Secondary Infertility -- Caught Between Fertile and Infertile Worlds

For most people, infertility conjures up the image of a couple without a child. But what about a couple who have borne a child, and now want to extend their family but find they are unable to do so?

Secondary infertility is the inability to conceive after one or more successful pregnancies. The medical causes are similar to those of primary infertility, and include sperm problems, tubal factors, endometriosis and ovulation difficulties. However, there are differences. For one thing, the couple is usually older, which is why time is at a premium!

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Moreover, there are emotional aspects that are unique. The couple experiencing secondary infertility often find it difficult to gain understanding or sympathy from family, friends and relatives. Since they have one child, most people assume that the couple will have no problem having another. Even other infertile couples offer little sympathy! Patients with primary infertility often resent couples who have a baby and believe their own pain would disappear if only they too could bear one child. A common remark is, "You have one child, you should be grateful for that." Couples who are victims of secondary infertility thus, are caught between two worlds, fertile and infertile --- and are excluded from both!

Guilt and frustration are common emotional responses. The frustration is borne out of surprise because the couple didn't think it would be difficult to conceive a second time (unless they had difficulty in getting pregnant the first time as well). However, just because they have got pregnant once doesn't make them immune to all the illnesses which can cause infertility --- and tubes can get blocked and sperm counts drop as time goes by!

Couples with secondarily infertility who have undergone an elective abortion to terminate the first pregnancy and cannot conceive a second time around have a very hard time coping with their feelings of guilt. They often feel they are being punished for their sin of rejecting a child when they could have had.

Couples with a child at home may also feel guilty. This guilt arises because they catch themselves feeling that one child isn't good enough for them; and also for their inability to provide their child with a sibling. The child of a secondarily infertile couple may also bring unwitting pressure on his parents by asking when he will have a baby brother or sister. This is especially difficult when the child is being asked by his friends why he doesn't have a baby brother or sister and then begs his parents for a baby.

Parents may become very overprotective, fearing that something may happen to the one child that they do have. They may also relentlessly pin all their hopes on their one child, and may push him to be a high achiever.

Many couples with secondary subfertility choose never to take medical treatment. Often, this is because they are unsure about whether they do have a problem - and they keep on trying, hoping to "hit the jackpot" once again (after all, if they could do it once, why can't they do it again?)

What are the chances of a couple with secondary subfertility conceiving with medical treatment? While this would depend on the individual's problem, their chances are really about the same as a couple with primary infertility. While they have the benefit of having "proven" their fertility once, they usually have the handicap of an increased age against them.

If the couple choose to seek medical intervention, they also must decide what to tell their child about medical procedures. The presence of a child at home can make coping with the demands of infertility treatment much more difficult!

The financial burden of going in for treatment can also add to the emotional stress of the couple and they may wonder if they shouldn't be spending the money on the child they already have rather than pursuing the hope of expanding their family.

Adoption can be a choice for some of these couples, but such an alternative is often more complicated because they worry about the possibility of "favoritism"; and may also feel that it is unfair to their biological child to bring an adopted child into the family.

Coming to terms with secondary infertility is no easier than coming to terms with primary infertility --- and it's important that the family of the couple with secondary infertility share their feelings together and maintain a positive attitude.

Credits: Dr. Aniruddha Malpani, MD and DR. Anjali Malpani,