Having a baby is one of the most meaningful events of one’s life. Perhaps you were one of the lucky ones and easily became pregnant with your first, but now, completing your family and giving your little one a sibling is not as easy as you expected or experienced with your first. Frustration increases as friends and family frequently ask, “so, when are you going to have another one?!” As if this is not what your intention has been month after month, negative test after negative test. If you are experiencing feelings of guilt and sorrow, you are not alone.
Numerous women in the United States and abroad are experiencing what has been termed “secondary infertility.” Many are quietly struggling with feelings of guilt that they are not able to achieve what they could so naturally accomplish previously. Plenty are afraid to share their struggle, fearing their concerns may not be taken seriously, especially when others are struggling with primary infertility and are unable to conceive their first child.
Armed with information and access to care and counseling, women should feel empowered to shrug off their feelings of guilt and seek treatment. The following are frequently asked questions about the sometimes enigmatic entity that is secondary infertility.
What is Secondary Infertility?
Secondary infertility is the inability to conceive in women who have previously had a pregnancy after having regular unprotected intercourse for 12 months.
How Common?
According to data published by the National Center for Health Statistics, more than 3 million women of childbearing age in the United States who have one biological child have difficulty getting pregnant or carrying another to term. Additionally, roughly 800,000 married women with one child are unable to get pregnant again after one year of having unprotected intercourse.
The Cause?
Secondary infertility may be due to a variety of causes. Sometimes, it is due to increased age and the associated decline in egg quantity and quality, making conception more difficult. Other times, it can be due to pregnancy-related complications, damage to the uterus or fallopian tubes, ovulation disorders, changes in sperm count or motility, or other changes in medical history since the prior pregnancy was achieved. It is a common diagnosis, and treatment depends on the potential cause. Much like primary infertility, secondary infertility can sometimes be unexplained, in which case there are still several treatment options to pursue.
Secondary Infertility Evaluation
Secondary infertility is evaluated in a similar way to primary infertility. Common tests to perform are a hysterosalpingogram (an X-ray) to confirm that the fallopian tubes are open and the uterine cavity is normal; a semen analysis to check the quantity and quality of the sperm; and blood tests and a pelvic ultrasound to assess a woman’s reproductive hormones and ovarian reserve. The entire evaluation can generally be done within one cycle and a treatment plan can be devised based on findings.
When to See a Specialist Regarding Fertility?
This is a very personal decision. In general, a workup and treatment is recommended in women under 35 who have been engaging in unprotected intercourse for 12 months, or six months in women over 35. However, if a woman is not having regular periods, or has a specific suspicion or concern about her or her partner’s fertility or health as it relates to achieving a pregnancy, it is not unreasonable to see a specialist sooner. Sometimes having a general evaluation to insure that all of the basic components of fertility are functioning properly is at the least, anxiety relieving.
Who Can I Talk to About Secondary Infertility?
It is important to remain a healthy, happy parent to your existing child even in the face of struggle with secondary infertility. To do this it is important to maintain a proper support system. Friends and family are often a good resource for support. However, if confiding in friends or family feels burdensome, you may benefit from joining a support group of women going through the same circumstance or, for more one-on-one care, a reproductive psychologist. Ask your OB-GYN or Reproductive Endocrinologist for such contacts. Additionally, organizations such as ASRM and RESOLVE offer websites with information and access to care.
Anate Aelion Brauer, M.D., is a Reproductive Endocrinologist at Greenwich Fertility and Greenwich Hospital. Greenwich Fertility has offices in Greenwich and Stamford, Conn., and Tuckahoe, N.Y. Brauer is also Assistant Professor, OB-GYN, NYU School of Medicine. greenwichivf.com.
