Secondary Infertility
Although the word ‘infertility’ is often associated with those who are childless, secondary infertility is as common as primary infertility. The lack of mainstream recognition of secondary infertility may be a reason for a lack of sympathy and understanding towards it.
People experiencing infertility at any stage of their lives may feel frustrated by a lack of control. For those with secondary infertility, these feelings may be exacerbated if their first child was conceived easily. They may experience shock – particularly as they have ‘proven’ their fertility with a first child. The family that was always dreamed of; and the children who were always planned for; may seem like they are suddenly slipping out of reach. Some people experiencing secondary infertility may attempt to search for reason, to identify a cause for their misfortune. Self-blame is not uncommon, particularly in women. This may take the form of regretting that babies had not been tried for earlier in life; or even feeling like another child has been denied because they have not been good enough parents.
Women and men often exhibit different emotional responses to secondary infertility and these differences in experience may create tension in the relationship. Conversely, the shared experience and interdependency can bring a couple closer together. Anger and resentment can also be felt, particularly when faced with families with more than one child or pregnant women. Social expectations, whether real or perceived, may create additional stress for those experiencing difficulty conceiving their second child. Frequent reminders of a personal loss of fertility may be through peers falling pregnant with second or third children, upgrading to larger vehicles and using double buggies. Conversations within social circles may again be centered around babies, breastfeeding and childbirth.
Causes
Causes of secondary infertility are many and varied. A major factor is age-related, as women delay childbirth until, often, well into their thirties. As a woman’s fertility is diminishing, a minor fertility issue (such as slightly low sperm count or mild endometriosis) that was possible to overcome at the time of conception of the first child may have more impact as the woman’s chances of conception per cycle is in decline. Sometimes, conceiving the first child was due to good luck, rather than secondary infertility being a change in underlying fertility. Male factor should not be discounted in secondary infertility and a semen analysis should always constitute part of an investigation.
Key factors which may contribute to secondary infertility include:
• If the time it took to conceive the first pregnancy was more than one year of trying or involved miscarriages;
• Infection after the first pregnancy;
• Hormonal disruption/imbalance after the first pregnancy;
• Immunological imbalances after the first pregnancy;
• Age of the woman when trying for the second baby;
• Family history – the age of the woman’s mother when she was menopausal. If this, for example, was 45 then that woman trying to conceive a second child at 38 may have more trouble than if her mother was later with menopause.
It is difficult to know whether stress, including working full-time and parenting; the exhaustion of parenting a young child; or post natal depression may contribute. In general, infertility causes stress, rather than the other way around.
Treatment
Unless age is a significant factor, secondary infertility can be treated as successfully as primary infertility. However, because women are generally older, it is important to seek help promptly. You may think that because conception happened naturally the first time, you should try longer to see it if happens again. But for many people, the time it takes to become pregnant the first time is largely a matter of chance. If you have been trying for more than 12 months or for more than 9 months and you are 37 or older, then it is appropriate to seek help.
Coping mechanisms
Ensure your social network includes people without children, or with only one child. Join a support group for secondary infertility (such as through Fertility NZ). Ensure you have at least one reliable person to confide in – if the situation is taking its toll on your relationship, try to find a friend or other family member who is willing to take on that role. Seeing an infertility counsellor may assist you through this experience and suggest specific techniques to help manage it.