By Nina Resetkova, MD

As a fertility doctor, I see many instances in which women who have been able to get pregnant in the past are unexpectedly having trouble conceiving a second (or third) time around.

For some, it has been a few years since their last child was born, and they are now doing many of the same things in anticipation of another positive pregnancy test. They're not using birth control and are properly timing sex with ovulation. Yet, this time, the results haven't been as expected.a fertility doctor, I see many instances in which women who have been able to get pregnant in the past are unexpectedly having trouble conceiving a second (or third) time around.

When this occurs, it can leave individuals and couples feeling confused and full of questions. How could this happen if they've already had a child without issue? Did they do something to suddenly become infertile?

Undoubtedly, these concerns are justified. Unpredictable situations, especially when trying to conceive, can be startling and confusing. It's very important, however, to understand that not all hope is lost. For those who are experiencing "secondary infertility," the path to parenthood can be full of unique twists and turns, yet the chances of a future healthy pregnancy are quite good.

What is secondary infertility? Secondary infertility is when a woman is unable to get pregnant or carry another pregnancy to term after having one child. If you have previously been able to conceive, are over the age of 35, and have been trying to conceive for longer than 6 months, you may be experiencing secondary infertility. Under the age of 35, this diagnosis is reached after 12 months of unprotected intercourse.

Why am I unable to get pregnant this time around? It was much easier before! Many things change as a woman ages. One of the most important aspects, in relation to female fertility, is the aging of the ovaries. Egg quantity and egg quality decreases as you get older, so getting pregnant again may take a little longer, as a higher proportion of eggs that are released may be abnormal.

With advanced age also comes new medical diagnoses that may affect the function of the ovaries, so it's important to assess whether you may be at risk for infertility related to any new medical conditions that have emerged since your last pregnancy.

How should I take care of myself while trying to get pregnant? It's easy to make changes in the way you care for yourself since you last gave birth. Many studies tell us that stress is an important contributor to menstrual cycles and infertility, but stress and the way we perceive it can be difficult to study.

If you are trying to get pregnant again, make sure you are finding strategies to keep stress at bay, either through exercise, self-care, yoga, or meditation. If you are overweight or obese, setting small goals, such as losing 5% of your body mass, may help get you back to a healthier weight and can also help with ovulation for women with ovulatory dysfunction.

Lastly, finding time to be intimate with your partner (for the second or third attempt) can become more challenging now that there's another member of the household. It's easier said than done, but it's important to try and make time for just yourself and your partner.

What should I do if I am experiencing infertility? For women who are having trouble conceiving, it may be time to seek an evaluation with an infertility specialist, especially if they are:

* Under age 35, and trying to conceive for 1 year. * Age 35-39, trying for 6 months. * Age 40 or older. * Experiencing irregular menstrual cycles. * Experiencing recurrent pregnancy loss (miscarriage). * Diagnosed with PCOS or endometriosis. * Aware of a family history of early menopause.

A specialist will perform a basic infertility evaluation, which includes assessing the fallopian tubes, your ovarian reserve (egg supply), and a semen analysis for men.

Even if some of these tests have been conducted when you were trying for your first child, or with a different partner, it's a great idea to update testing to ensure there have been no changes that could affect your chances or future treatment options.

What if my doctor can't find anything wrong? Can I still get pregnant? If there is no clear-cut diagnosis that can be reached after testing, don't be discouraged. Thirty percent to 40% of couples fall into the diagnosis of Unexplained Infertility, and the success rates with fertility treatments can be quite good in comparison to the general infertility population.

Nina Resetkova, MD, MBA, is a reproductive endocrinologist (fertility specialist) at Boston IVF and a member of the American Society for Reproductive Medicine. She specializes in all aspects of fertility care, including difficult cases, second opinions, LGBTQ reproductive care, recurrent miscarriage, egg freezing, and more. She treats patients at Boston IVF's South Shore/Quincy Fertility Center.