Secondary infertility: the invisible pain

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Secondary infertility is defined when a woman fails to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child did not involve any assisted reproductive technologies or fertility medications.

The National Center for Health Statistics (NCHS) estimates that there are more than 3 million US women with one child, that then have a difficult time getting pregnant again or carrying another baby full-term. The NCHS also estimates that 800,000 women with a child are unable to conceive again after a year of trying.

Causes of secondary infertility can be:

  • Age – women are obviously older when they are attempting to have a second or third child, but unfortunately after 35 years of age, a woman’s fertility decreases rapidly
  • Onset of endocrinologic disorders or systemic diseases
  • Exacerbation of previous disorders like fibroids, endometriosis, or immunology isues.  Fibroids can grow and become an issue altering the pelvic anatomy, can impair tubal patency or implantation failure being a reason for miscarriage. Endometriosis is a chronic disease. There is a common misconception that pregnancy cures endometriosis, this is not true as endometriosis will resume once the normal menstrual cycle returns after pregnancy and breastfeeding. Endometriosis can actually become more severe with time if not treated properly.
  • Common causes are anatomic adhesions with anatomy distortion and tubal blockage (i.e. post C section), and intrauterine  such as post myomectomy or post infection for missed abortion, placenta retention, post-partum curettage etc.
  • Sexual Transmitted Disease (STD) like Chlamydia can cause Pelvic Inflammatory Disease (PID) with frequent consequent anatomy distortion and tubal blockage due to scar tissue formation. Papilloma virus infection can be the cause of cervical pre and cancerous lession that can necessitate surgical procedures as LLETZ that can lead to cervical incompetence or stenosis.
  • Male fertility also change due to age, habits, environmental reasons, STD, and onset of systemic diseases etc.

If you are under 35 and you have been trying to conceive for at least one year or if you are over 35 and have been trying for 6 months, you should consult a physician. If you are over 30 and have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if you know that your partner has a low sperm count or you recognize yourself in any of the examples above, DO NOT WAIT, please consult a fertility specialist.

After this brief scientific summary on this particular reproductive disorder, that hopefully will help and guide you to the quickest diagnosis and solution of the problem, I would like to talk to you about what I think is the main issue with secondary infertility: the emotional side.

Unlike primary infertility, with secondary infertility there is an unspoken stigma attached to it. Couples with secondary infertility tend to receive less social support, there is much less sympathy for women with secondary infertility than there is for those who have never been able to conceive and are often recipients of criticism by others. Essentially, since you have already had a child, there is the perception that you should be happy and grateful with what you have and that those who have never been able to conceive are in a worse state than you. Secondary infertility puts you in that unique position that you feel like you do not truly qualify to grieve about being infertile and yet you are still experiencing all those same troubles and frustrations that the “never-had-a-baby” infertile couples go through.

There are some other unique challenges as well associated with secondary infertility, parents feel guilty and worry about how their current emotional state will affect their existing child. Taking your child with you to medical appointments or having to get babysitters on a regular basis is challenging. Likewise, your emotional ups and downs can have an impact on your child. The financial strain of treatments may be a bigger concern when you are currently parenting. The pressure from your child to have a sibling can be painful and you feel powerless.

And what if the treatment does not work? Deciding what to do next can be a challenge as you also have the wellbeing of your children to take into consideration.

You ask yourself difficult questions like – “If I adopt, would I be able to love them at the same way? If I use a donor egg or sperm should I share this information with my children? How this will affect the relation between us? What would it be like to have an only child?”

On top of this, pain associated with secondary infertility is invisible as the couple have a visible child!  Even the closest family members or friends rarely recognise these feelings, they tend to associate it more with stress or tiredness due to the work and parenting and definitely not to infertility. Well, you do have a child already, so why should they think you are suffering with infertility? This can bring a mixture of distressing feelings such as anger, depression, isolation, guilt, jealousy, and self-blame, but it is especially painful because of this invisibility that you need to reach out! Do not wait for people to recognise your pain, ask for professional help now, we are here!

We know that you are extraordinarily thankful for your existing children.

We understand that you still long for more children and there is nothing to be ashamed of in wanting a bigger family.

We see your pain.

We CAN and WILL help you. Whether your goal is to pursue medical treatment, to grieve the loss of a child, or to embrace your family as it is, you need a resolution.

– Dr Corona

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