In the immortal words of Baseball’s Yogi Berra, “It's déjà vu all over again!” For many, Yogi’s words perfectly describe the struggle with secondary infertility, or difficulty getting pregnant a second time … or a third.
Although exact numbers are difficult to pin down, according the most recent U.S. government statistics, (HHS.gov accessed November 2019) one in ten women ages 15–44 experience infertility. This means that 6.1 million women in the U.S. experience infertility, and 12–13 out of every 100 couples experience infertility.
In this chapter, we define secondary infertility and then take a closer look at its emotional impact, as well as what you can do to deal with the merry-go-round of infertility — take two.
Facing Secondary Infertility
Defining secondary infertility is not as straightforward as it may seem. Also, the term secondary infertility can be applied to a number of different situations. The Department of Health and Human Services (HHS) of the federal government defines secondary infertility as “infertility in a woman who has had one or more pregnancies, but cannot become pregnant again.”
Secondary infertility can occur whether the first conception was difficult or easy. It can be due to female issues, male issues, or a combination of both. One problem with the definitions is just what is meant by pregnancy. Does pregnancy mean a rise in the HCG shortly after a missed period? Does pregnancy include first trimester losses? Does pregnancy mean having a normal, healthy child at term? Considering that the purpose of the exercise is to have a full-term, live birth, it would seem that the most appropriate definition of pregnancy would be just that — a pregnancy that ended in the delivery at term of a healthy child.
The situation is complicated by the history of the previous pregnancy. Was the pregnancy conceived within a normal time frame and thus the couple were considered to have normal fertility? Or was the pregnancy conceived only after a diagnosis of infertility was made and the pregnancy was a result of treatment? The history helps determine what course of action is most appropriate to try for the next pregnancy.
For people who conceived spontaneously within six months to a year of trying, the diagnosis of infertility is made if they have been trying for six months to a year for another pregnancy and they have not achieved a pregnancy. After all, infertility is infertility, whether you call it primary or secondary. The significance of this is that once the term infertility is applied, the course of action is the same whether it is primary or secondary: use diagnostic tools to make a diagnosis. However, if the couple had the diagnosis of infertility for the successful pregnancy, then the course of action is determined by that diagnosis. It is not always necessary to reinvent the wheel! Other problems may have arisen in the meantime, but many problems will persist. The approach is to make sure nothing else has changed and then apply the previous diagnosis to determine what the best course of action will be.
For example, if there is a severe male factor in a young couple and it took IVF with ICSI to achieve a pregnancy, it most likely will require the same process for another child. If the diagnosis was polycystic ovarian syndrome, then it may actually be more difficult to conceive again. Possible reasons for this are that age may play a role, but many women gain weight when pregnant and it is difficult to lose this weight. Increased weight may make the PCOS more difficult to treat.
Frequently, couples seek consultation because of secondary infertility, and they feel they are unique and alone … this only happens to them. They start to question themselves, and this can lead to a feeling of isolation and guilt or of not being as good as someone else. If you find yourself in this bad head space, take note: Secondary infertility is common! The actual number of people experiencing secondary infertility is hard to determine, but estimates indicate that at least 30 percent of couples seeking help for infertility have secondary infertility.
Whatever the exact nature of the definition, few disagree that secondary infertility, whether an adjunct to primary infertility or a new challenge all its own, can be a confounding and painful experience that can prevent many from creating the complete family of their dreams.
Wanting an Heir and a Spare?
“I want another child,” Jackie cried out, only weeks after her long-awaited daughter was born (following a three-and-a-half-year battle with primary infertility). Those first few weeks of babydom were filled with all the promised dreams of baby food commercials everywhere. She and her husband often looked down upon their (then) sleeping baby and commented that if only they “could,” they’d have many more. And then the long-awaited daughter “came to.”
Jackie relates, “Seriously, the next few months were consumed with feeding issues, sleeping issues, adjustment issues, family issues, and so on. We could barely imagine how we could care for the child we had, let alone another.
“Four years later, our son was born. I was convinced that we were perched on the edge of Camelot. Yet, a mere three years later when trying to negotiate an all-out war between the siblings we had dreamed of, I told my then seven-year-old daughter, ‘You’re so lucky! I always wanted a sibling. I thought you would too.’ In her inimitable manner, she stared at me before responding, ‘But, Mommy, you thought wrong!’ The best laid plans.”
In case you’re wondering about moving on down the road before you are even fully in the driver’s seat, we give you some good reasons to not rush into trying for another child:
Underestimating the responsibility and work of a new baby: Perhaps this is one of the reasons why sex is forbidden in the six weeks following delivery. If it wasn’t, maybe in that pink (or blue) cloud of new parenting, second babies would be sprouting up everywhere!
Wanting to have a spare: As a friend of multiples pointed out, doubling your child load doesn’t halve your fears of bad things happening. It actually doubles your fears, since it doubles your love.
Trying for that elusive son or daughter: Trying again just for another gender is a sure way to set yourself up for disappointment. You need look only as far as Jackie’s poor grandmother who birthed seven daughters prior to finally producing a male heir. Jackie’s uncle didn’t marry until much later in life and then decided to limit himself to one child whom he adores — who, by the way, is a daughter and will not continue the family name anyway!
Giving your child a playmate: As an only child myself, I (coauthor Jackie) always imagined the “luxury” of having a sibling to share my joys and the responsibilities of dealing with my parents as time went on. All I needed to clear up that misconception was time and eyesight. For as many inseparable siblings that exist, so do those who never speak at all. Biology is no guarantee of love or friendship. Nor is it a promise of commitment. Most families that I have encountered are made up of one child who bears many of the family burdens, including mending fences, dealing with aging relatives, and facilitating communication throughout the flock. Seldom are those responsibilities equally divided. The other lack of equality is in perception. I often wished for a sibling to share my views on my parents, our home, and life itself. Yet, it seems that there are as many different views of a family as there