Secondary infertility, a condition where couples struggle to conceive after successfully having had at least one child, is becoming an increasing concern among families worldwide, including here in Thailand. Recent reports and new research highlight not only a steady rise in cases but also the typically overlooked emotional turmoil experienced by affected parents—an issue that has resonated with many Thai families amid shifting demographics and social expectations.
The significance of this trend is well-captured by the candid story of Charlotte Bennett, as reported in The Times. Bennett, already a mother, described the “horrendous” guilt of being unable to give her six-year-old son a sibling, despite years of effort. For many parents, secondary infertility brings an unexpected and deeply personal form of distress, often complicated by cultural expectations and misconceptions that once a couple has had one child, further pregnancies should be easy and natural (The Times).
Why does this matter for Thai families? Secondary infertility threatens not just individual plans but also longstanding societal values that place a great emphasis on family unity and sibling bonds. In Thai culture, the idea of “phuen phi nong” (พี่น้อง), or the vital support siblings offer each other throughout life, runs deep, reinforcing the emotional pressure to provide more than one child. Add to this the rising average maternal age at first birth, later marriage, and changing lifestyles in urban Thailand, the topic is quickly shifting from a private challenge to a public health issue.
Recent studies estimate that secondary infertility affects about 5-11% of couples trying for a second child, depending on population and sensitivity of reporting methods (University of Utah Health; World Health Organization). Some of this increase can be linked to demographic shifts: women are having their first children later in life, when natural fertility starts to gradually decline, making subsequent conceptions more difficult. Local context reveals a similar pattern, with more Thai women delaying childbirth for career and financial stability—a phenomenon seen particularly among well-educated urban dwellers.
A 2024 case-control study published in Frontiers in Medicine provides much clearer insights into risk factors. The research, which analyzed 690 women aged 20-45 with prior pregnancies, found that advanced maternal age remains a leading predictor of secondary infertility (Frontiers in Medicine). The risk rises especially after age 35—a threshold often referenced in reproductive medicine. But the study also exposed a web of social and medical contributors: obesity, history of pelvic inflammatory disease (PID), diabetes, joint family living, cousin marriage, history of abortion, breastfeeding duration, relationship difficulties, and even workplace stress all correlated with heightened odds of secondary infertility.
The numbers are eye-opening. According to the study, women with a history of abortion were nearly 12 times more likely to experience secondary infertility, with a similarly dramatic effect for those with urinary tract infections (almost 6 times) or PID (over 5 times). Working women were found to be three times more at risk, and living in joint families—common in both rural and some urban Thai settings—was linked to almost triple the risk compared to nuclear families. Regarding social pressure, 88% of women in the ‘case’ (infertile) group reported relationship difficulties with their spouse, highlighting the mental health and marital stress that frequently accompanies fertility struggles.
Modern medical theory distinguishes secondary from primary infertility—where pregnancy has never occurred—yet both share root causes. These include tubal factors, endometriosis, hormonal imbalances, uterine problems, and male infertility (the latter contributing to about one-third of cases). However, secondary infertility often surprises couples who conceived easily the first time, leading to unique frustration and guilt. As Dr. Wafa Fatima and co-authors of the Frontiers in Medicine study argue, “identified risk factors of secondary infertility are mostly modifiable and can be prevented or treated. By managing these risk factors, we can reduce the risk of secondary infertility” (Frontiers in Medicine, 2024).
Expert viewpoints highlight that rising obesity and metabolic syndrome—partly due to more sedentary lifestyles and poor dietary habits—should be a concern for Thai families. According to a global review published in early 2024, infertility prevalence and Body Mass Index (BMI) increased together, and secondary infertility was especially prevalent among overweight women (Nature, 2024). This aligns with trends seen in urban Thailand, where fast food, sugary drinks, and long working hours have spurred a national surge in non-communicable diseases affecting reproductive health.
But medical causes go beyond lifestyle. Gynecological conditions like endometriosis and fibroids, complications following prior childbirth, infections, and even long-term effects of untreated sexually transmitted diseases play critical roles. The World Health Organization stresses the need for early fertility assessment, especially for women over 35 or those with known risk factors (WHO).
On the psychological side, the sorrow and shame of failing to expand one’s family can be overwhelming, especially when there is an existing child. Dr. Ben Spencer, Science Editor at The Times, notes how societal assumptions may lead to relatives and neighbors minimizing the struggle, telling couples, “at least you have one already.” This can aggravate parental guilt, with many mothers holding themselves responsible for not providing a sibling—reflecting a sentiment echoed in Thai society, where family completeness is highly valued.
Recently, global interest in infertility—including secondary infertility—has spurred new data-driven approaches. The Frontiers in Medicine study used both traditional statistical modeling and artificial neural networks (ANNs) to build predictive models, offering high accuracy in identifying at-risk women based on a spectrum of variables. While these computational advances remain experimental, they suggest that future fertility counseling could become much more personalized, taking into account not just age and medical history, but also family structure, relationship dynamics, and mental health.
Thailand-specific implications are clear. As women increasingly join the workforce and pursue higher education, the age at first pregnancy continues to inch upward. Urbanization, smaller home sizes, and more nuclear family structures mean that the traditional assumption of having multiple children is no longer automatic. Yet, social expectations have not entirely shifted, with grandparents and extended family often encouraging more offspring. Moreover, access to fertility screening and treatment remains highly variable between urban centers like Bangkok and rural areas, where awareness and medical support can be limited.
A look back at Thai demographic trends underscores a sharp contrast in family planning. The post-boom era from the 1960s to 1990s saw a steep decline in average family sizes thanks to successful public health campaigns, but from the 2000s on, the fertility rate dropped below replacement levels, prompting government concerns about an aging population. Now, as birth rates fall, attention has turned to factors—including secondary infertility—that keep families smaller than desired, despite national attempts to encourage more births.
Looking ahead, experts forecast that secondary infertility will continue rising as a side effect of social modernization unless modifiable risk factors are addressed. The pressure is not only biological but also emotional and cultural, as the tension persists between individual aspirations and communal values. In fact, new fertility solutions are on the agenda as top wellness trends for 2024, including personalized reproductive counseling and innovations like AI-based sperm and egg selection (MSN, 2024).
For Thai families concerned about secondary infertility, what action can be taken? Preventive steps include regular reproductive health checkups, maintaining a healthy weight, managing chronic conditions like diabetes and hypertension, and seeking timely treatment for infections or menstrual irregularities. Women planning a second child should be aware that fertility declines with age—if possible, not delaying for too long. Couples are encouraged to support one another emotionally and openly discuss challenges with trusted health professionals, rather than suffer in silence. For those feeling isolated, connecting with support groups (either local or online) for infertility can help reduce anxiety and guilt, and provide coping strategies.
For policymakers, the take-home message is equally urgent: expand access to fertility screening, subsidize fertility treatments where needed, and launch new campaigns to destigmatize secondary infertility—emphasizing that it is a medical condition, not a reflection of parental success or failure. As Thailand looks to balance its aging society with the dreams and realities of modern families, supporting those facing secondary infertility will be key to building a healthier, happier nation for generations to come.
Sources:
- Secondary infertility is rising. Parents say the guilt can be awful
- Predicted risk factors associated with secondary infertility in women: univariate and multivariate logistic regression analyses
- Infertility - World Health Organization
- Obesity and overweight and associated factors among women with secondary infertility
- Understanding Secondary Male Infertility | University of Utah Health
- Top wellness trends from AI in fertility, infertility solutions to gut health