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Secondary infertility can, and often is, every bit as painful as the first go-round. Some friends have said that it can be even more difficult. Suddenly, you are thrust into the world of children where everything seems to come in pairs, if not higher multiples. The “lonely only” child is regarded by many in the child-abundant world as somehow missing out, whether it be in social interaction or family dynamics.

      

You can’t miss out on what you don’t have. Children without siblings tend to be higher achievers, quite social, and often leaders in society. And you can certainly have spoiled, lonely, or maladjusted children, even amongst large sibling groups. “I don’t want my only child to grow up spoiled,” whine many parents. Yet, upon having baby number 2, many of these families find that indeed they don’t have one spoiled child anymore, they now have two! Remember, history repeats itself. Don’t assume that another child will miraculously convert you … or your parenting skills. That’s a job that you have to do, whether with 1 child or 20.

      Losing support the second time

      Another emotional dilemma of secondary infertility can be the lack of support from those who once mopped your tears. “Be thankful for the child you have,” family and friends may snap at you impatiently. It’s hard to explain that you’re immensely grateful and through the joy of conceiving, delivering, and raising your first son or daughter, you have awakened your own inner parent, one that dreams of adding to the flock.

You can’t quantify pain, particularly not that of another. Many women grieve as much for the inability to have child number 3 as others do for number 1. Dreams are highly personal and don’t generally adjust themselves too easily to life’s ups and downs. But, explaining that to family and friends who don’t understand can be as challenging as any other aspect of secondary infertility. Even “classic” forms of support, including the internet, often disregard those suffering from secondary infertility, claiming that at “least” they have a child.

      

Dr. R says, “I once had a patient who consulted me at age 40. She had four children but wanted to have another. I was much younger then and far smarter than now, so I found this almost inconceivable — pun intended. As so often happens, she taught me invaluable information about the desire to have children. After much discussion and negative predictions, we attempted IVF. It did not work. Again, after considerable consultation and negative predictions on my part, we did IVF again and again and again. And guess what — on that fourth try she conceived and now has child number 5. This single case report is in no way endorsing endless IVF, but it does demonstrate the medical limitation to predicting the outcome. And it emphasizes that each individual has a different drive for children. As a follow-up, she knew when she started to try for number 5 that that would be the last. And true to her plans, five was enough — she did not return for number 6. She thanked me after the delivery because she acknowledged that she knew I did not think it would work. I tried to tell her how much her willingness to work with me helped so many patients who came after her.”

      You are not alone. Look for specific friends and organizations, whether online or in person, that address some of the issues of secondary infertility. You may be surprised, upon getting to know other parents in your child’s playgroup, to find that others have or are dealing with the same issues.

      After a particularly painful second-trimester loss of a second child, Jackie was swinging her daughter Ava in the park one day in between two pregnant mothers (just for the record, Jackie was there first!). As Jackie quietly bemoaned her fate, feeling sorry for herself and simultaneously jealous of these strangers, she found herself eavesdropping on their conversation. One of the mothers was sharing how she was just approaching the “critical” point of her pregnancy. As she appeared to be ready to pop, Jackie was a bit confused and continued her nosy vigil. Apparently, she had prematurely delivered her last child at seven months and the baby had not made it. This woman, who Jackie saw as filled with baby and with hope, had endured an even greater tragedy than Jackie had. This is a good reminder to not measure your insides against another’s outsides.

Planning Treatment for the Second Time Around

      Approaching secondary infertility is not that different from approaching primary infertility. First, what were the circumstances surrounding the previous pregnancy: Was it spontaneous or was it achieved through treatment for infertility? If there was an infertility diagnosis, is that a diagnosis that does not change as a result of a pregnancy? Have you tried long enough: six months if over the age of 35 and one year if younger? Has something changed in your life that would suggest a change in fertility?

      Consult your doctor or, if you were working with an REI, consult with that REI.

      At this point, diagnostic testing will usually be in order. Check all three areas associated with normal fertility: eggs, female anatomy, and — yes — the male.

      Based upon the results of these tests, you can choose a path that gives you the best chance for another successful pregnancy.

      Success rates for secondary infertility are the same as for primary infertility because they are based upon the diagnosis. If the diagnosis has changed — for example, age-related infertility — then the chance of success may be less than it was for the first pregnancy. Only your medical provider can determine this.

Part 2

      Taking the Initiative

IN THIS PART …

      Find out how to improve your efforts by looking at ovulation predictor kits and timing sex right.

      Be aware of some special situations that may throw a wrench in your plans, including age and certain diseases.

      Get modern medicine on your side.

      Look at diets and supplements and what effect they may have.

      Manage emotions and relationships while on the bumpy road of fertility issues.

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