Most couples assume that if they were able to get pregnant easily the first time, they won't have fertility problems when they're ready for baby number two. Unfortunately for the millions of families who are dealing with secondary infertility, that’s not the case.
When Anne Alexander and her husband, Hubert Kulikowski, set out to conceive their first child, everything went smoothly. “Having my son Casimir was a breeze. I got pregnant quickly, had minimal morning sickness, and just felt like a superwoman—working, pregnant, tons of energy despite being 38,” says Alexander, who is now 43.
But when the couple started trying to get pregnant again, they hit one roadblock after another. On her son’s first birthday she had a miscarriage at 10 weeks. Then, about six months later she had another miscarriage. Then, she couldn’t even get pregnant.
“It was so easy to get pregnant—and stay pregnant—the first time. I had no idea that it could be so difficult the second time around. I just wasn’t prepared to have any problems,” Alexander says.
Being unable to have a second child caused Alexander and her husband a tremendous amount of stress. “The hardest part was trying to accept that our family was going to be so small. I really wanted a second child so that my son wasn’t brought up as an only child and wouldn’t have to bear all of the expectations that my husband and I would inevitably, consciously or unconsciously, foist onto him.”
Alexander started to blame herself for waiting to have a family. “I began to think that I had put too many of my eggs, so to speak, in the career basket and that this was the sad price I ultimately had to pay.”
Most couples, like Anne and Hubert, believe that if they’ve had one successful pregnancy, they can have others. Unfortunately for the 3 million people in America who are experiencing secondary infertility, that’s simply not true. Secondary infertility is defined as the inability to conceive a baby or carry a pregnancy to term after the birth of one or more children. It’s actually more common than primary infertility.
“Having conceived one child, it’s natural for couples to take it for granted that another conception will easily follow,” says Lawrence Werlin, M.D., a reproductive endocrinologist and director of Coastal Fertility Medical Center in Irvine, California. “Since they’ve already been able to have one baby, they may not even consider the possibility of infertility.”
Why does secondary infertility occur? Just as with primary infertility, there are many causes, according to Daniel F. Rychlik, M.D., a reproductive endocrinologist specializing in infertility, and associate medical director of the Fertility Treatment Center in Scottsdale and Tempe, Arizona. Among women, culprits can include ovulatory disorders, early menopause, pelvic adhesions, inflammation or infection, damage or blockage of the fallopian tubes, uterine fibroids or polyps, and endometriosis. In men, primary causes include low or no sperm count, impaired motility, ejaculatory problems, or poor quality sperm.
“Pretty much anything can occur between pregnancies,” says Carolyn Kaplan, M.D., a reproductive endocrinologist and director of IVF at Georgia Reproductive Specialists in Atlanta.
The cause (or causes) of secondary infertility can be determined in about two-thirds of cases. In the remaining one-third of couples, the reason for the inability to conceive or carry a pregnancy to term remains unknown. Lifestyle choices can contribute to secondary infertility, says Dr. Rychlik. A woman’s fertility can be hampered by smoking, sexually transmitted infections, and excess body weight. A man’s ability to father a child can be compromised by drug or alcohol abuse, or sexually transmitted infections.
Often the difference is simply the passage of time. As people age, their ability to conceive a child and have a successful pregnancy declines. A woman’s fertility starts to decrease, and her ovaries may release eggs less often, and egg quality declines. “Eggs grow older with each passing year,” says Dr. Werlin. So a woman who was pregnant with her first child in her early to mid-thirties may be in her late thirties—and less fertile—when she’s ready for number two.