You and your partner are the proud parents of a beautiful child. You pour your heart and soul into your family and love every minute that you get to spend shaping the heart and mind of this little gift. But you are sad, too, because after a year of trying to conceive a sibling, you still aren’t pregnant. Since you got pregnant the first time without infertility treatments, you aren’t sure what the problem is, but you suspect that you have secondary infertility.

Unfortunately, this is the case. Secondary infertility can be a surprise for couples that conceived naturally the first time.

Secondary infertility is the diagnosis when a couple is unable to conceive a child after one year of trying despite the fact that they may have conceived naturally before.

It’s also defined as trying to conceive for one year without being able to become pregnant or being unable to carry a pregnancy to term after the birth of another biological child, secondary infertility is a common condition. The Centers for Disease Control estimates that secondary infertility affects 11 percent of couples that already have a biological child conceived naturally. Furthermore, some estimates say that almost half of infertility cases today are the result of secondary infertility.

Like primary infertility, it is possible to treat the condition with infertility treatments. Many couples are shocked by this diagnosis because they had no problems conceiving children in the past.

The reason for secondary infertility is as varied as those for primary infertility. Usually, the cause develops between the last pregnancy and their attempts to conceive again. Common causes can include ovarian reserve depletion, fallopian tube damage from previous delivery, changes in the ages of the parents, or the development of conditions that affect either one or both of the couple’s reproductive systems. Like primary fertility, the causes are attributed 30 percent to the woman, 30 percent to the men, and 40 percent to unexplained infertility or a combination of the couple’s problems.

What Happened to My Fertility?

Many couples that learn they are suffering from secondary infertility wonder what happened between the first and second child. There is not always a clear answer, unfortunately. But many times, the change to a couple’s fertility occurred between the first child and the present time. Some common causes could be:

•  A depleted ovarian reserve or decrease in quality of eggs remaining due to age of the mother
•  A decrease in sperm count, movement or shape for the father
•  An infection that injures or impairs the reproductive system, such as a blocked fallopian tube or the growth of fibroids
•  A missed diagnosis before their first pregnancy that worsened since the last pregnancy, like endometriosis or polycystic ovarian syndrome (PCOS)
•  A significant weight gain by either partner, as a healthy reproductive system requires a body mass index between 18.5 percent and 25 percent BMI.

Secondary Fertility Is Tougher for Eliciting Empathy

Couples with the diagnosis often receive less empathy from their family and friends than couples with primary infertility. Generally this is because the couple does have a child or children. As a result, family and friends can minimize the emotional shock and distress the couple experiences as a result of secondary infertility. Many couples hear things like, “Well, do what you did last time” or “At least you have a child (or children)” in response to their diagnosis.

In addition, the couples are often left with feelings of guilt for not being able to provide a sibling for their child or children. Feeling they have denied their family this important relationship, these parents suffer stress and grief as a result. This can be difficult to manage when parenting their other children.

The Good News: There Are Successful Treatment Options for Secondary Infertility

While the diagnosis can be difficult, there are treatments for these couples that can help successfully build their families. Assisted reproductive technologies (ART) can help these couples conceive, including the use of infertility drugs, intrauterine insemination (IUI) and in vitro fertilization (IVF). If the secondary infertility diagnosis is the result of of blocked fallopian tubes, fibroids or endometrial tissue in the pelvic cavity, laparoscopic surgery can help correct these conditions to facilitate successful conception.

The guidelines for when a couple should see a specialist for secondary infertility follow those for primary infertility. They are:

• After one year of unprotected, well-timed sexual intercourse without conception for those couples under 35
• After six months of unprotected, well-timed sexual intercourse without conception for couples over 35
• If the woman has suffered two or more successive miscarriages, has a history of pelvic inflammatory disease, or has irregular and painful menstrual cycles

Treatment for secondary infertility is the same as that for primary infertility. Once the couple has a fertility workup by a fertility specialist, then a treatment plan will emerge that can best foster success for achieving conception. The biggest difference for couples with secondary infertility is that they are usually managing the rearing of another child or children while they are in treatment, which can be challenging.

Secondary infertility is as common as primary infertility, but couples often feel more isolated and unsupported than their peers struggling with primary infertility. Reasons for this include a general sentiment that they should be happy that they have a child or children at all and not feel sad about their inability to have more children. But for couples that have not yet completed their family-building journey, this diagnosis is just as devastating to them as a primary infertility diagnosis is for a couple with no children.

Secondary infertility is hard for many couples and their supporters to accept since they have had children in the past. But like primary infertility, there are treatments that can help couples with their family building goals. Working together with a fertility specialist, they can make their dreams of having the family they always wanted a reality.

Sources:

“Secondary Infertility.” www.resolve.org. Web. 5 March 2014. <http://www.resolve.org/diagnosis-management/infertility-diagnosis/secondary-infertility.html>

Gurevich, Rachel. “What is Secondary Infertility?” infertility.about.com. 3 December 2013. Web. 5 March 2014. <http://infertility.about.com/od/causesofinfertility/a/what-is-secondary-infertility.htm>