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Where is baby number two?

Family with one child walking on the beachBaby number one arrived with ease and is growing up quickly. You have decided the time is right to try for number two but the months are passing and nothing is happening.

You find yourself on an emotional roller coaster as feelings of hope mix with feelings of loss, or guilt at not being able to give your little one a brother or sister.

You may be feeling isolated from all your friends who have gone on to have their second or third baby, or feel ungrateful for feeling emotional when you already have one child. After 6 months or more you are completely baffled as to what is going on.

You may be thinking that this delay in pregnancy will sort itself out soon enough, but fertility experts will tell you that you are probably experiencing something you may not have even heard of … secondary infertility.

What is secondary infertility?

A couple is defined as having secondary infertility if despite having had a child in the past they are unable to do so again after 6 months or more of trying. Secondary infertility is heartbreaking for those whose family remains unfinished.

What causes secondary infertility?

Male and female factors can contribute to secondary fertility. These factors are the same as those which cause infertility. Some of the most common are:

A woman’s age

You are older this time than you were with your first baby and as women age the quantity and quality of their eggs decline. The decline of fertility in women is greatest once you enter your mid 30s. This is true whether or not you have conceived easily in the past.

Secondary infertility is becoming increasingly common as couples are choosing to start families later than generations past and many are finding they are now in their mid to late 30s or early 40s by the time they start trying for a second child.

Sperm quality and quantity

Just as a women’s fertility can change over time so to can a man’s.

Weight gain

Weight can have a big impact on the ability to conceive. Your lifestyle may have changed since your first pregnancy and you are not as active as you used to be, or you are still carrying some of the weight you gained during your first pregnancy and this excessive weight has led to ovulation dysfunction. Similarly sperm production can be affected when men are overweight.

PCOS or endometriosis

With time you may have gained weight and you already have PCOS and this may affect your frequency of ovulation, the same applies to endometriosis you may have had it for a while but it has now become severe enough to cause adhesions or scar tissue that affect the anatomy and may block the fallopian tubes.

How can we treat secondary infertility?

Secondary infertility is treated in the same manner as infertility.

The first step beyond this is for both you and your partner to seek a fertility assessment from a GP or fertility specialist, particularly if you have been trying for six months or more. They will take a thorough medical history and order some initial investigations including an AMH test for her and a semen analysis for him. Although seeking advice can be daunting, early evaluation can be critical and one appointment may be all it takes to find a solution to expanding your family.

Coping with secondary infertility

It is important to remember all of these feelings you are experiencing are normal and totally OK, secondary infertility affects everyone differently. Counselling staff are available through most IVF clinics to help you develop coping skills and with decision making.

-written by Melbourne IVF Fertility Specialist Hossam Elzeiny


This blog post is sponsored by Melbourne IVF

Hossam Elzeiny is a reproductive endocrinologist and infertility specialist, he is particularly experienced in treating women with serious fertility concerns relating to diminished ovarian reserve, and in dealing with recurrent IVF failures and miscarriages and PCOS.


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