Does infertility apply to couples having difficulty trying to conceive their first child, right? Wrong. Millions of women in the United States experience problems getting pregnant after they’ve successfully conceived a child. This type of infertility is called secondary infertility, and it is defined as the inability to become pregnant or carry a baby to term after previously giving birth.
“Secondary infertility is caused by pretty much anything that could cause primary infertility,” says Dr. Jeremy Groll, medical director of SpringCreek Fertility, a fertility clinic in Centerville. Those causes can include impaired sperm production, function or delivery in men and fallopian tube damage, ovulation disorders, endometriosis and uterine conditions in women. Age, weight or certain medications for both partners can also play a role. “People assume there isn’t a male factor,” says Dr. Groll, “but male factor is involved fifty percent of the time. It’s a major problem.” Another big issue can be a change in ovarian function. “That declines over time, especially as we reach our mid-thirties,” says Dr. Groll.
It may surprise some to know that secondary infertility is not always age related however. Amy Welborn, a birth doula and childbirth educator in the Dayton area, had her first child at the age of 23 and then struggled with secondary infertility. The oldest of five children, she says she went into the idea of motherhood pretty naively. “I took for granted that my mom got pregnant so easy. Infertility wasn’t brought up. I didn’t know anybody who had those issues. You assume that infertility issues happen the older you get but that wasn’t the case for us.” So, when she struggled to conceive her second child, the experience took its toll on her. “Nobody ever talks about secondary infertility and so here we were, and it was affecting me at a greater depth because with secondary infertility came the guilt of [not] providing a sibling for my son.” She adds, “I ended up going to counseling.”
Even if a couple conceives without delay initially, there’s no guarantee that it will be easy the next time. “It is always going to be a matter of probability,” says Dr. Groll. “If a couple got pregnant the first time around, what that tells us is that they had an egg, a sperm and an open tube. It doesn’t tell us much beyond that. You can have pregnancies with low sperm count or not ovulating regularly, but if everything hits then it is a successful pregnancy – though statistically it is low.”
In terms of optimizing fertility conditions, Dr. Groll says, “Look at balanced nutrition and maintaining fitness. I often talk to folks about avoiding excess sugars. People worry about caffeine but one of the biggest culprits is excess sugar, largely from soft drinks.” He advises couples who have had a previous successful birth but are now experiencing a delay in conception of six months or longer to talk to their primary gynecologist who may refer them to a fertility center.
Welborn, who did eventually conceive again and is now the mother of eight, has this advice for women struggling with secondary infertility. “Find your tribe and get a support team. It was hard for my husband, too. Focus on being a really strong core because it can rip you apart and make you feel guilty and worthless. It can tear your marriage apart if you let it.” She says that it helps to find support from other women that have had the same experience and that finding a great health care provider also helps. “We struggled with being brushed off a little bit with a ‘just be patient’ from the provider. Those weren’t comforting words at all.”
It’s Welborn’s hope that the topic of secondary infertility will be discussed more openly. “Pregnancy loss, infant loss, those things are widely talked about but there isn’t really awareness for secondary infertility.”
Doctor Groll wants women struggling with secondary infertility to remember that they aren’t alone. “One of the important things that people don’t realize when they see other people with kids is they don’t know how those kids were conceived. They don’t know how many years they were delayed; they just know they were conceived,” he says. “A lot of people assume other people aren’t going through it.”
For more information on secondary infertility, talk with your doctor or visit Resolve – The National Infertility Association (www.resolve.org) for resources and support.