According to the March of Dimes, studies suggest that about one-third of women between the ages of 35 and 39 and about half of those over age 40 have fertility problems. “As a woman gets older, there is less estrogen produced by the ovaries,” says Dr. Kaplan. “This can lead to decreased cervical mucus, so sperm may not get as much help getting through the cervix after intercourse.” Age also increases a woman’s chances of developing endometriosis and other disorders that interfere with successful conception and pregnancy. And miscarriage risk also increases with age: the miscarriage rate is about 10 percent for women in their 20s, 20 percent for women age 35 to 39, and about 50 percent for women over age 40 to 44, according to the March of Dimes.
Men’s fertility also decreases with age. As they get older, men produce fewer, less mobile sperm. Older men also may have trouble maintaining an erection, and all of this combined may make it harder for sperm to reach their destination.
Like primary infertility, secondary infertility can cause couples a huge amount of emotional turmoil. In fact, people experiencing secondary infertility report feeling as much stress and anxiety as those facing primary infertility. “You’d think it would be easier since they already have a child,” says Alice D. Domar, Ph.D., executive director of the Domar Center for Mind/Body Health, Boston IVF, and author of the book Conquering Infertility (Penguin, 2004). “But it’s not. Now that they have a child, they know how much joy the child brings and how much they could love another child.”
The emotional anxiety and stress a couple feels while dealing with secondary infertility may be magnified by the lack of sympathy they receive from others. Because secondary infertility is less recognized and understood than primary infertility, friends and acquaintances may assume that a couple with one child simply doesn’t want another. Or, if they know the couple would like to be pregnant again, but is facing challenges, they may try to console them by telling them how lucky they are to have one child already. “Your family, your friends, and even your physician may not understand how devastating it can be,” says Iris Waichler, MSW, LCSW, author of the book Riding the Infertility Roller Coaster (Wyatt-Mackenzie Publishing, 2006).
This lack of understanding and empathy can cause feelings of self-blame and guilt in couples experiencing secondary infertility. “They feel guilty because they believe they are greedy to desire more than one child,” says Dr. Werlin.
Even other women dealing with fertility problems may not be very sympathetic. “Women with secondary infertility are like outlaws—they feel they don’t get a lot of support from the infertile world,” Domar says. “Primary patients think it’s selfish for secondary patients to be upset about not being able to have two children when they don’t even have one.”
Another source of stress comes from being surrounded by couples who have no trouble conceiving second, third, or fourth children. “If you have primary infertility, you can escape the child world,” says Domar. “But when you already have a child, you’re immersed in the child world. You can’t avoid birthday parties, other pregnant moms, Toys “R” Us, and preschool.”
Couples with secondary infertility even face unique challenges once they begin fertility treatment. “Having small children to care for can certainly affect how easy it is for a couple to have sex,” says Dr. Kaplan. “Lovemaking can start to feel like work when pregnancy doesn’t happen when a couple wants it to.” Also, unless you have fantastic childcare, you can end up having to drag your child along to doctors’ appointments, ultrasounds, and other medical procedures—something that can be embarrassing for you, agonizingly boring for the child, and immensely irritating to the women in the waiting room who have primary infertility.
Fortunately, as with primary infertility, secondary infertility can often be successfully diagnosed and treated. Simple tests can uncover problems with hormones, sperm counts, and tubal blockages. “It’s crucial to get a diagnosis and, if appropriate, be treated as early as possible,” says Dr. Werlin.