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Secondary Infertility

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Why Can't I Have Another Baby?

Don't let the term fool you: there is nothing "secondary" about "secondary infertility". As many can attest, it feels very much the same as "primary" infertility, that is, the inability to conceive. Secondary infertility is defined as the inability to conceive or maintain a pregnancy after having successfully done so before, and is thought to be more common than primary infertility.

The relatively common occurrence of secondary infertility is not widely known about, however, and takes most people by complete surprise. For those who have easily conceived, carried, and delivered a baby to suddenly find themselves wondering about their fertility is bewildering at the least.

Emotional Aspects of Secondary Infertility

In most cases, people who have children already and find they are having trouble conceiving or carrying again report a lack of empathy everywhere they turn. Like "primaries", they suffer from the misunderstandings of the fertile world, family, friends, and acquaintances who express well-intentioned but hurtful opinions. Misinformed conversations frequently center around the importance of siblings and spacing your children just-so.

Unlike primaries, however, "secondaries" also face stigma in the very arenas where they might seek understanding. Primaries they meet in support groups, chatrooms, and online forums may convey resentment that secondaries dare complain about their situation. After all, goes the argument, they have at least one child already. The best way to deal with these rifts is to remember that there is no difference in the capacity or quality of feelings around these issues. The important thing is to share what everyone learns from the hand dealt them.

In cases where children are present, secondary infertility also brings with it a new kind of guilt: the guilt for feeling that one's child "isn't enough". This can be particularly devastating for people who had always planned on having a large family, or who come from large families themselves. The conflicting emotions of envy and anger toward those who seem luckier may be further compounded by feeling isolated from the fertile world and your child's world. It may be helpful to invest some time in corresponding with others who are experiencing the challenges of infertility while parenting.

Not everyone who can be classified as "secondary" has children. Folks who have experienced primary infertility and then miscarried are also considered to be in this group. Anyone who conceives relatively easily yet experiences recurrent miscarriage is also categorized as "secondary". While these groups may experience slightly more community understanding, they may also be viewed with distrusting eyes, stemming from the innate human defense mechanism to witnessing someone else's tragedies. Onlookers may feel caught in a bind between feeling sorry for the couple or wondering if there is "good reason" for the continued losses, and the infertile individual may sense this ambivalence. Again, seeking the support of others who have been through it can help shield one from others' grief and confusion.

Medical Aspects of Secondary Infertility

Just as it is important for many with primary infertility to seek the assistance of a qualified specialist, that point must be emphasized even more so with secondaries. Many will feel a strong loyalty to their OB/Gyn if it is the same doctor who assisted with prior deliveries. Secondaries should follow the same general rule as primaries, that is, seek specialty care if one year of well-timed intercourse doesn't result in a pregnancy (or after only 6 months if the woman is in her 30's or older). The transition to a specialist may be difficult emotionally, resulting in a feeling of betraying the OB, but could very well result in correction of any new or previously unknown problems.

Dr. Kathy Trumbull, assistant professor at the University of Illinois College of Medicine at Peoria, and director of the division of reproductive endocrinology, offers some insight into the subtle differences between treating primary and secondary infertility:

"I definitely explore what happened with the (previous) delivery and anything new since then, because there are a few things like Asherman's syndrome that are rarely seen in a nulliparous (never pregnant) woman."

Dr. Trumbull adds that she looks for any new symptoms which may point to endometriosis, pelvic or uterine infection, and other fertility inhibitors.

Like it or not, especially in cases where several years have passed since a couple last conceived, the aging reproductive systems must be considered as possible factors. On this note, Dr. Trumbull adds:

"I still do the usual basic workup of cycle day 3 hormones (TSH, FSH, estradiol and sometimes prolactin and LH), semen analysis and hysterosalpingogram, as I remind them that things can change with age. If I am worried about age related luteal progesterone problems, then I watch levels like a hawk."

Through consultation with a specialist, some couples may find that they were just lucky to have ever successfully conceived and carried a child to term.

"Sometimes I find a couple in which the woman has never really ovulated regularly who conceived "easily" the first time. I tell them they have just been very lucky and probably more sexually active in the beginning of their marriage. Now that they have the 2-3 year old child at home creating a possible interruption or other problem, they just don't have sex often enough to catch the infrequent chances to conceive.

Sometimes all it takes is an ovulation predictor kit used for extended periods of time until they catch the ovulation."

It is important to emphasize that all bodies change over time, and there are many reasons that a once-fertile reproductive system may no longer be as responsive. Bodily trauma such as surgery, acute or chronic illnesses, undiagnosed disease, and the expected effects of aging are all possible causes. The key is finding the right assistance at the right time. Whether primary or secondary, the goal remains the same: building your family.

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