Background <p>Infertility is a neglected component of sexual and reproductive health. Despite rising concern of infertility, comparative data distinguishing associated factors of primary and secondary infertility remain limited. This study was conducted to determine factors associated with primary and secondary infertility among women attending a tertiary care hospital.</p> Methods <p>An analytic cross-sectional study was conducted from October 2022 to October 2023 at a tertiary care hospital in Rajkot, Gujarat, India. Total 240 married women aged 15–49 years with a complaint of inability to conceive after at least 12 months of unprotected intercourse were interviewed using a pre-tested semi-structured questionnaire after getting written informed consent. Descriptive statistics, Chi-square tests, and multivariate logistic regression were applied to examine association between risk factors and type of infertility.</p> Result <p>Primary and secondary infertility were almost equally prevalent (51.2% and 48.8%). Women and husbands aged ≥ 30 years, husbands’ smoking and central obesity were common in secondary infertility (<i>p</i> &lt; 0.05). Irregular menstrual cycles and abnormal menstrual duration were significantly higher in primary infertility (<i>p</i> &lt; 0.05). Logistic regression revealed that duration of marriage ≥ 5 years [Adjusted Odds Ratio (AOR) = 2.54], husbands’ smoking (AOR = 3.68), and prior contraceptive use (AOR = 2.27) predicted secondary infertility, while husband living away from spouse predicted primary infertility (AOR = 3.02).</p> Conclusion <p>Findings highlight distinct risk profiles across types of infertility and its multifactorial nature. Targeted public health interventions integrating infertility risk assessment, lifestyle modification counselling and early referral at the primary healthcare level can support timely management and reduce delayed infertility care.</p>