Published Jul 25, 2026 | 7:00 AM ⚊ Updated Jul 25, 2026 | 7:00 AM
Delayed parenthood is probably one of the biggest contributors.
Synopsis: Many couples assume that conceiving naturally once guarantees another pregnancy. Fertility specialists say delayed parenthood, age-related fertility decline, male infertility, Caesarean-related complications and lifestyle changes are driving secondary infertility. Experts urge early evaluation, stressing that IVF is not the only treatment and that timely diagnosis can preserve more reproductive options.
Many couples rarely think about fertility for years after the birth of their first child.
Life moves on. Careers take off, mortgages need paying, children start school, ageing parents need care, and the idea of another baby is quietly pushed into the future. When they finally decide the time is right, most assume conception will happen just as easily as it did the first time.
It often doesn’t.
Instead, months pass without a positive pregnancy test. The reassurance from family and friends is almost predictable: “Relax.” “It happened once, it’ll happen again.” “At least you already have one child.”
But fertility specialists say that assumption—that a previous pregnancy guarantees another—is among the biggest myths delaying treatment for what doctors call secondary infertility, the inability to conceive again after having conceived at least once before.
Across fertility clinics, doctors say they are seeing a steady increase in couples seeking help not for their first child, but for their second.
“Yes, definitely,” Dr Parinaaz Parhar, Regional Medical Head and Fertility Specialist at Oasis Fertility in Hyderabad, told South First. “Over the past decade, around 30% of couples coming to our Secunderabad centre already have one child. Ten years ago, that group was much smaller.”
Similar trends are being reported elsewhere.
“Compared to five or 10 years ago, I see many more couples seeking help for a second pregnancy. Around 30-40% of the infertility patients I see already have one child,” said Dr Swathi, Consultant Obstetrician and Gynaecologist, Fertility Specialist, Laparoscopic and Robotic Surgeon at Prashanth Hospitals, Chennai.
Dr Ramya MR, Consultant in Reproductive Medicine and Infertility at Rainbow Children’s Hospital, Chennai, said the shift has been striking.
“Earlier, most fertility consultations were from couples struggling for their first child. Today, nearly 30-40% of patients in many fertility clinics already have one child and are finding it difficult to conceive again,” she told South First.
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Doctors said today’s couples are not necessarily less fertile than previous generations. Rather, they are trying for their second child later in life.
A decade ago, many families planned a second pregnancy within two or three years of the first. Today, that interval is often five to eight years.
The reasons are familiar: careers, financial planning, childcare responsibilities, relocations, rising education costs and the absence of family support.
“Many couples are older than before, often planning their second child after a gap of five to eight years because of career goals, financial planning or personal commitments,” Dr Swathi said. “Earlier this was mainly seen in urban couples, but now we’re seeing the same trend in smaller cities as well.”
Dr Parhar has observed a similar change.
“The typical woman is now in her mid-thirties, not her late twenties. Couples once left two to three years between children. Now it is five to eight years because of careers, relocations, housing and the cost of raising a child in a city,” she said.
The problem, specialists said, is that biology does not adjust itself to life plans.
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Perhaps the biggest misconception surrounding secondary infertility is that having conceived naturally once somehow protects fertility in the future.
Doctors said it does not. “Fertility is a snapshot, not a lifetime certificate,” Dr Parhar said. “Many people assume the husband has already proved himself or that because pregnancy happened once, it will happen again. Fertility changes with time.”
The biggest driver, according to every fertility specialist interviewed for this story, is age.
“The biggest reason behind the rising trend of secondary infertility is age,” said Dr Rani Aiswarya, Consultant Fertility Specialist at 9M Fertility by Ankura Hospital told South First.
“After the birth of their first child, many couples delay planning a second pregnancy because of work, financial commitments or other personal reasons. By the time they decide to have another child, the woman is often 35 years or older, when there is a rapid decline in both egg quality and quantity.”
While conditions such as polycystic ovary syndrome (PCOS), endometriosis, fibroids and obesity also contribute to infertility, doctors consistently point to age as the single biggest factor.
“Delayed parenthood is probably one of the biggest contributors today,” Dr Swathi said. “Many women who conceived naturally in their late twenties may face difficulties when trying again in their mid- or late thirties.”
Dr Ramya explained why. “Many couples think, ‘We conceived naturally once, so it will happen again whenever we decide.’ Unfortunately, biology doesn’t work that way. A woman’s eggs age with her. Egg quantity and quality decline every year.”
She noted that while fertility begins declining gradually after 30, the drop becomes steeper after 35 and more pronounced after 40. Male fertility also declines with age, though usually more gradually.
Age may be the biggest factor, but doctors stress it rarely acts alone.
The years between the first and second child often coincide with weight gain, reduced physical activity, chronic stress, poor sleep and the progression of underlying medical conditions.
“The uncomfortable truth is that those five to eight years between children are usually a couple’s unhealthiest,” Dr Parhar said.
“Weight goes up, exercise stops, sleep disappears. That window is also the most fixable.”
Doctors frequently identify multiple factors working together.
Among women, they include reduced ovarian reserve, PCOS, endometriosis, adenomyosis, fibroids, tubal blockages, pelvic inflammatory disease, hormone imbalances and thyroid disorders.
For men, reduced sperm count, poor motility, abnormal sperm shape, DNA fragmentation, obesity, smoking, alcohol consumption, diabetes, chronic stress and poor sleep all contribute to declining fertility.
“Sometimes more than one factor is involved,” Dr Swathi said.
One of the least recognised causes of secondary infertility is that the first pregnancy itself can leave behind problems that only become apparent years later.
Doctors point to Caesarean sections, postpartum infections, uterine surgeries and procedures performed after miscarriage or childbirth.
“Previous pregnancies and deliveries can contribute to secondary infertility,” Dr Rani Aiswarya said.
“With the rising incidence of Caesarean sections, pelvic adhesions and scar tissue can develop, potentially interfering with implantation and fertility. Untreated postpartum infections may lead to pelvic inflammatory disease and fallopian tube blockage.”
Dr Parhar felt this aspect of fertility receives far too little attention.
“A Caesarean scar can sometimes heal with a small pocket known as an isthmocoele, where fluid and old blood collect. This can make it harder for an embryo to implant,” she explained.
Other procedures, including dilation and curettage (D&C), can occasionally leave scar tissue inside the uterus, while untreated infections after childbirth may affect the fallopian tubes.
Fortunately, specialists say many of these conditions can be identified through ultrasound, hysteroscopy or laparoscopy and treated before couples move on to more advanced fertility procedures.
Despite growing awareness, infertility continues to be viewed largely as a woman’s problem. Fertility specialists say that perception often delays diagnosis because many couples spend months investigating only the female partner before evaluating the man.
“Men contribute to roughly half of all infertility,” said Dr Parhar. “In secondary infertility they are even more likely to be missed, precisely because everyone assumes the matter is settled. Fertility is a snapshot, not a lifetime certificate.”
Dr Aiswarya echoed the concern.
“Even in primary infertility, the trend is roughly 50% male factor and 50% female factor, and the same applies to secondary infertility. The male factor is often overlooked. Weight gain, smoking, alcohol consumption, chronic occupational stress and metabolic disorders can progressively reduce sperm concentration, motility and morphology after the first child.”
Doctors said male fertility is not static. Like women, men also experience age-related changes, although more gradually.
“We are seeing more men with reduced sperm count, motility and DNA quality, possibly related to lifestyle, stress, obesity, smoking and environmental factors,” said Dr Swathi.
Dr Ramya said the list of contributing factors has grown longer in recent years.
“We are seeing lower sperm counts, reduced motility, increased abnormal morphology and higher DNA fragmentation. Smoking, alcohol, obesity, heat exposure, pollution, sedentary lifestyle, poor sleep, diabetes and stress all contribute. Male fertility should always be evaluated early rather than after months of unsuccessful female treatments.”
Perhaps the biggest misconception after “it happened once, so it will happen again” is that fertility treatment automatically means IVF.
Doctors said that is far from true. “IVF is a tool for specific problems, not the default answer,” Dr Parhar said.
She explained that many couples conceive after treating the underlying cause—through lifestyle modification, ovulation-inducing medication, intrauterine insemination (IUI), hysteroscopic removal of scar tissue or polyps, laparoscopy for endometriosis, correcting thyroid disorders or insulin resistance, or even losing five to ten per cent of body weight.
“In our practice, a good proportion of these couples conceive without IVF,” she said.
Dr Aiswarya was equally emphatic. “A couple who is unable to conceive should not be sent directly for IVF. That is a definite no,” she said.
“We first evaluate what is causing the infertility. Sometimes the underlying issue may simply be a thyroid disorder, elevated prolactin levels or lifestyle-related factors. Correcting these problems, along with lifestyle changes over one to three months, may allow the couple to conceive naturally. We usually try natural conception first, then around three cycles of IUI, and only after that consider IVF.”
IVF is generally recommended when there is a clear indication, such as blocked fallopian tubes, severe male-factor infertility, markedly reduced ovarian reserve, advanced endometriosis, repeated IUI failure or when maternal age leaves little time to try less intensive options.
Specialists said the biggest mistake couples make is assuming time is on their side simply because they conceived naturally before.
Their advice is straightforward.
If the woman is younger than 35 years, couples should seek evaluation after one year of trying. If she is 35 years or older, they should consult a fertility specialist after six months. Women over 40 should seek medical advice without delay.
Earlier consultation is also recommended for women with irregular menstrual cycles, PCOS, endometriosis, fibroids, thyroid disease, recurrent miscarriages, previous pelvic surgery or Caesarean scar-related symptoms. Men with a history of testicular problems, surgery, diabetes or known fertility issues should also undergo evaluation early.
Doctors also advised couples planning to delay a second pregnancy not to wait until they encounter difficulty before assessing their fertility.
“Plan according to biology, not just life plans,” Dr Ramya said.
“If you anticipate delaying pregnancy, discuss your reproductive plans with your doctor early, especially if you’re over 30 or have conditions like PCOS or endometriosis. Early awareness gives couples more options and better outcomes.”
Dr Parhar offered similar advice. “Get tested when you decide to wait, not when you start struggling,” she said.
“An AMH blood test, an ultrasound scan and a semen analysis take very little time and can tell you whether you have plenty of time or very little. Most importantly, don’t let anyone talk you out of asking for help. You do not need to justify wanting a second child.”
For many couples, the hardest part of secondary infertility is not simply that pregnancy doesn’t happen again. It is discovering that fertility changes with time, regardless of what happened in the past.
The first pregnancy may offer hope, doctors say, but it offers no guarantee. And the sooner couples recognise that, the more options they are likely to have.
(Edited by Majnu Babu).
