Secondary infertility, or the inability to conceive after a previous baby, is not uncommon
by John Storment, M.D.
“When are you going to have another baby?” “Do you want an only child?” “Mommy, when can I be a big brother?” I’ll bet most couples have had these questions asked of them at one time or another. But for couples experiencing secondary infertility, these questions hurt.
Couples and women who have had a previous pregnancy often think of themselves as having “normal” fertility, but this isn’t always the case. Secondary infertility, or the inability to conceive subsequent biological children, can be frustrating, emotionally taxing, but is not uncommon.
Recent statistics suggest that more than 3 million women of childbearing age in the U.S. who have one biological child have difficulty getting pregnant or carrying another to term. And roughly 800,000 married women with one child are unable to get pregnant again after one year of having unprotected sex, month after month, according to data.
Just last week a couple with an 8-year-old child walked into my office unable to conceive again after years of trying. “It was easy the first time. So why is it so difficult now?” she asked me on the brink of tears.
Patients who are having difficulty conceiving their second child have a very difficult burden to bear. They often do not think of themselves as “infertile” since they have conceived in the past. Unfortunately for some, having a child once is not a guarantee that you will be eternally fertile.
Causes of secondary infertility may include age, structural abnormalities, unhealthy sperm or even unexplainable
Why some couples and women experience secondary infertility is a complex question, and often one with no clear explanation. Age is one major factor since women are born with all the eggs they will ever have and slowly lose them throughout their lifetimes. Egg quality and quantity starts rapidly declining at around age 35. The vast majority of patients I see for secondary infertility are in their mid- to late-30s, and age is typically the usual suspect.
Structural complications, like blocked fallopian tubes and pelvic adhesions caused by scarring during pregnancy or childbirth, can cause secondary infertility, too, along with medical conditions, such as polycystic ovarian syndrome or endometriosis, two conditions I see often in 30-something women.
But a woman’s reproductive organs aren’t the only factor that can play into a secondary infertility diagnosis. A man’s sperm quality and quantity, which can change both from month to month and over time, can affect fertility as well. Lifestyle changes, such as smoking, testosterone supplements or excessing drinking, can affect a man’s sperm, making conception difficult.
In other cases, secondary infertility is simply unexplainable, leaving my hopeful couple in the office last week feeling confused and adrift. The lack of identification of a specific problem is always frustrating. It’s frustrating for us, and it’s frustrating for patients.
Secondary infertility can cause frustration, anxiety and even guilt
And with secondary infertility, that frustration can compound the feelings that they do not completely belong to any one category. They are not “infertile” in the way that people struggling to have a first baby are, and yet there is something preventing them from becoming parents again.
Some couples are shocked and in disbelief when they find themselves unable to conceive a second child, particularly if they became pregnant easily, or accidentally, the first time. Other couples, who previously had problems with fertility, may be anxious to try again, and may feel greater pressure the second time around since they know it’s possible to have a baby. Still other couples may feel enormous guilt, or a sense of selfishness, for not providing a sibling for their only child, or for delaying a second pregnancy until it became “too late” to conceive.
On top of this, well-meaning friends and family members may unknowingly ask insensitive questions about when a couple is going to have another baby or why they’ve decided to only have one. They may also be less sensitive to a couple’s plight, saying things like “You’re lucky to have one child” or “Just relax. It will happen in time.” An infertile couple may find it stressful, too, to go through the rigors of testing and treatment when they have a small child at home to care for.
Consulting with a specialist can help you determine the cause
Whatever the underlying causes for a woman’s difficulty conceiving, talking with a specialist is the best way to untangle a web of confusing information and emotions, including the helpful “advice” from friends and family and the myriad ways people blame themselves when things don’t go as planned.
The bottom line is don’t wait! Get an evaluation of his sperm, your tubes and your ovarian reserve. Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue. If all tests are normal, then maybe it is just a matter of time. If the tests are abnormal, then maybe it’s important to pursue treatment to improve your chances.
Reproductive medicine has come a long way in recent years with many fertility treatments and assisted reproductive technologies, like IVF and ovulation medications, producing pregnancy rates better than what Mother Nature can give you. By seeking the support of a medical team trained to help couples find the answers to fertility issues, you can get started on your way to building the family you dream of. Even if, like my patients last week, you’ve already started.
— Dr. S