First time was a charm, but now that you want a second child…or a third…it’s taking forever.  What’s going on?

You’ve tried everything – rhythmic timing, hormones, IVF. You’ve even gyrated to the music of some exotic fertility dance. Meanwhile, your older child is in grade school pleading every day for a baby sibling. 

It turns out an easy first pregnancy does not equate with easy conception the second time around. Struggling with this condition – known as secondary infertility – is often a long and disappointing road. The age of the woman is a major factor when trying to conceive. Fertility potential reaches its peak at 35 years old, and declines sharply after that.  It then becomes harder to get pregnant with every year that passes.

Other common explanations for secondary infertility include:

• Ovulation problems
• Endometriosis
• Pelvic adhesions
• Uterine fibroids or polyps

The same factors affecting primary infertility also come into play. Factors that affect egg production or sperm quality, or transport of the sperm to meet the egg will affect chances of getting pregnant again.

The first step is to test the couple to determine if the woman is ovulating, her tubes are open and the man’s sperm is plentiful. Depending on the identified cause of infertility, assisted reproductive techniques are offered, ranging from ovulation induction with timed intercourse, artificial insemination, or in vitro fertilization.

The emotional upshot

Secondary infertility is actually more prevalent than primary infertility, but couples are less likely to seek treatment for this condition.  It is not unusual for a second pregnancy to become a matter of obsession. Caught between the world of larger families and childless couples, joy over the child they have and heartbreak over the ones they don’t, the experience of parents who cannot overcome secondary infertility is uniquely painful. They worry about their only child who will never know what it’s like to grow up with siblings. This inability to produce siblings for the existing son or daughter frequently leads to guilt.

Suffering one or more miscarriages is also a common scenario when dealing with secondary infertility. Naturally, couples also have to contend with feelings of grief and loss.

On another level, the grieving couple may isolate themselves from friends who have more than one child due to feelings of jealousy and pain. It is completely normal for women to feel resentment towards others who were able to conceive more than once.

Since secondary infertility is often unrecognized as a problem, couples may feel tentative about seeking support and communicating their feelings, afraid they may be perceived as ungrateful for the child they have already.

Differences on how to cope and whether to accept the situation as such may affect a couple’s relationship. When this hits crisis level, professional help from a marriage counselor or a psychotherapist is necessary.

Embracing the established family

Once both parents have accepted that they are facing secondary infertility, they will need to make more decisions as a couple—primarily about whether to treat the problem at all and, if so, when to end it.

It will be necessary to talk to one’s child, and to do so in a manner that is age-appropriate.  No doubt he or she has felt the fall-out of this emotional journey and may have thoughts or feelings to express.

Though there may be discontentment, with counseling and communication, couples learn in time to accept and focus on their nuclear family of three and channel their energies to raising their only child well.

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