Secondary Infertility & The Struggle For Another Child

Secondary infertility is defined as when a couple who have one or more biological children are unable to conceive another child after trying for 12 months or more. Also, that their current child or children were conceived naturally without the intervention of reproductive technology or fertility drugs.

It is estimated that approximately 10-17% of all couples experience either primary or secondary infertility or sub-fertility at some stage during their fertile years. Around 40% of primary or secondary infertility is related to male factors, 30% to ovulation dysfunction & 20% to female reproductive conditions such as blocked fallopian tubes, fibroids & endometriosis. Frequently both male & female factors are involved. Approximately 10% of cases are diagnosed as unexplained infertility.

Often the assumption is that if you have easily concieved a child you will have no problem with subsequent conception attempts. However, this is not always the case as the body can change and new health issues can arise & sperm & egg quality can decline

The Emotional Aspect Of Secondary Infertility
Firstly, if you are experiencing difficulties in having more children, I just want to acknowledge that any feelings you may have of anger, loss, grief, jealousy, resentment, isolation or despair are just as valid as they are for a women who has not been able to conceive at all. However, you may receive less support & understanding as often the message is 'be grateful for the child or children you already have."

Frequently, the women I see with secondary infertility issues say something like "don't get me wrong I am very grateful for the child I have & I know I am lucky but........" This is because they have somehow been made to feel guilty about their desire to have another child when others struggle to have one at all. It's okay to long for another child, you are not being selfish & it is natural to feel the loss & pain of being unable to conceive another child. Very often too there is a strong desire to provide a sibling for your child, especially if you experienced close relationships with your sibling[s] when growing up.

Causes Of Secondary Infertility
The causes of secondary infertility are exactly the same as those of primary infertility. Therefore, what I will focus on in this article are the factors that I commonly see change after the birth of a child that can create a state of sub-fertility:


Vitamin & Mineral Deficiencies/Imbalances
Pregnancy & breastfeeding places an extra demand on the mother's vitamin & mineral resources. Some experts say that it takes approximately 18 months for a mother to replenish her vitamin & minerals stores after pregnancy & breastfeeding. Also, with the extra demands of looking after a child, the mother may neglect her own needs including eating healthily. I find that women often slip into just grabbing something sugary or starchy when they 'get the chance to just keep them going.' This will further deplete vitamin & mineral stores & place additional stress on the body. In this type of situation your body is less likely to prioritize reproduction because it is in survival mode.

Physical &/Or Emotional Stress
Chronic stress can have an adverse effect on hormone balance & decrease fertility levels in both men & women. Although having a child can bring much joy into a couples life it can also turn their life upside down & lead to increased stress levels. For example, there is often the physical stress of sleep deprivation & less time for self-care. Adapting to changes in your role & relationship with your partner once you become parents. There maybe additional financial stress as the income is reduced to one income for a time


Significant Weight Gain
If weight gain in either parent has been significant since the birth of their child, this can impair fertility in both & women. Being overweight relates to having a BMI greater than 30.

Studies show that a woman who is overweight has a 2-5 fold increase in fertility problems, a 2-3 fold increase in miscarriage rates and a reduced success rate of  IVF treatment. Whereas, as little as a 5% weight loss has been to shown to improves pregnancy rates & outcomes.

In men obesity leads to lower testosterone levels [good testosterone levels are needed for healthy sperm] & studies have shown a 2 fold increase in fertility problem & 3 fold increase in erectile dysfunction in men who are overweight. Just being 9 kg overweight is sufficient to have this effect & losing weight will in turn increase testosterone levels.

Increasing Age Of Parents
As we age there is a natural decline in our fertility levels & the time it takes to conceive. With the trend for couples to delay having there first child until their mid-thirties or older, I am seeing an increased incidence of secondary infertility or sub-fertility. This does not mean that you can not conceive in your mid-thirties to forties, but it does mean that preparing your body for conception & pregnancy becomes even more important for older couples. This relates to both men & women as it is a myth that fertility does not also decline in men.

Thyroid Imbalances
Thyroxine the hormone secreted by the thyroid gland has a role in the growth & activity of many tissues in the body. This includes having a role in reproductive function & menstrual cycle regularity.

Thyroid disorders are more common in women & are often triggered after pregnancy where there is either a personal past history or family history of thyroid problems. This can include hypothyroidism [underactive thyroid] which can increase the risk of miscarriage.

Postpartum thyroiditis occur in 5-10% of mothers & is an autoimmune disorder that occurs in the first year after delivery. Women who suffer form other autoimmune conditions or have a past or family history of thyroid disease are at an increased risk of it's development.

Past History Of A Cesarean Section
The development of scar tissue following a c-section, may have occurred. This is rare, but is more likely to happen if you developed a wound infection after wards. If scar tissue develops in the uterus this could impair implantation & in the fallopian tubes it could lead to blockages.

Traumatic Birth
If the birth of your child was particularly traumatic then unresolved conscious or subconscious fears about child birth, could be contributing to difficulties in you conceiving again.

What Can You Do?

1. Diet & lifestyle: work towards getting back on track with a healthy diet & lifestyle if this has gone by the wayside.
2. Stress management: find ways to make time to take care of yourself & reduce your stress levels. For example you could do a childcare swap with another mother, in which you each take it in turns to do something for yourself or look after the children. Such as have a massage or attend a yoga class.
3. Emotional Support: You may need some professional counseling to help you deal with the emotions of secondary infertility & to help you gain clarity around your decisions & options. You may like to do an internet search for a local support group or online forum specific for secondary infertility. It is often helpful to share your experience with others in a similar situation to you.
4. Medical Investigations: as a first step it is worthwhile having blood tests for hormone levels & thyroid function, check for genitourinary infections & a sperm analysis.