What happens when baby number two doesn't come easily... or at all? Here's what you need to know about the silent struggle of secondary infertility.
If there was one thing Jennifer Chaves always wanted, it was to someday "give birth to a baby from my body." Chaves herself was adopted, but she hoped to have a biological connection to her own children.
So at age 34, a year after she got married, she and her husband got to work. Within a month, she was pregnant. She gave birth to a healthy baby boy named Thomas. Wanting a big family, the Clinton, Mass., couple tried again almost immediately, when Thomas was just a year old.
This time, however, they struggled. Chaves' doctor suggested she lose 20 pounds. She did. Still not pregnant six months later, she tried acupuncture. After another six months with no success, she moved on to in vitro fertilization (IVF). Over the next three years, she watched her diet and did tai chi and qigong moving meditation to reduce stress. Out of four IVF cycles, one resulted in a miscarriage—the rest failed.
Through it all, she felt guilty, ashamed and isolated. "My mother-in-law told us to just have another," she said. "Meanwhile, my acupuncturist told me to be grateful for the one child I already had."
Most women assume that if they had no problem conceiving once, they won't have trouble again. But secondary infertility (commonly described as the inability to get pregnant after having had at least one child without fertility assistance) may be as common as primary infertility. The latest data from the National Survey of Family Growth estimates that more than 1.5 million married women in the United States ages 44 and younger are infertile—defined as not getting pregnant after 12 months of unprotected sex—and more than half of those women are mothers already.
A Hidden Sorrow
Secondary infertility hides in plain sight because many women feel too guilty to talk about it, says Judy Becerra, supervisor of counseling at the Colorado Center for Reproductive Medicine (CCRM). "People with secondary infertility may feel that they're being greedy by wanting a second and that they don't deserve the sympathy of other women."
That's a feeling Jen Noonan could relate to when she first entered a CCRM support group for infertile women. "I was always the only one who had a child already," she remembers. "I would mention the miscarriages I'd had before I would ever say I had another child." (She finally had a second child at age 37, after two years of struggling to conceive.)
The pain of women who can't have a second child shouldn't be dismissed, says Catherine Birndorf, MD, a reproductive psychiatrist in New York City: "If your narrative is 'I come from four kids and I wanted three kids,' you may feel as much pain as someone who's never had a child."
The Search for Solutions
Age is the main cause of secondary infertility. The quality of eggs that a woman has begins to drop by age 35, regardless of whether she has given birth. "Getting pregnant is like a lottery," explains Jesse Hade, MD, a reproductive endocrinologist at Boston IVF in Scottsdale, Ariz. "The odds change depending on your age and ovarian reserve. Each egg in a healthy woman age 34 or younger has an 8.3 to 10 percent chance of creating a healthy live-born baby, or odds of about 1 in 12 to 1 in 10. By 40, that goes to about 5 percent, or 1 in 20, and by 45, it's 1 or 2 in 100."
Getting older is not the only culprit, of course. Sometimes there are problems that arose from a previous pregnancy, like scarring. Other conditions, such as endometriosis, uterine fibroids, diabetes, or thyroid disease, may also play a role. In some cases, the woman is in a second marriage and the new husband has a low sperm count.
Most doctors will do essentially the same workup (checking sperm count, evaluating ovulation, looking for tubal blockages) for secondary infertility patients as they would for primary infertility patients, says William Schoolcraft, MD, the founder and medical director of CCRM. If no obvious cause is discovered, doctors may encourage an older woman to move quickly toward IVF, rather than spending a lot of time on more basic treatments (like taking the medication clomiphene, or Clomid) while the clock is ticking.
Of course, even IVF does not guarantee success, as Jennifer Chaves learned the hard way. But Dr. Schoolcraft notes that IVF failure isn't necessarily the end of the road. Donor eggs may be a solution; women ages 45 and older will often require them to conceive, he points out.
Chaves and her husband took a lower-tech path to completing their family. "In the end," she says, "we adopted the most perfect baby."