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Another Baby? Maybe, or Maybe Not — Coping with Secondary Infertility

By UCS Psychiatrist Dorrie Degutis

Getting pregnant the first or second time around was a breeze. But now you’re in a new relationship and would like another child. You try and try, but nothing takes. What’s different this time around?

You are experiencing secondary infertility. This is defined as the inability to conceive or carry a child to term, after having produced a live heir. This is a relatively common problem,

occurring in up to half of all infertility cases and affecting 12% of American women.

Why haven’t you heard of this before? There is a common misconception that if you have had a child, you are not infertile. Actually, infertility can happen to both men and women at any time during their reproductive years. Couples may be reluctant to share their struggle with their medical providers, and sometime medical providers minimize the stress of this disorder.

Meanwhile the emotional experience is one of wonderment, isolation, depression, and anger. If you are in a new relationship and have had previous children, there can be a tendency to blame the problem on a partner who has not had prior children.

Couples with secondary infertility receive less social support than couples who have primary infertility, because the infertility may not be openly acknowledged. The pain is invisible since the couple already has a child, and there is no concrete or visible loss. Couples may feel guilty and worry that their depression or other strong feelings about not being able to conceive means they are ungrateful for their current progeny. If they have several children, the couple may perceive outsiders as critical of their desire to have more children.

When should you get help? Medically, if you are over 35 and have been trying to get pregnant without success for at least six months, or are under 35 and have been trying for over a year, then it is time to see a Reproductive Endocrinologist. Ask your primary doctor or OB/Gyn for a referral. Do not accept your doctor’s (or anyone else’s) suggestion that you should give it more time. Time is of the essence, for reasons that are explained below If you have had multiple miscarriages or have a serious medical problem such as Diabetes, Polycystic Ovary Disease, or an Autoimmune Disorder, sooner rather than later (as in today) is a good guideline.

What are the causes of secondary infertility?

The most common one is age. Women are born with a finite amount of eggs .Over time, the eggs become less fertile and start to die. This process accelerates with age. Not only are there fewer eggs, they are of lesser quality, which decreases the chance of fertility, and increases the chances of fetal problems (i.e., Down’s Syndrome). So your body is actually very biologically different at 30 than it was at 25.This natural decline in egg viability is the most important factor in female fertility. A similar, but not as severe process takes place in men. Although males produce sperm continually after puberty, as they age the amount and the quality of sperm declines.

Medications, lifestyle choices, and medical conditions are also contributing factors. Obesity and smoking decrease fertility, as does taking testosterone supplements. Prior pelvic surgery or complications from a prior delivery such as infection) can also be factors.

Secondary infertility is in many ways more complicated than primary infertility. You still have to continue to parent, despite a myriad of emotions. You may find yourself resenting your child while your emotional reserve is being tapped. Conflict within the couple is also very common at this stressful time.

You are faced with a difficult decision: how much are you willing to go through to pursue having another baby? If you and your partner are not on the same page about how to proceed, then matters are even more complicated. Can you imagine being satisfied without having more children? Can you tolerate a “wait and see” attitude? How do you feel about getting assistance with what is supposed to be a natural biological process?

If you decide to pursue infertility treatment, this is a time-consuming and potentially very expensive process. Who will watch your child if you have to go to the doctors three days a week for treatment? Will your insurance pay for treatment, and if so, for what kind and for how long? How will you decide if and when to stop treatment if you are not getting results? If poor sperm or egg quality is the issue, how do you feel about donor sperm or egg? Can you see yourself having this discussion with your extended family someday or sharing this knowledge with your child?

If you are thinking about adoption, the choices are likewise complicated, and often expensive.

Older children are more readily available for adoption, but they come with their own history and set of problems.

There may be a wait for an infant. You will need to think about how well an adopted child will fit into a family that already has a biological child. How well will the child fit into the larger community if he/she is from a different racial, ethnic, or religious background? Many adoptive children have special needs, such as attachment, sensory and emotional issues. Can you afford the on-going care? How do you feel about contact with the birth family? The questions go on and on, but do deserve careful thought, as you will be responsible for the child’s wellbeing for the rest or his/her life.

The paradox is: while the infertility clock is ticking, you need to take some time to think carefully and thoughtfully about the implications for bringing another child into your relationship and your family.

A great source of information and help is the national infertility association, Resolve (www. Resolve.org). Resolve has both in-person and on-line support groups, as well as education on infertility treatments. It is a must for sorting out this complicated maze of options and feelings.

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