secondary infertility blogBy Dr. Diana Chavkin

A few months ago, Claire*, a woman in her late 30s, walked into my office. Tall and confident, with a strong handshake and a wry smile, she was the owner of a small textile firm, married for five years, mother to a beautiful three-year-old child.

She was also sitting in the office of an infertility specialist facing something she had spent more than a year pretending was not happening. As she told me her story, her composure began to fray at the edges.

"I just don't understand it," she said. "My best friend and I got pregnant at the same time. It wasn't on purpose, it just happened that way. And we did prenatal yoga together and went shopping for baby clothes together, and she delivered three days after me and our children share a nanny now. It's amazing."

"And then?" I asked gently.

Claire was looking down at her lap and playing with the strap of her handbag.

"But then she got pregnant again. And Greg and I keep trying, but every month goes by and I'm not pregnant. Now she's having a second baby. And I'm just not understanding what's wrong. I mean, it's not like I'm infertile."

Claire's words were a refrain that too many women find themselves echoing to their physicians. Patients who are having difficulty conceiving their second child have a very difficult burden to bear. They often do not think of themselves as an infertile couple since they have already successfully conceived. And, as I explained to Claire, having a child once is not a magic potion that guarantees eternal fertility.

It is possible to get pregnant once and then experience difficulties the second time around--what is commonly known as secondary infertility. A diagnosis of secondary infertility maybe be rendered if:

Couples in these situations usually ask themselves the same questions as Claire did when she came to see me: "It was easy the first time. So why is it so difficult now?"

Possible Causes of Secondary Infertility

Causes of secondary infertility vary, but there are a number of factors that may be at play.

Whatever the underlying causes for a woman's difficulty conceiving, talking with a specialist is the best way to untangle a web of confusing information and emotions. This includes the helpful "advice" from friends and family and the myriad ways people blame themselves when things don't go as planned.

Recommended Treatments

Fertility treatments are constantly improving: pregnancy rates for infertile couples using Assisted Reproductive Technologies (ART) are currently higher than the average monthly fertility rates. Even if you already have a child, if you suspect secondary infertility, seek help from a fertility specialist as early as possible! Early evaluation is critical since, as time passes, certain treatment options may be more difficult to pursue.

In Claire's case, after a thorough course of examinations, including ultrasounds, blood work, x-rays and semen analysis, we were able to come up with a plan of action that made her comfortable. Even leaving my office that first morning, her head was high again because she had taken control of her fears and asked for help.

It's important to remember that some couples will have an identifiable reason for their infertility, and some will not. Regardless of whether or not there is a ready diagnosis, every woman struggling with questions about her fertility can benefit from a consultation with a specialist. By garnering the support of a medical team trained to help people illuminate an uncertain road, by educating yourself about your body, your issues and your options, you can get started on your way to building the family you dream of having.

Even if, like Claire and Greg, you've already started.

*Names and details have been changed to ensure patient confidentiality