As someone who spent two full years trying to conceive a third child via in vitro fertilization (IVF), I’ll be the first person to admit that I never thought secondary infertility would happen to me. I conceived my 5-year-old twins during my second frozen embryo transfer cycle, with 9 embryos left in the freezer. Since IVF had worked for us before, I didn’t think we would have unexpected challenges when we started trying for another baby. I couldn’t have been more wrong.
Something else I was wrong about…that secondary infertility couldn’t be nearly as emotionally painful as 'primary' infertility, because we already have kids. Spoiler alert: it is just as heartbreaking, albeit for slightly different reasons.
Secondary infertility feels like a constant push-and-pull between wanting to complete my family in the way I have always envisioned and feeling guilty for wanting more than I already have. It’s being aware that I can be grateful and sad at the same time, but also knowing that it’s not always that simple.
What is secondary infertility, exactly?
Secondary infertility is defined as the inability to conceive or carry a pregnancy to term after previously having a child (or children).
"Secondary infertility involves holding the joys (and challenges) of parenting, and the pain and yearning of infertility together. It can feel isolating in a culture where ‘being grateful for what you have’ is seen as the overarching way to live a fulfilling life. Our truth lies in knowing that trying to build the families we have envisioned does not take away from our present gratitude,” explains Allie C. Karagozian, MS OTR/L and Founder of Holding Both, a support community for women experiencing secondary infertility.
And, based on my conversations with Allie and those in the fertility community at Rescripted, I know we are not the only ones experiencing these complicated emotions.
What causes secondary infertility?
Secondary infertility is more common than people may think. According to the Cleveland Clinic, it is just as common as primary infertility – affecting approximately 11% of couples in the United States. This means they are unable to conceive after one year of trying, despite already having had a child or children.
As with primary infertility, the causes of secondary infertility can vary widely. And it often happens for similar reasons.
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Age: Women are born with all the eggs they will ever have, and as they age, fertility naturally declines, as does egg quantity and quality. This can make it more difficult to conceive, even after previously having a child.
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Infertility-Related Conditions: Infertility-related conditions such as endometriosis, where tissue grows outside the uterus, polycystic ovary syndrome (PCOS), a hormonal condition that causes irregular menstruation and impacts ovulation, and thyroid disorders, where hormone production is irregular, can affect a woman's fertility. Infertility-related conditions can impact women even if she has had a prior pregnancy.
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Male Factor Infertility: Factors such as sperm count, motility, and morphology, can also contribute to secondary infertility. Even if a man has fathered a child in the past, he may still experience infertility later on in life due to age and/or various lifestyle choices.
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Tubal Factors: Blocked or damaged fallopian tubes may prevent an egg from being fertilized and can lead to secondary infertility. This can occur as a result of infections and/or scar tissue from a previous surgery.
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Uterine Factors: Uterine factors such as fibroids and/or scar tissue remaining from certain procedures may make it difficult for an embryo to implant in the uterus.
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Unexplained Infertility: In some cases, couples trying to get pregnant again may not have an easily identifiable cause for infertility. Those with unexplained infertility may have challenges with egg quality, fertilization, genetics, tubal function, or sperm function that are difficult to diagnose and/or treat.
When to be evaluated for secondary infertility
It's recommended that women under the age of 35 who have been trying to conceive without success for more than one year – and women over the age of 35 who have been trying for 6 months without success – see a fertility specialist for additional testing. In the case of ovulatory disorders like PCOS, it may warrant being evaluated even sooner, especially if you have irregular or absent periods.
The good news? A diagnosis of secondary infertility doesn’t mean it’s the end of the road. There are many treatment options, including medications to help induce ovulation, procedures to assist in reproduction like intrauterine insemination (IUI) or IVF, or surgery to remove endometriosis, scar tissue, polyps, or fibroids. I would encourage women to talk to their doctor about potential options.
The emotional impact of secondary infertility
Secondary infertility can have a profound emotional impact on individuals and couples struggling to conceive; I know, because I've been there. My advice is that it’s normal to feel blindsided by an infertility diagnosis, especially if getting pregnant came ‘easy’ the first time around. Added pressure from family members, friends, or society to have more children, or guilt for wanting to give your child(ren) a sibling can all contribute to the stress and anxiety. If this describes you, know that your feelings are valid.
"Have gentle compassion for yourself during your secondary infertility experience. Honor the pull and knowing that you and your partner have about your family’s vision, and keep re-evaluating it with open conversation. Consider joining a support group specific to secondary infertility to build community with those who can understand some of the feelings and challenges that you may be experiencing,” recommends Allie.
To help work through these complicated emotions, finding a support system to talk through these feelings and experiences can be incredibly helpful – whether it be a friend or a licensed therapist who specializes in fertility. If you just want to dip your toe in, online communities like Rescripted and Holding Both can be a great place to start.
Despite well-meaning people saying, “At least you already have a child,” there’s no denying that secondary infertility can be hard – physically and emotionally. Add being a parent on top of that, and it can feel impossible at times. But while getting pregnant may be more difficult this time around, there are options available to help grow a family, as well as a community of people who are there to offer company and support. You've got this!
Kristyn Hodgdon is the Co-Founder and Chief Creative Officer at Rescripted.