Many couples who conceived a first child easily, or even accidentally, are stunned to find themselves unable to conceive a second child. According to Resolve, the National Fertility Association, more than 3 million Americans suffer from secondary infertility, making it more common than primary infertility, yet couples are far less likely to seek treatment for this condition. Many couples delay seeking help because they mistakenly believe their past fertility ensures future fertility and their doctors may downplay their concerns and resist taking action.
Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The rising rate of secondary infertility, which has increased 60 percent since 1995, is thought to be caused by the increasing number of couples waiting until they are older and more financially stable to have children, as well as couples on their second or third marriages who decide to have another child.
One of the most common causes of secondary infertility is age, so if it has been a few years since you had your first child, your egg production and quality may have begun decreasing, or you may have developed a physical condition that affects fertility, such as weight gain, ovulation problems, endometriosis, pelvic adhesions, uterine fibroids or polyps, or suffered an infection from previous childbirth, D&C, or c-section. In addition, your partner’s sperm count, motility, or health may have deteriorated, or he may be experiencing impotence or ejaculation problems. Many couples who already have a child aren’t having as much sex as they were the first time around because they just don’t have the time, are too tired from taking care of the younger child, or may be experiencing marital stress.
In general, if you are under 35 and have not conceived after one year of regular, unprotected sex, experts recommend you see your doctor. However, if you are over 35 and have not conceived after six months of regular, unprotected sex, you should be tested for fertility. And you should make an appointment to see your doctor sooner than six months if you had problems conceiving the first time, have experienced two or more miscarriages, have irregular periods, especially painful periods, burning, an increase in vaginal discharge, or if your partner is experiencing a decrease in his sex drive, painful ejaculations, or impotence.
Suffering secondary infertility can be particularly difficult for couples to cope with for many reasons. They may feel guilty for not providing a sibling for their child, selfish for delaying a second pregnancy until it was “too late” to conceive, or feel guilty for feeling that one child isn’t enough for them. Many childless couples can avoid child- and baby-centered situations such as children’s birthday parties or baby showers; but couples with children often find themselves surrounded by their child’s friends, pregnant mothers or those with new babies who serve as constant reminders of their inability to have another baby. In addition, the couple’s first child may begin asking when they will bring home a little brother or sister, and friends and family may inadvertently ask insensitive questions such as “When are you going to have another?”
Couples dealing with secondary infertility may also have a difficult time finding help from infertility support groups because the members may feel couples who have already been blessed with one child should be grateful for and satisfied with what they have and are greedy for wanting another. These couples are often caught between two worlds, fertile and infertile, and are shunned by both.
Treatment for secondary infertility depends on the root cause of the infertility, just as with primary infertility. However, your doctor will probably ask you about your previous pregnancy and delivery because a few conditions, such as Asherman’s syndrome (intrauterine adhesions as a result of scarring after uterine surgery), are rarely seen in women who have never been pregnant. Your doctor will also look for any new symptoms which may point to endometriosis, pelvic or uterine infection, and other fertility inhibitors. Treatment for secondary infertility can carry special considerations when a couple must choose between spending money on fertility treatments to conceive another child or spending that money on the child they already have.
In many cases, the cause of secondary infertility can be treated, so consult a reproductive specialist and have both you and your partner tested. In addition, Resolve sponsors support groups specifically for couples struggling with secondary infertility.