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When you don’t have as many children as you want

No matter who you are, no matter what your situation, infertility can challenge everything from your sanity to your marriage. But it’s not just couples trying to become parents for the first time who experience roadblocks.

Young family

Secondary infertility is a common experience for many couples. Attempting to conceive far outside of the bedroom has almost become the norm. There are many clinical options to try in the hopes that they might expand your family, but it’s important to realize the commitment that each method requires.

“After a year of trying to get pregnant on our own, we went to a fertility specialist,” says Laura, who has one child. “First were ovulation-boosting drugs, which didn’t prove successful. Artificial insemination (AI) was next. After three AIs that included precision timing of drugs, blood work, ultrasounds, hormones and finally my husband’s contribution, we still weren’t pregnant and we were done trying. Super-ovulation then in vitro would have been the next steps, and we weren’t willing to risk having twins or triplets.”

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Causes of secondary infertility

Pregnancy isn’t easy — getting there, going through it and having your child. And, for some, it’s even more challenging the second time around. The Centers for Disease Control and Prevention (CDC) reports that about 11 percent of couples experience secondary infertility, which makes up about half of all infertility cases.

“Age is one of the most common reasons for secondary infertility. Women are older when they start trying for a second child,” says Eve Feinberg, M.D., of the Fertility Centers of Illinois. Weight gain, weight loss and cumulative effects of old habits like smoking can also cause secondary infertility. “Growths such as fibroids or polyps can occur and interfere with the likelihood of getting pregnant. Sperm counts can also decline with age,” says Feinberg.

Ovulation disorders and tubal infertility are common causes of secondary infertility, according to Jane Nani, M.D., Feinberg’s colleague. “Depending on maternal age, egg factor and ovarian reserve should be re-evaluated.” Sometimes diagnostic tests come back with “unexplained” secondary infertility, which is incredibly frustrating. At that point, a range of treatment may be offered.

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Treatment for secondary infertility

“Infertility treatment always starts with a basic evaluation to check out the ovaries, the uterus and the sperm,” explains Feinberg. This can involve a series of extensive tests that can extend over a period of months as specialists determine the cause of the infertility, from basic blood work to ultrasounds to laparoscopy which requires anesthesia.

“Treatment usually starts with inducing the ovaries to ovulate more effectively and placing the sperm into the uterus, an intrauterine insemination. If unsuccessful, stronger treatment such as in vitro fertilization (IVF) may be used,” says Feinberg. “Infertility treatment is always tailored to the specific problem at hand and it is critical to work with a specialist in the field who provides comprehensive fertility care.”

The three most common infertility treatments include:

Fertility drugs: Taking a drug such as Clomid helps stimulate ovulation. Many fertility drugs increase the chances of releasing more than one egg per month, however, so should you successfully conceive with this method, be prepared for the possibility of multiples.

Artificial insemination: Also known as intrauterine insemination (IUI), artificial insemination is when a woman is injected with specially prepared sperm. Timing is critical for this treatment, as is the window of opportunity, and you have to be ready at a moment’s notice to help this fertility method work to your advantage.

In vitro fertilization: In IVF, the sperm and eggs are taken outside of the body and fertilized in a laboratory. Embryos are then placed into a woman’s uterus to give her the best possible chance of getting pregnant.

While no method of infertility treatment is easy mentally, physically or emotionally, what can sometimes be even harder is finally deciding to call it quits. And sometimes, it can be a relief.

“We had one beautiful, healthy girl and considered ourselves more fortunate than many people. I also didn’t like living my life wondering if I would be pregnant in the near future — it affected everything from shopping for new clothes to planning vacations!” says Laura, who has made peace with her decision.

More about secondary infertility

How infertility is impacting my child
Can your marriage survive infertility
Staying grateful while facing infertility

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