A conversation with Dr Tan Shu Qi from The O&G Specialist Clinic
For many couples, conceiving the first child happens naturally and relatively quickly. When trying for a second child, it can come as a surprise when pregnancy does not occur as easily. In Singapore, this situation is not uncommon, and it can understandably feel confusing and discouraging. Although secondary infertility — difficulty conceiving after a previous pregnancy — may not always be widely discussed, it is a recognised reproductive health concern. Local healthcare experts and public health data suggest that biological, lifestyle and demographic factors can all play a role.
According to Dr Tan Shu Qi, a Fertility and O&G Specialist with over 10 years of experience, secondary infertility is more common than many couples realise, and couples are often surprised when conception does not happen as quickly the second time.
Misconceptions About Fertility
“One Healthy Pregnancy Means Fertility Forever”
It is a common and understandable assumption: if you conceived naturally before, it should happen again. After all, your body has already “proven” it can carry a pregnancy. However, fertility is influenced by age, health, hormones, lifestyle, and reproductive conditions — all of which can evolve over time.
“Even if a couple conceived quite quickly in the past, things may be very different a few years later,” says Dr Tan Shu Qi, whose clinical focus includes fertility management, IVF and elective egg freezing. “Age, new medical conditions, or changes in lifestyle and stress levels can all affect how easily pregnancy happens again.”
Female fertility naturally declines with age due to changes in egg quantity and quality. Women are born with a finite number of eggs, and this reserve decreases steadily over time. Even if the first pregnancy occurred quickly at age 30, trying again at 35 or 37 may involve very different biological circumstances.
Infertility can arise from multiple factors affecting either partner, and these factors can develop after a previous successful pregnancy. Conditions such as thyroid disorders, uterine fibroids, endometriosis, or changes in sperm quality may emerge years later. A previous healthy pregnancy is reassuring, but it does not guarantee future fertility will remain unchanged.
Understanding Natural Fertility Variation
Fertility is dynamic, even within the same couple. It can fluctuate over months and years due to natural biological processes and life changes. Fertility assessment always considers the couple’s current reproductive health, not just their past pregnancy history.
“Many couples are caught off guard because they assume what worked the first time will automatically work again,” shares Dr Tan Shu Qi. “We encourage them not to blame themselves, but to recognise that their bodies and circumstances may have changed since their first child.”
“Secondary infertility is not uncommon, and it does not mean something is ‘wrong’ with you,” she adds. “It simply means we need to reassess your current fertility status.”
Biological and Age-Related Changes
The Role of Maternal Age
Maternal age remains one of the most important factors in fertility. As women age, egg quantity and quality decline naturally. This can affect fertilisation, embryo development, and the risk of miscarriage.
In Singapore, more women are starting families later, which means second or third pregnancies often occur at an older age, notes Dr Tan Shu Qi, a MOH-accredited IVF clinician who frequently manages such cases. This shift alone can make the journey to conceive again slower and more stressful, even for couples who had no difficulty the first time.
Paternal Factors
Male fertility also evolves over time. Sperm count, motility, and morphology can decline with age and be influenced by lifestyle factors such as smoking, alcohol consumption, weight changes, stress, and environmental exposures.
“We always assess both partners,” says Dr Tan Shu Qi. “Fertility is shared, and sperm parameters can change over time just as egg quality does.”
Hormonal Shifts Post-Pregnancy
Pregnancy and childbirth trigger major hormonal changes. After delivery, the body undergoes a recalibration process. In mothers who breastfeed, elevated prolactin levels can temporarily suppress ovulation. Hormonal adjustments post-pregnancy may affect menstrual cycles for several months, sometimes making conception timing more complex.
“Some women only notice irregular cycles or ovulation changes after their first baby,” explains Dr Tan Shu Qi, drawing on experience caring for women through pregnancy, postpartum recovery and long-term gynaecological health. These cycle changes can quietly influence fertility, which is why she often recommends tracking cycles or doing basic hormone tests if conception is taking longer than expected.
Breastfeeding and trying to conceive can occur at the same time, adds Dr Tan Shu Qi. However, if menstrual cycles have not yet returned, it may indicate that ovulation has not resumed. In such cases, a medical assessment can help determine whether fertility has recovered and whether ovulation is taking place.
Health and Lifestyle Influences
Secondary infertility can feel especially challenging because couples are often juggling childcare, work and other responsibilities at the same time. Looking after overall health, sleep and stress levels also supports fertility.
What Does a Fertility Evaluation Involve?
A comprehensive fertility evaluation typically assesses both partners, since infertility often has multiple contributing factors. This may include hormone testing, ultrasound imaging, fallopian tube assessment, and semen analysis.
“From a medical perspective, we always remind couples that fertility is a shared journey,” emphasises Dr Tan Shu Qi. “Evaluating both partners together often gives us the clearest picture and helps us tailor a plan that feels realistic and hopeful for their family goals.”
Treatment depends on the underlying cause and may include lifestyle optimisation, ovulation induction medications, intrauterine insemination, or in vitro fertilisation.
You Are Not Alone
Struggling to conceive again after a successful first pregnancy can be emotionally taxing. Fertility naturally changes over time due to biological, lifestyle, and health factors. The positive news is that many causes of secondary infertility are identifiable and treatable. Seeking early evaluation allows couples to understand their current reproductive health and explore options proactively. With the right guidance and medical support, many couples are able to expand their families successfully.
“As difficult as this journey can feel, many couples do go on to conceive successfully,” Dr Tan Shu Qi adds. “With timely assessment and the right support, there are often more options than people realise.”
For couples who may be facing challenges conceiving again, seeking professional guidance can provide clarity and reassurance. At The O&G Specialist Clinic, patients receive personalised fertility care tailored to their individual circumstances. Led by Dr Tan Shu Qi, the clinic offers comprehensive evaluation and evidence-based fertility treatments to support couples on their journey to growing their families. For more insights on fertility, women’s health and pregnancy care, you can also follow the clinic on Instagram at @ogfamilysg, where they regularly share educational resources and updates.