We have heard of terms like infertility or fertility related problems. But do you know secondary infertility also exists?

This condition arises when a couple has at least one child, is trying to get pregnant again, but doesn't conceive after at least one year of trying. This diagnosis can be confusing. You had no trouble getting pregnant last time. So, why isn't it happening now? In many cases, about one-third of all the secondary infertility cases can be traced to be originated in men.

Kanchi Khurana, Senior Fertility Consultant, Cloudnine Group of Hospitals, Chandigarh, explains: "Secondary infertility strikes a man as he ages and usually comes to the fore when the couple tries for a second child but are unable to conceive one. But not all men suffer from secondary infertility. A healthy lifestyle, exercise and cutting down on vices like alcohol and tobacco can go a long way in boosting the sperm health of men. But despite doing all the good things, some men do suffer from secondary infertility."

* Varicocele: This condition is responsible for 1 in 5 male secondary infertility cases. Varicocele is an enlargement of veins in the scrotum or the sac of the skin encasing the testicles. This is one of the most common condition causing decreased sperm production and infertility in men. About 30 per cent of the infertile men may have varicocele. A heated environment can be deadly for sperm, causing them to diminish and die.

* Reduced or decreased testosterone levels: Testosterone or male sex hormone as it is commonly referred to plays a key role in sperm production. Levels of testosterone can be decreased due to aging, injury to genital or urinary organs or certain medical conditions as genitourinary infections, thyroid disease, DM, TB, Mumps, Small Pox, Stress or surgery of the genital tract.

* Unhealthy Habits: Tobacco, drugs and alcohol can make life hard for your little swimmers. Its one thing to have got healthily pregnant on these the last time around, but a build-up of toxins in your body may eventually catch up with you, masquerading as secondary infertility.

* Poor semen quality: As the age advances the quality of semen (that carries sperm) tends to decline. After the age of 40 years poor quality semen is one of the most common cause of secondary infertility in males.

* Stress: Stress can unleash a torrent of setbacks -- premature age lines, insomnia, chronic anxiety and perhaps worst of all, infertility. Even if you were under just as much stress before your first child was born, it's possible that the mental pressure has now snowballed into a physical manifestation.

* Prostate enlargement or prostate removal: Prostate enlargement causes low sperm count and may hinder ejaculation. Prostate removal due to cancer or other conditions can cause retrograde ejaculation and hence infertility.

* Use of drugs: Some antibiotics and few medications used to treat high blood pressure for example can affect the sperm count and quality. Also chemotherapy or radiotherapy used for most of the cancers will decrease the sperm count and quality.

* Use of commercial sexual lubricant: These non-toxic, natural lubricants including peanut, safflower and vegetable oils and petroleum jellies are toxic to sperms and hence decrease fertility.

* Exposure to chemicals: Pesticides, lead, industrial chemicals and excessive heat or cold can impact a man's fertility. In the world we live in, we are unwittingly exposed to toxins every day. But some toxins are even more damaging than others. Lead-laden products, pesticides, harmful chemicals and radiation are vicious for sperm.

* Excessive weight gain decreases the levels of testosterone and increases estrogen levels. Obesity, overweight and type 2 diabetes are common causes of infertility. Often, an increase in weight disrupts the hormonal equilibrium, leading to hampered sperm production and quality.

Tips to manage secondary infertility in Men

"Regardless of whether infertility is primary or secondary treatment options remain quite similar. Most of the times ruling out the cause and treating the cause of infertility wins the battle and solves the problem. However the treatment of secondary infertility in males depends upon the count and the cause leading to the same," says the doctor.

* Diagnostic Investigation: The easiest, most convenient and the best diagnostic investigation for a male suffering with secondary infertility is a semen analysis done after 48-72 hrs of abstinence at a good infertility centre. According to WHO (2010) guidelines/criteria the normal count for sperms in a male is count of more than 15 million per ml. If the count is more than 15 million per ml -- Antioxidants and anti-aging supplements can increase fertility in men. Drug treatment can also improve semen quality.

* IUI (Intrauterine insemination) as an option for planning a pregnancy: If the count is between 10-15 million per ml -- IUI (Intrauterine insemination) which involves surgically placing sperms inside woman's uterus to increase the chance of fertilization.

* In-Vitro Fertilization: If the count is less than 10 million per ml -- IVF which involves stimulating the ovaries of female to retrieve eggs and taking husband's sperm for fertilization with eggs in a lab to make embryos and transferring the embryos back to uterus helps to conceive. However if the sperm count is nil that is azoospermia the cause of azoospermia again needs to be ascertained.

"Infertility can be devastating with a high emotional toll on individuals and couples. If treatments for secondary infertility fail, couples might suffer from a range of emotions, including anger, sadness, grief, guilt and loneliness. They might experience a lack of empathy from family members and friends, who may tell them they should be thankful to have one child. The key to coping with secondary infertility is to open communication channels with those that are close to you. Lean on your partner and open your heart to them about how you feel."

Knowing you're in this together can lend strength to your bond and prepare you both for medical intervention. Turn to close family and friends to help you navigate your headspace. There are myriad online support groups for secondary infertility that you can also draw inspiration from. For professional guidance, it is a good idea to meet a counsellor who can help you on the path to conception.