Even if you've successfully conceived before, you might have fertility issues later in life. This phenomenon is called secondary infertility, and it's more common and emotionally painful than many people think.

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Secondary infertility refers to a couple's inability to conceive a baby despite having at least one child. It's just as common as primary infertility, and it often comes with its own physical and emotional frustrations. 

Indeed, parents often have a mental image of their ideal family, and if they find themselves unable to make that happen, it can be devastating. "Parents with secondary infertility don't often get much sympathy, so they end up feeling as though they don't have a right to be sad," says Marie Davidson, Ph.D., a psychologist at Fertility Centers of Illinois. In fact, they're often told to appreciate the child they have (as if they don't). 

What's more, parents dealing with secondary infertility can feel guilty for not giving their child a sibling—and also for directing some of their focus and resources away from that child. "Having a child already doesn't make going through infertility any easier," says Alice D. Domar, Ph.D., executive director of the Domar Center for Mind/Body Health, in Waltham, Massachusetts, and author of Conquering Infertility.

If you're dealing with secondary infertility, it's important to realize you aren't alone. It might also help to remember that the majority of people who seek help for fertility problems end up getting pregnant. Keep reading for more about secondary infertility causes, treatment options, and tips for coping.

Secondary Infertility Causes

We don't know what causes most cases of secondary infertility, says Jamie Grifo, M.D., Ph.D., program director of the New York University Fertility Center, in New York City. "The majority of the time, though, it reflects the fact that you're older now, so it's simply more difficult to get pregnant."

Female fertility peaks at age 25 and drops significantly between ages 30 and 40. Egg quality also declines as women age, and they're more likely to develop fibroids and endometriosis (a condition that causes the uterine lining to attach itself to other pelvic organs)—both of which can affect fertility. 

Other factors that might cause second infertility in women include being overweight or underweight, taking new medications, developing fallopian tube disease, or having surgery since your last pregnancy. Hormonal shifts or scarring after childbirth might also be contributing factors.

Secondary infertility could also stem from the man. It's possible, for example, that he's suffering from low sperm count or poor sperm motility. Male fertility can also be negatively influenced by chronic illnesses, excessive alcohol consumption, moderation marijuana usage, sexually transmitted diseases, and more. It's important for both the man and woman to see a doctor as soon as they feel they're having trouble conceiving.

When to See a Doctor for Secondary Infertility

With each year that passes, your chances of conceiving decrease, says Julie Tan, M.D., a gynecologist at the Cleveland Clinic Center for Reproductive Medicine, in Ohio. Sometimes even doctors downplay infertility, she notes. Most experts recommend seeing your doctor after a year of unsuccessful unprotected sex if you're under age 35, and after six months if you're over 35. 

But if you're worried sooner, speak up. "If it's been three months and you're concerned, it's not too early to get evaluated, even though it may be premature to treat," explains Dr. Grifo. "Waiting a year to find out there's an issue with sperm count or egg supply can lead to a lot of heartache."

You can start with your primary care doctor or OB-GYN, but if you're not pregnant after a few months or feel your doctor isn't taking the situation seriously, see a fertility specialist.

Secondary Infertility Treatment

During an infertility appointment, you and your partner will answer questions about your current health and medical history. "We're looking to see what might have changed from previous pregnancies," says Dr. Tan. "If we find something we can fix—say, removing scar tissue—we'll start there." Also expect blood work and ultrasounds to determine whether you're ovulating and to check your egg supply, an X-ray to look for blocked fallopian tubes, and a semen analysis to measure sperm count and quality.

The good news: Secondary infertility can often be fixed if you act quickly. Indeed, according to the American Society for Reproductive Medicine, up to 90 percent of infertility cases are treated with "conventional medical therapies such as medication or surgery."  

Your secondary infertility treatment plan will depend upon the causes, your age, how long you've been trying, and many personal decisions, including financial pros and cons. Some possible treatment options include:

  • Medication: Taken orally or injected, fertility drugs deliver different hormones that help boost ovulation. Medications can also correct hormonal imbalances in men. 
  • Surgery: Fallopian tube blockage, fibroids, or other problems in the uterus may be treated through different surgeries. If you're dealing with male factor infertility, certain procedures may fix blocked or scarred tubes, remove varicoceles (varicose veins in the testicles that can hinder fertility), or reverse vasectomies.
  • Intrauterine insemination (IUI): Also known as artificial insemination, this procedure involves inserting sperm directly into the uterus using a syringe.
  • In vitro fertilization (IVF): In an IVF procedure, eggs are fertilized with sperm in a lab, then inserted directly into the uterus. 

Dealing with Secondary Infertility 

Some couples are shocked when they find themselves unable to conceive a second child, particularly if they became pregnant easily (or accidentally) the first time. Other couples may feel enormous guilt for not providing a sibling for their only child, or for delaying a second pregnancy until it became "too late" to conceive. These tips might help you through the physical and emotional turmoil of secondary infertility.

Create a plan. Sit down with your partner and make a "fertility road map" that outlines what you're willing to try and for approximately how long, suggests Dr. Davidson. "Would you do in vitro fertilization? Would you consider an egg donor? How much money can you spend on treatment? Then build in a timeline," she says. "When you at least loosely define a time frame, dealing with infertility doesn't feel like an endless void."

Accept your feelings. Couples without children often choose to avoid pregnancy- or child-related activities, such as baby showers or first birthday parties, in order to minimize their pain. But couples with secondary infertility often have young kids of their own and may find themselves surrounded by mothers who are pregnant or nursing, or by the younger siblings of their children's friends. It's normal to feel sadness, anger, or anxiety in these situations. 

Seek help. Meeting with a mental health professional or seeking out blogs and online groups for secondary infertility can help. The website of the National Infertility Association is a great place to start.

Prep for tough questions. No matter how many times you've been asked, "When will you have another baby?" the query still stings. Try coming up with a quick comeback—like 'We actually love having an only child'—and commit it to memory, says Dr. Davidson. Another heartbreaker: your child's pleas for a sibling. Try, "You're so wonderful we don't need anyone besides you." Or maybe admit, "We'd like nothing more than to make you a big brother. We hope it'll happen."

Focus on now: One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"