child doesn't always mean you'll need fertility treatment to get pregnant again. And just because you had to go through treatment to have one child doesn't mean you'll necessarily need it to conceive your next. A little confusing, right?

What are the similarities between primary and secondary infertility?

Whether you are striving to have your first child or longing to give your child a sibling, the desire for that child is typically very strong. It's often coupled with a yearning to fulfill the vision we have of the family of our dreams. Many people have described it as if “I see my family at the dining room table and feel like someone’s missing.”

The emotional and physical ups and downs of expanding your family through fertility treatment are the same, regardless of whether you already have a child or not.

Related: The Biggest Side Effects of IVF Egg Retrieval

The rigors of treatment still include hormone medications that wreak havoc on your emotions. The physical demands of repeated doctors’ visits for monitoring, blood draws, ultrasounds, diagnostic testing and procedures is the same. The logistical demands of driving to your fertility clinic first thing in the morning (often several times a week) are the same, no matter what.

All of that time and energy spent working towards your goal, a baby, means that your time is not available for other everyday things, including work obligations. This can be incredibly challenging! Some patients describe fertility treatment as a full-time job, and we agree - it's a lot to manage.

Navigating the Twists & Turns

Another similarity? The unpredictability of fertility treatment. Any good fertility practice designs every treatment protocol based on each patient’s individual response (which is great), but this can mean that the timing of your appointments and procedures may change frequently (which can be challenging).

The emotional ups and downs of infertility can also decrease your self-esteem. More often than not, patients feel less than, damaged, incapable - feelings that are manageable and temporary, but typically feel oppressive and challenging.

What is the difference between primary and secondary infertility?

The number one difference between primary and secondary infertility is that secondary infertility patients have already achieved the title of parent. Once you've reached that goal of becoming a parent, so many dreams come true and there is relief in finally having a baby in your arms. 

What is surprising, but also true, is how quickly someone with primary infertility starts to think about having another child, a sibling for the little one that they love so dearly. 

Note: If you had to undergo fertility treatment to conceive one child, the sense of urgency and uncertainty around how long it may take to conceive again is often very strong. Many patients report starting to think about getting back into treatment soon after their baby is born, or even before!

For those with an only child:

There are some unexpected struggles for parents with one child that often include (usually) well-meaning but insensitive questions and comments, like:

  • "So, when are you going to have another baby?
  • "Don’t you want your child to have a sibling?"
  • "Well, don’t wait too long - you don't want a big age gap!"
  • "Don't you think it's a little selfish to have only one child?"

Many parents get bombarded with these questions and comments very quickly, sometimes as soon as their baby is just a few months old - which means they've barely had enough time to adjust to being a new parent!

There are some unavoidable situations that are a little easier when you have at least one child, like playdates, school events, even those dreaded baby showers. While those events may still send an arrow through your heart, having a child means putting some of their needs first, which can divert some of the focus.

Dr. Hurwitz shares more common "tips" people offer:

11 Things to Never Say to Someone Struggling with Infertility

Returning to Fertility Treatment Again

If you've been through fertility treatment previously, returning to treatment can feel a bit different the next time around. The logistics are different: you need to find childcare or bring your child with you, with the knowledge that another patient's heart may be breaking by seeing your child at the fertility clinic. 

And no matter how sad, frustrated or disappointed you are with test results, you still need to care for your child, which often happens at the expense of caring for yourself adequately. As any parent knows, juggling the needs of yourself and a child can be very tricky.

Related: 11 Ways to Manage Stress During Fertility Treatment

You may also feel guilty about stopping something like breastfeeding earlier than planned in order to start fertility treatment again. Or you may feel pressure to return to treatment without being able to fully enjoy the early months or years with the child you already have. All of this is completely normal and understandable.

Note: If you're struggling with decisions around fertility treatment or family planning, or just want some extra support on your journey, our team of fertility counselors is always ready to help. Learn more here.

Are primary and secondary infertility treated differently?

Put simply, the treatment options for primary and secondary infertility are the same. Whether you choose IUI, IVF, donor conception, surrogacy, or another pathway to parenthood, you will essentially be treated in the same way. 

However, if you've been through fertility testing or treatment previously, your doctor will have some great existing information to work with (for example, they may already know that your uterus is a normal shape or that you respond well to a certain fertility medication).

At the end of the day, each person's journey is unique (regardless of whether you're considered a primary or secondary infertility patient), and your Care Team will work closely with you to achieve your goals - no matter what your history may be.

What if I've gone through fertility treatment before? Am I considered a primary or secondary infertility patient? Great question! If you have existing fertility challenges and went through treatment to conceive a child, you're still considered to have primary infertility. Only patients who have conceived on their own (without assistance) and now need help conceiving again fall into the secondary infertility category.

Primary vs Secondary Infertility in Support Groups

The single greatest point of conflict between those facing primary and secondary infertility is when the focus shifts from the desire for a child to parenting a child.

When the emphasis is kept on the fertility journey at hand, there is usually a magical, comforting camaraderie that occurs when those with infertility get together in one place (like a support group). There’s shared laughter, questions, tears, stories and other interactions that bond us as fertility warriors. 

So how can we move past this pain point, so that everyone can feel supported and welcome? It's very simple: this is not the group to discuss potty training, car seats or whether your baby is sleeping through the night. There is lots of great support out there for those things, but a fertility support group is not it.

Read about one new mom's journey:

Read More

Should we mix primary and secondary infertility patients?

When it comes to fertility support groups, one question to consider is: "Well, why not just have separate groups for primary and secondary infertility patients?"

This question has been raised many times over the years. And every time it is brought up again, even with new viewpoints, we come to the same conclusion: both primary and secondary infertility patients have much more in common (and much more to gain) when they're brought together.

A good way to explain it is through a visual. 

Picture a group of 12 people, with different challenges - unexplained infertility, diminished ovarian reserve, blocked fallopian tubes, PCOS, secondary infertility, endometriosis, poor response to medications, recurrent miscarriage, male factor issues, genetic concerns, uterine dysfunction, those using egg or sperm donors. The list could go on and on. 

Related: 10 Ways to Take Back Control On Your Fertility Journey

It might make sense to have a separate group for each of those diagnoses, right? If we group the folks with more specific challenges and concerns in common, they're sure to be able to relate to each other better...

But now, instead of 12 people in a group, visualize 12 rooms, with one person in each room. This would lead to less support and camaraderie, and wouldn't feel the same as a group discussing infertility as a whole, their strong yearnings for a child, and the obstacles and hopes they encounter. 

So, we choose to mix primary and secondary infertility patients together to focus on the bigger picture - the desire to expand our families and have a baby. We choose to concentrate on the things we have in common, instead of the things that we don’t. We choose to give and receive love and compassion, drawing from the participants who show up, open their hearts and share their stories in our support groups. 

The Beauty of Infertility Support Groups

Some things in life feel just about perfect, and for me, facilitating infertility support groups is one of those things.

Over the decades that I’ve led these groups, each one of them has turned out to be uniquely perfect. Sometimes it’s just 5 patients who show up, and they have so much in common that they bond instantly. Sometimes there are 20 people in a group and certain people choose to listen more than talk. 

Being with each other gives everyone a chance to talk, ask questions, be able to remove their masks and be themselves, and have a good laugh or cry. 

But no matter what, people leave our support groups knowing that they're not alone.

What do you think? Should we focus more on the similarities or the differences between primary and secondary infertility? Would you prefer two separate groups? Email me and tell me your thoughts!

Want to find friends who truly understand?

Join a Support Group

Infertility is the Common Denominator

Whether you already have a child in your arms or not, the experience of navigating infertility is largely the same. The ups and downs can be incredibly challenging and bring on a lot of complicated emotions (not to mention the impact that hormonal medication can have on your mental and physical state). 

At the end of the day, your journey may be personal and individual to you, but you will likely experience many of the same things as other fertility warriors - whether they're already parents or not.

Allow yourself the space to process what you need to, reach out for support from those who really "get" what you're going through, and remember that you're never alone

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Lisa Rosenthal

With 35+ years experience in the fertility field, as well as navigating her own infertility, Lisa has dedicated her life to advocating for and supporting those struggling to grow their families. Her work includes serving as Illume Fertility's Patient Advocate, Strategic Content Lead, and founder of Fertile Yoga, as well as advocating for those with infertility at RESOLVE, Resolve New England, and other organizations.

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