World IVF Day 2025: Doctor explains what secondary infertility is, why it's rising and 10 tips to protect fertility

If you are struggling to conceive again after the first baby, chances are you may be suffering from secondary infertility. Check this out to know more.

World IVF Day: It’s commonly believed that if something happened easily the first time, it will be just as simple the second time around. But when it comes to fertility, that’s not always the case. Many couples are now facing unexpected and difficult challenges in conceiving again, even if their first pregnancy was smooth. Secondary infertility is an alarming concern, especially in urban India. On the occasion of World Fertility Day on July 25, a day dedicated to spreading awareness about fertility methods and reproductive health, let’s take a closer look at the growing issue of secondary infertility and why it needs more attention.

Infertility can happen after a successful pregnancy as well.(Shutterstock)

In an interview with HT Lifestyle, Dr Sunita Tandulwadkar, HOD of obstetrics and gynaecology, IVF and Endoscopy Centre, Ruby Hall Clinic, Pune and President of the FOGSI, shared the alarming condition of secondary infertility and how it is common in urban places.

She explained secondary infertility and said, “'We conceived so easily the first time… why not now?' This is a question many Indian couples are silently struggling with today. Secondary infertility is the inability to conceive again after already having one biological child, and it is becoming increasingly common, especially in urban India. And yet, it often goes unrecognised or is dismissed by society with statements like, ‘At least you already have one child’. But the truth is, secondary infertility is a growing concern and deserves attention, empathy, and timely medical intervention.”

Cause: Women's ovarian ageing is more rapid now

Ovary ages with biological age.(Shutterstock)

Fertility changes with age, and for women, it typically begins to decline after the age of 30. Commonly, there’s a natural gap before planning a second child. and with many couples now choosing to marry later in life. conception becomes difficult than it may have been the first time around.

Dr Sunita Tandulwadkar elaborated more about the concept of premature ovarian ageing and added, “What most couples don’t realise is that even in their late 20s or early 30s, a woman’s ovaries may already be ageing faster than expected. This phenomenon is called premature ovarian ageing, and it is increasingly being observed in young Indian women due to chronic stress, poor lifestyle habits, pollution, underlying inflammation, or unnoticed medical conditions."

Moreover, ovarian health plays a crucial role in both egg quality and quantity, and inflammation in the ovaries tends to increase with age so Dr Tandulwadkar commented, " Ovarian inflammation can quietly reduce both egg quality and quantity, even in women who previously conceived without difficulty. Over time, this leads to reduced fertility potential and challenges with conceiving again."

What are the signs and symptoms of secondary infertility?

Irregular period is one of the signs.(Shutterstock)

Much like how there are many health conditions which don't have any strong or obvious symptoms, secondary infertility is also similar, catching couples off guard when they think about planning a second or third child. Timely medical tests help with the issues.

Dr Tandulwadkar said, “Unlike other health issues, secondary infertility often arrives without clear signs. AMH (Anti-Müllerian Hormone) testing and pelvic ultrasound are valuable tools that can reveal declining ovarian reserve or structural issues early on."

Here are 5 signs and symptoms that Dr Tandulwadkar listed:

• Irregular or delayed periods.
• Difficulty conceiving despite regular unprotected intercourse.
• Hormonal fluctuations.
• Changes in mood, weight, or energy.
• Failed attempts despite timed cycles or ovulation tracking.

The gynaecologist further reiterated the importance of getting a timely check-up done to evaluate the fertility risk factors. She said,"If you're under 35 and trying for over a year without success, or over 35 and trying for six months, it's time to consult a fertility expert. If you have irregular periods, known conditions, or any fertility risk factors, don’t wait at all. Early diagnosis allows for timely lifestyle correction, fertility preservation like egg freezing and the use of targeted therapies or supplements."

4 reasons for secondary infertility in India

While premature ovarian ageing is a medical cause, secondary infertility is often the result of many overlapping factors, from pregnancy planning to underlying health conditions. Dr Tandulwadkar listed out 4 reasons and described how they impact:

1. Delayed second pregnancy planning: Many couples now wait longer for their second child due to career, financial, or personal priorities. But biologically, fertility, especially for women, starts to decline after 30, and even more rapidly after 35.
2. Unnoticed health changes after first birth: Conditions like thyroid imbalances, PCOS, insulin resistance, or uterine fibroids can develop silently after the first delivery and affect future fertility.
3. Male factor often ignored: Sperm health can also change with age, lifestyle, or environmental toxins. Just because a man fathered one child doesn’t mean his fertility is intact.
4. Lack of awareness and late diagnosis: Couples assume, ‘It happened once, it’ll happen again.’ But by the time they seek help, options may be limited.

Why is NAD⁺ a game-changer for egg health?

NAD⁺ offers a promise to enhance egg health. It helps slow egg ageing and improve fertility. It is one of the fertility prevention tools that couples explore.

Dr Tandulwadkar said, “One powerful tool in fertility preservation is NAD⁺ (Nicotinamide Adenine Dinucleotide)—a natural compound essential for DNA repair, energy production, and slowing cellular ageing, including in ovarian cells. As inflammation increases or age progresses, NAD⁺ levels drop, especially in the ovaries. This accelerates egg ageing and lowers fertility."

So, how can the declining NAD levels be replenished to support fertility outcomes? "To counter this, oral supplements like NMN or NR can help, though they’re easy to take, they tend to be less efficiently absorbed by the body. IV or injectable NAD⁺ therapy, on the other hand, is more effective as it directly boosts cellular repair and supports egg health." But always consult a doctor before starting these," she explained.

10 tips to protect fertility after one child

Taking proactive steps is important if you are planning for a second baby or just want to keep the options open. Dr Tandulwadkar shared 10 tips on how to support and protect your fertility after your first pregnancy:

1. Get 7–8 hours of sleep.
2. Avoid smoking, alcohol, and processed food.
3. Exercise for 30 minutes a day.
4. Practice yoga and pranayama.
5. Control stress levels.
6. Get fertility tests (AMH, ultrasound) by age 30–32.
7. Consider egg freezing if delaying a second child.
8. Discuss NAD⁺ options with your doctor.
9. Keep thyroid, weight, and blood sugar in check.
10. Plan your next pregnancy with intention.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.