What Is Secondary Infertility and How Common Is It?

If you already have one child (or more), but you’re struggling to conceive again, you’re not alone. It has its own term: secondary infertility, and it’s more common than you might think. Secondary infertility is just as emotionally jarring as primary infertility, but with its own unique punch. Here, we’ll try to break down why it happens, and how to deal as you enter this totally unfair journey. Believe us, you’re in good company. *raises hand* 

What is it?

Secondary infertility is defined as the struggle to conceive a child after the healthy pregnancy and delivery of another baby by the same parents. According to a 2013 report from the CDC’s National Center for Health Statistics, it affects as many as 3.6 million couples in the US, and this number is, unfortunately, probably even higher today. These numbers are actually not all that different from the stats for couples struggling to conceive their first child. 

What causes secondary infertility?

The common causes for secondary infertility are pretty similar to those for primary fertility: egg and sperm quantity and quality, uterine factors, PCOS, fallopian tube blockage, lifestyle factors...it totally runs the gamut. But unlike primary infertility, these factors are often amplified by the inevitable increased age of the parents trying to conceive a sibling for their first child. It’s even possible that while you may have had a healthy, uncomplicated pregnancy the first time, new complications may have developed in your system, keeping you from easily conceiving a second child. 

Having a second child

If you’re ready to pursue fertility treatment, there are options available. If a doctor finds that you aren’t ovulating regularly, they may prescribe a medication like Femara or Clomid. IUI and IVF are common fertility treatments, but can be expensive for those without health insurance coverage. In some cases, though, your doctor may recommend donor eggs. To learn more about the process of using donor eggs after secondary infertility, click here.

Why is it so hard emotionally?

The emotional wallop of secondary infertility can come both from inside your own head, as well as from external sources. Some of the most common emotional responses might include:

• Guilt vs. gratitude: others might (insensitively) wonder why you can’t just be grateful for the child you already have. This might get you thinking, am I steering my time and energy away from my first child in order to focus on getting a second? While this is a valid consideration, try not to let guilt take over. You’re working on building the family that you want, and whatever that looks like is up to you.
• FOMO: If you’ve made some amazing playgroup friends with your first child, but now they’re all starting to have second and third children while you just have the one, it can feel like you’re being left behind—not totally unlike how couples without kids can feel when all of their friends start having their first babies. 
• Eye rolling: Of course, there’s also the ever-present nosy neighbor or in-law who’s just as likely to say, “you know, little Johnny needs a baby sister!” as they were to say, “you’re not getting any younger!” before you had your first. Plus, you may find you’re not getting a lot of sympathy from your friends and family—at least not in comparison to those who are experiencing primary infertility. Explains Lindsey Liben, a licensed clinical social worker who sees couples and individuals struggling with infertility, “a lot of the people they may have relied upon in the past, their strong source of support, see them as a family constellation. So a lot of the feedback they typically get is, ‘at least you already have a child.’”
• PTSD: If you also faced primary infertility, reentering the world of fertility treatments—the shots, the waiting, did we mention the shots?—is uniquely hard, even after you already have a child. “Part of the challenge is that they almost feel they don’t have permission to experience the sadness and the grief and the frustration because they already have a child,” says Liben. Plus, if you didn’t deal with your feelings of primary infertility when you were going through it, they’re going to come back to haunt you if it happens again.
• Paralyzed: On the other hand, if you had little-to-no trouble conceiving your first child, you may experience shock and disbelief when it happens the second time around. “It can be so jarring. It can pull you out of the life you’ve been living,” says Liben. Couples experiencing this may even delay seeking medical help. Worse still, they might be initially turned away by doctors telling them to “just keep trying.” Don’t be afraid to ask for help. According to RESOLVE, if you’ve been trying for over a year, (or 6 months if you’re over 35), it might be time to see a doctor and find out if fertility treatments are the answer.

How can you cope? 

The first and most important step is to acknowledge what you’re feeling, and seeing a counselor familiar with fertility challenges is a great place to start. 

“The first thing I do is acknowledge the reality of the pain,” says Liben, of her patients. “Then, I talk to [patients] about what a new normal could look like—[how they can live] a meaningful and productive life based on where they currently are in their journey.” What would it look like to undergo full IVF treatments while still caring for your child? How will your family deal with the inevitable ups and downs of these treatments? These are some important things to think about. 

Lastly, don’t forget to speak with your child(ren) about what they might be feeling. Be honest with them about what your family is going through. Obviously keep it age appropriate, but if they’re asking for a sibling, start by asking them about their feelings. If they’re feeling peer pressure because their friends at school have siblings, ask them about how they’re feeling about being an only child. You can also share that you wish you could expand your family too, and then pivot the conversation to talking about what’s wonderful about your family, just as it is. 

Again, the most important thing throughout this entire process is to acknowledge each of your feelings in the moment. You’re entering the emotional roller coaster of infertility (maybe for the second time) and you have every right to feel angry, hurt, frustrated, sad and anything else that may occur. Don’t listen to anyone—including yourself—who tells you that you should just be grateful for what you have. Of course you’re grateful; but you’re also allowed to want more.