Sharon LaMothe
Infertility Answers, Inc
http://infertilityanswers.org/
Secondary infertility: Why can’t I get pregnant again?
By: Melissa Chapman
If you're dealing with secondary infertility, you are not alone in your struggle with trying to get pregnant again. When my daughter was two and a half, the barrage of questions as to when we were going to have another kid came fast and furiously. Initially I did not mind, however after nine months of trying to conceive the old-fashioned way—and even incorporating some romantic accessories to take the drudgery out of our mandatory “lovemaking sessions” -no amount of hot wax or fur-lined handcuffs were able to procure us a viable fetus. We went the route of meeting with a reproductive specialist, who flat out told me that I’d be unable to conceive without intervention.
Unable to fathom the information, being that our first stab at conception happened almost by accident, we chose to get a second opinion. Unfortunately the physician diagnosed me with secondary infertility and advised us that our best odds at conceiving were via medical intervention.
For my husband and I, the whole process of dealing with our diagnosis of secondary infertility and the battery of tests which ensued; having my fallopian tubes essentially snaked and his sperm scrutinized—months of painful injections, blood test, sonograms and insane mood swings all took a very heavy toll on our marriage. I also vividly recall wanting to deck every friend and family member, who during those difficult months- endlessly questioned me about when I was going to expand my family. In fact I even toyed with the idea of blurting out- on more than one occasion to a handful of relatives this very statement; “Well I’ll tell you how our next insemination goes, after my husband ejaculates into a cup and we rush it over to our doctor's office.”
Secondary infertility diagnosis
According to RESOLVE: The National Infertility Association over three million Americans are affected by the painful experience of secondary infertility. Dr. John Rapisarda of the Fertility Centers of Illinois says infertility, whether primary or secondary, is defined as one year of attempting to become pregnant without success. Evaluation is often recommended for individuals over 35 who have been unable to conceive after six months.
Causes of secondary infertility
Although they are pretty similar to primary infertility, Dr. John Rapisarda admits that age factors play more of a significant role in individuals with secondary infertility relative to those with primary infertility. These causes are broken down into three main categories such as male factors, hormonal factors and pelvic/tubal factors.
Male factors include: Changes in sperm quality may occur due to medication use, changes in health or in testicular function, or may be the result of hormonal or environmental changes.
Hormonal factors in the female include: The natural decline in ovarian function that occurs with age, other hormonal imbalances such as hypothyroidism, lifestyle changes, and change in weight, change in health or certain medications.
Pelvic/tubal factors can be the result of infections that damage the Fallopian tubes (sexually transmitted/ruptured appendix), endometriosis, pelvic or abdominal surgery that can lead to scarring in the pelvis or uterus, cervical surgery and growth of fibroids or polyps in the uterus that may interfere with implantation.
Secondary infertility treatment options
Depending on the factors that have been diagnosed Dr. John Rapisarda says there are several medical interventions to help couples experiencing secondary infertility. These include:
Surgery to remove scar tissue, excise endometriosis, or remove fibroids/polyps
Hormonal therapy to correct ovulation disturbances, or other hormonal imbalances
Fertility medications, such as clomid, to increase egg production in someone who is suspected of having reduced egg quality, or with unexplained factors.
Insemination for mild sperm abnormalities.
IVF to bypass pelvic/tubal abnormalities, for severe sperm related abnormalities, or for someone who has failed other interventions
Use of a sperm or egg donor.
Emotional toll of secondary infertility
“Infertility always takes an emotional toll on those experiencing it, whether primary or secondary. It is stressful and frustrating and often associated with a sense of a loss of control," says Dr. Rapisarda. “Those with secondary infertility are always grateful that they have a child(ren) at home, but when they begin their attempts at becoming pregnant again, they have the expectation that they will be able to add to their family without a problem. When this doesn’t happen it can lead to the above feelings as well as a feeling of guilt that they might have waited too long, or done something else to cause their secondary inability to conceive. Physically, the treatments may lead to weight gain and other symptoms associated with hormonal changes.”
According to Sharon LaMothe, co-owner of Infertility Answers, Inc., who, after experiencing her own bout of secondary infertility, gave birth to her second child and went on to become a gestational surrogate twice.
“I was put on Clomid (which made me very moody and emotional) and told to chart my temperature. That's when it starts to take a toll on a marriage,” says Ms. LaMothe. “I have to say that my husband was really great about talking about anything that I felt like talking about but mostly he said that he was grateful for whatever we had in the way of family.“
Ms. LaMothe admits that having her husband take the pressure off of her to "perform my god-given duty to populate the earth" was the best gift he could give. However she believes that as women we do put a lot of pressure on ourselves and when we can't have children we can sometimes feel worthless.
“No matter when you are infertile in your life it is still a heart breaking experience. You can't have what everyone else has "naturally". You have to "work at it" and spend money on "it" and talk about "it" and IT becomes a huge elephant in the room," says Ms. LaMothe. “And the reason why the elephant becomes so big is because we feed it our resentment, our grief, our money, our time, our anger, and sometimes our marriage and for sure we feed it parts of ourselves.
Five tips to ease the impact of secondary infertility
Sari Eckler-Cooper LCSW a sex therapist s well as a sexuality educator who has been in private practice for 18 year offers these tips to deal with the social and emotional impact of your secondary infertility:
Dealing with feelings of guilt: Many couples, experiencing secondary infertility struggle with the guilt they feel about wanting another child since they already have one. It pushes their “buttons” of feeling too selfish, and not feeling grateful enough for the child they have. I would first have a talk with yourself, write in a journal, and discuss these feelings with your spouse so you can figure out where your beliefs stem from (parents, religion, and culture). Then articulate a response to these held beliefs which help you to feel at peace with your decision to pursue the second pregnancy. Write them down if you need to, memorize them and have them in your back pocket.
Dealing with personal questions: The first part is to discuss with your spouse/partner who in your circle of family and friends you want to share the details of what is going on. You may have differing views around this and may need to negotiate a compromise. Once you do this stick, with the agreement, it will minimize tension in your relationship and at times like this you need to be as supportive a team as possible. Once the rules or boundaries are set it will be easier to say the following:
“I’m a very private person and I don’t discuss personal issues like this with anyone outside my immediate family”. With this comment you’ve actually drawn a circle around your intimates with whom you have shared details of your infertility treatment (like your spouse, sister, best friends) and let the person in question know that these are your boundaries. You could also say: “We’re working on it and that’s the most I’m willing to talk about at this time”. If they take this as a tempting opportunity to dig for more information you can say: “I would ask you to please respect my boundaries as I respect yours”.
Dealing with the emotional toll on your marriage: A husband/partner not going through the physical symptoms may just not understand how frustrating and emotional the pursuit and the medications are to your body and mind. The other point is that sometimes a spouse is ready to give up trying before you are. You need to talk things calmly and slowly and try to come to an agreement about how much money, time, and pain you’re each willing to invest and then come to a compromise. Talking with a therapist about these issues is extremely helpful and can clarify the issues more calmly.
Check out our trying to conceive and infertility message boards to connect with other women going through the same struggles.
Take a mini-vacation from the topic: Just as you have to be aware of timing and schedules when you go through the process of trying to have another baby, you can carve out time not to think or talk about the process, a mini-vacation so-to-speak from the topic. This allows you, your spouse and your child the opportunity to focus on other events and activities in your life that are also important. Your child feels that you are genuinely “present” with him/her, not distracted by worries or thoughts about the baby you’re hoping for.
This takes focus and organization on your family’s part. It will also help in the bedroom since sex has now most probably become solely about getting you pregnant and lost some of its fun, relaxing qualities that are so important in releasing tension and bonding you and your partner. If you feel you’re not being understood, that you’re fighting too much of the time or slowly losing connection then it's time to seek help from a counselor or therapist.
The next step - adoption or surrogacy: This answer is only yours and your partner’s to make. Some clients of mine stop after one IVF and others have had 5 before either deciding not to have the second child, adopting, or go through the surrogate route.
“My last piece of advice is to seek out a spiritual path or practice that helps you keep you present, focused and calm,” says Ms. Eckler-Cooper. “It helps to imbue your path with meaning that resonates for you. Whether that’s the religion you were brought up in, meditation or a new practice, your soul is as much a part of this process as your mind and your body.”
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