When you can’t get pregnant a second time

Many couples who easily conceive and carry their first child, face a shocking diagnosis: secondary infertility. Medically, the term refers to parents who, after 12 months of unprotected intercourse, have failed to conceive another child, but most experts also include recurrent miscarriage in the definition. The sadness, however, is the same: a blank space in a family where a child is longed for.

Indeed, one of the best-kept secrets of the fertility industry is that nearly a quarter of couples seeking treatment are already parents. Some of these patients had trouble conceiving the first time, so they know what they're up against when they try again. But many others have been stunned to learn that in fertility, past success is no guarantee of future success.

What Causes Secondary Infertility?

The decline in fertility between a first and a hoped-for second pregnancy can often be chalked up to age. A woman's most fertile years are between ages 15 and 30, with a drop-off occurring at 30 and a quite precipitous plunge at 35. (In fact, by 36, almost 25 percent of women may already be infertile.) Many women are unaware of this reality and delay first-time pregnancy until 30 or beyond. That means they are even older when seeking a second. It is thought that a woman's eggs suffer chromosomal damage as they age; the older the eggs, the more damaged they are, and the less likely they are to become fertilized or go to term.

Passing time also means that other conditions, not specifically age-related, can develop where they didn't previously exist. Hormonal shifts or other endocrine problems can crop up, altering the body's delicate balance. Male-factor causes -- low sperm count or poor sperm motility -- are the culprit in about 40 percent of infertility cases. Occasionally, the change in a man's fertility can be traced to a chronic illness such as hypertension or diabetes. Excessive alcohol consumption or smoking can also impair male fertility.

Hidden scars are another possible cause. Untreated infections (after a D&C, for example, or childbirth) can leave abnormal tissue in the uterus. These adhesions may prevent a fertilized egg from implanting properly or create scarring in the fallopian tubes, which keeps an egg from reaching the uterus. A new mother may develop an infection without realizing it. A woman who's never had a baby before can be completely unaware of how much postpartum pain or bleeding is normal, and many women have symptoms of infection they never report. Their diminished fertility won't be discovered until they try to conceive again.


How Long Should You Wait?

The amount of time you should allow before consulting a fertility expert operates on a sliding scale according to age. (Remember: Even at the peak of fertility, a woman's chances of conceiving during any given cycle are about 30 percent.) If you are under 30, give it 12 months; if you are over 30, you should try for 6 months.

Many gynaecologists have attended infertility workshops and are competent to perform basic diagnostic procedures and to prescribe ovulatory medication. If you've had no success after six to nine months of treatment, see a specialist.

The good news: Secondary infertility is more likely to be treatable than primary infertility. If you act promptly, consult with a specialist, and faithfully follow the prescribed treatment plan, you have every reason to feel confident that eventually you'll have another baby.

Emotional Isolation

Secondary-infertility patients are in a kind of no-man's land. As parents, they're shunned by the infertility world, which is apt to see them as ingrates because they already have a child. Yet they feel alienated from the fertile world because they cannot conceive. And though childless couples can immerse themselves in adult concerns, focusing on travel or career, parents of small children encounter pregnant women and newborn babies everywhere they go.

Jealousy and Resentment

Normally rational people often find it difficult to think clearly about infertility; the pain and frustration simply overwhelm logic. They can’t quite grasp the fact that other women's pregnancies didn't hurt their chances in any way.


A lot of patients feel guilty because they're given the message that they should be grateful for the child they have. They are grateful, but that doesn't take away the longing for another child. This desire is just as urgent, just as desperate and all-consuming as it was the first time around.


Some patients feel nothing but fury when others fail so utterly to understand the way they feel. They are constantly being reminded to be thankful for their first babies, as if they aren’t already. No on tells an expectant mother to she should be thankful for her first baby and asks why she’s pregnant again. Similarly, why would you ask a woman who is trying to get pregnant why she wants a second baby?

Pressures From the Baby

Sometimes the existing baby itself adds to the heartache. Around age three, when children see other children with siblings, they want one of their own. One of the most poignant experiences for secondary-infertility patients is when their child begins to ask for siblings. There's also the issue of child care. Infertility treatment is very demanding and a lot of treatments require daily blood tests and ultrasounds, injections, and other procedures, and it's hard to do all that when you have a child.

Marital Discord

Like primary infertility, the secondary variety can take a steep toll on a relationship. But couples suffering secondary infertility are more likely to be out of sync than childless couples (though most survive the stress). The medication and procedure can turn women into entirely different people. Many times, too, mothers want to pursue treatment, while fathers argue for settling for the family they've got. These treatments can be very disruptive and most men want the happiness and joy of a family back instead of wanting to go through the stress and adding to it.