Secondary infertility

We've been trying to have a second child for two years. Do we have a fertility problem?

Yes. It's called secondary infertility when a woman is unable to get pregnant or carry another pregnancy to term after having one child. And although primary fertility problems get most of the attention, more than 3 million women in the United States have secondary fertility problems.

What causes secondary fertility problems, and how are they treated?

The same factors responsible for primary fertility problems can also cause secondary infertility. These include:

• pelvic or uterine scarring
• blocked fallopian tubes
• endometriosis
• defective ovulation
• being underweight or overweight
• smoking
• excessive drinking
• poor sperm quality or quantity

Whatever the cause, the condition either developed or worsened since you gave birth. For example, complications during labor and delivery could have triggered a problem. Or, your fertility problems may be age-related if several years have passed since your first pregnancy.

Treatments for primary and secondary fertility problems are the same, and the first step is usually to get evaluated by a fertility specialist. If you haven't become pregnant after one year of having frequent unprotected sex, or if you're older than 35 and haven't become pregnant after having frequent unprotected sex for six months, you may want to visit a fertility specialist.

You can see a specialist even sooner if you're older than 30 and know you have a condition that could affect fertility, such as endometriosis or irregular menstrual cycles.

I'm jealous of friends who have larger families, but then I feel guilty that one child isn't enough for me. Why is that?

Although you love your child, you may feel deprived of the bigger family you always dreamed of having. Common reactions to secondary fertility problems include:

• Denial. You may think, "I've been pregnant before, so I can't possibly have a fertility problem." This mindset explains why so few couples with secondary problems seek medical treatment. Even those who had fertility problems before becoming parents sometimes assume the problem is resolved and have a hard time accepting the idea that they might face more fertility problems.
• Envy. You may feel like you don't have anything in common with your friends whose families are growing and feel jealous of their success in having more than one child.
• Isolation. If you're dealing with secondary fertility problems, you may feel like you don't fit easily into any one group. Having one child already means you can't seek support from infertile couples, but neither can you relate to parents who have had more children. And fertility problems place enormous stress on a relationship, so you may even feel estranged from your partner.
• Sorrow. You may view your child's milestones – going off to kindergarten or learning to ride a bike – with a mix of joy and sadness, knowing you might not experience another child at this particular age again.
• Guilt. Being unable to give your child a sibling may weigh heavily on you, yet your desire for another child may also cause pangs of guilt for not being satisfied with the child you have.
• Anger. You may be angry that you're denied something everyone else seems to do so easily – have another child.
• Anxiety. The treatment regimen of early morning blood draws, ultrasounds, and daily injections – all requiring appointments at the doctor's office – poses special obstacles for parents of young children. And most fertility clinics don't allow children in waiting rooms, so arranging childcare can be difficult and expensive. And, of course, financial pressures are another stressor. For instance, can you afford to pay for fertility treatments and still save for your child's education?

Unfortunately, all these tough issues are just part of the painful experience of fertility problems. As with primary fertility problems, you and your partner will sail through some ups and, most likely, weather a lot of downs.

If these emotions disrupt your life too much, talk to others who have also experienced secondary infertility or seek professional help – preferably a counselor familiar with fertility problems.

See more on coping strategies.

My family and friends don't seem to understand. How can I find other people to talk to?

Resolve, the national infertility association, sponsors support groups specifically for couples with secondary fertility problems. Sharing your feelings with others can help you cope, but make sure you don't join a support group that includes people with primary fertility problems, which wouldn't be helpful for anyone.

"While we were trying for a second child, I went to a weekend retreat in Boston for women with fertility problems." says Trish M. of Norwalk, Connecticut. "Almost everyone else was childless. I felt so greedy when I saw how desperate they were."

How can I handle fertility treatments and still be a good parent?

Feeling anxious and frustrated while undergoing fertility treatments is normal, but if these emotions make you too irritable or preoccupied to interact with your child, consider counseling to help you handle your feelings and learn techniques for stress relief and relaxation.

And look for fun activities you and your child can do together. See our article on games to play with your baby or check out our ideas for activities to do with your older child.

Reach out to friends and family members (or hire a babysitter) when you need a break. Your relationship with your child will be healthier as a result.