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Secondary Infertility

Definition
Secondary infertility is defined as the inability to become pregnant, or to carry a pregnancy to term, following the birth of one or more biological children. The birth of the first child does not involve any assisted reproductive technologies or fertility medications.

Do I have secondary infertility?
Infertility is defined as a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages.  

Infertility is a medical problem. Approximately 30% of infertility is due to a female factor and 30% is due to a male factor. In the balance of the cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

Should I see a specialist?
Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year and are under 35. If you are over 35 and have been trying for 6 months, you should consult a physician. If you are over 30 and have a history of pelvic inflammatory disease, painful periods, miscarriage, irregular cycles, or if you know that your partner has a low sperm count, do not wait one year. Consult a specialist, such as a Reproductive Endocrinologist or urologist, or in some cases your OB/Gyn.

Why is this happening?
When a first child is conceived with ease, you may feel completely off guard by the difficulty of having a second child. Take charge and talk to your primary care or ob/gyn physician. Secondary infertility is very common, but not often talked about. RESOLVE is here to provide the resources you need.

The emotional side of secondary infertility
Physicians, too, may downplay the possibility of secondary infertility in their previously fertile patients and encourage the couple to "keep on trying." The emotional experience of secondary infertility often is a compilation of the distressing feelings of anger, grief, depression, isolation, guilt, jealousy, self-blame, and being out of control. You may feel guilty for experiencing normal grief and worry about how your current emotional state will affect your existing child. The powerlessness to produce a sibling for the existing child often produces feelings of sorrow, as does the inability to perpetuate the parenting role. You may feel distant from friends as those who were a great source of support when parenting the first child are now linked to sensations of pain and jealously.

Sadly, couples with secondary infertility tend to receive less social support from others than couples who have primary infertility because the infertility is unacknowledged, the pain associated with infertility is invisible as the couple has a child, and there is no concrete loss in the family. In addition, couples experiencing secondary infertility may be recipients of criticism by others who think they should be grateful for one child and that it is foolish to go to extremes to increase family size. Of course, a couple can be extraordinarily thankful for their existing child and still long for more children.

I’m still a parent. How do I cope?
Unlike in primary infertility, couples who experience secondary infertility already have a child's needs and welfare to consider. It is important for parents to demonstrate to their child that problems are dealt with and not buried. It is naïve to think that a child will remain unaware of her parents' grief just because the parents do not talk about it or address it directly. In fact, if there is an absence of information, children resort to egocentricism and magical thinking to interpret events. For example, the child may be worried seeing the mother go to the doctor, getting shots etc. or the child may think her parents are dissatisfied with her if they are upset and anxious. The young child does not have the cognitive capability to understand her parents' actions and feelings as separate from herself, and, therefore, needs an explanation for her parents' melancholy. In addition to helping the existing child appreciate the parents' emotions, parents must help the child identify his own experiences and feelings.

Guilt about not providing the existing child with a sibling is a common experience of couples suffering from secondary infertility, as they feel they are failing their child. Many couples idealize the sibling relationship by believing the siblings would be emotionally close. Of course, there is no guarantee about any sibling relationship, and the existing child should not be burdened by the loss of this idealized relationship. It is crucial for parents to acknowledge and mourn the loss and then to legitimize the existing family. Families come in all shapes and sizes, even size three.

It is a cruel irony that the more positively parents feel about parenting, the more painful is their experience of secondary infertility. Many parents have expressed ambivalent feelings about their child growing up because they fear they will never re-experience the pleasure of the early years. In addition, parents may become overly protective and attentive to their existing child. In the face of loss, parents want to hang on to what they have and love. Of course, these parental feelings must be kept in balance with the growing child's needs for separation and independence.

Finding Resolution
The resolution of secondary infertility brings many variables into the decision making process. The couple must focus on the desire to parent a second child and the time, energy, and finances involved in pursuing medical treatment or alternatives such as adoption. These conditions must be weighed with the needs of the existing child in mind. Couples often are concerned whether or not they will continue to be good parents in light of the emotional and financial stresses associated with treatment. Sometimes, in grieving the loss, couples find there are advantages, such as more time and more resources, associated with having one child.

Couples often need assistance from professionals and/or support groups as they struggle with the turmoil of secondary infertility. Grieving what might have been is not an easy task, and couples often benefit from the contributions and support of others grappling with the same circumstances. If the grieving process extends for a long period of time, and symptoms of depression exist for more than six months, the help of a mental health professional with experience in reproductive medicine should be sought. With respect to secondary infertility the ultimate goal is to grieve the loss of a child, decide to pursue medical treatment or alternative family building options, or to embrace the established family as it exists. With resolution comes the reclamation of life.

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