Couples with Secondary Infertility Face Unique Challenges

by Sandra Glahn

When Charla and Bob Boyl tried to have a second child, they were shocked to discover they had a fertility problem. The Boyls have plenty of company; at least one in twelve couples of childbearing age experience secondary infertility. They have one child, maybe more, then find that after a year or more of trying, they have been unable to conceive or carry another pregnancy to term.

Fort Worth fertility specialist, Kathleen Doody, M.D. says, “Secondary infertility appears to be undertreated. Research reveals that while half of all couples diagnosed with primary infertility pursue treatment, only one fifth of couples with secondary infertility seek medical help.”

“Primary and secondary infertility patients experience almost identical medical problems and treatments,” says Dallas physician, James Douglas, M.D. “We look for the same causes. In addition, childbirth can leave fertility problems behind. And naturally couples are older when they try to have children again. The chances of conceiving per cycle drop off drastically in the upper 30s.”

Psychologists confirm that both primary and secondary infertility evoke feelings of guilt, denial, anger, depression, and frustration. But differences exist, too. Secondarily infertile couples are at an in-between place. The fertile population generally perceives them as having no problem because they have a child. And when they are with primary infertility patients, they often feel too ashamed to ask for support for fear childless couples will resent them.

Debra, who returned to fertility treatment after having a high-tech baby, says the second time she felt a different kind of pain: “Now that I have one child I’ve exchanged the anguish of having no children for the pain of knowing exactly what I’m missing the second time.”

Another mom finds that an activity as common as picking up her daughter from kindergarten brings unexpected grief: “You notice you’re the only mother who is not pregnant, carrying an infant, or holding a toddler’s hand,” she says. “Your child asks why she’s the only one in her class with no brothers or sisters. You listen to everyone in your play group discuss how far apart they want to space their children, and then you watch them conceive according to plan. Meanwhile, you continue with temperature charts, medications, and doctor visits. You wonder if your child will be emotionally scarred by your deep desire to have another. You struggle to answer friends and relatives who comment, ‘Time for another, isn’t it?’ Or worse, you answer those you’ve told you’re infertile who say, ‘At least you have one child; you should feel grateful.’”

“It’s nearly impossible to explain to someone who feels their family is complete why you grieve for the phantom child,” says Charla. “People try to tell us we should feel satisfied with the child we have. I compare it to how I feel about my mother. She died a few months before my daughter was born. I feel grateful to God for giving me a wonderful mother, but no matter how grateful I feel, it never takes away my longing to be with her. Gratitude never replaces longing.”

Secondary infertility often brings an overwhelming jolt with the realization that dreams may never materialize. One mother says, “Many of us grew up with a vision of our family as a Mom and Dad and at least two children. I think about my daughter and wonder if she will ever know the mischief of sisters caught with Mom’s make-up, the frustration of having to share her toys, and the confidences which can’t bridge generations. When we get old and start acting funny, who will she call to say, ‘We’ve got to make Mom stop wearing t-shirts to Neiman’s. I watch her now with two sets of eyes,” she continues. “One set watches her as any mother would. The other struggles to memorize every stage.”

Daniel’s mother, like most, feels guilty about her inability to give her son a sister or brother, recounting a recent experience that made her cry: “Three neighbor kids were teasing my son, saying, ‘If we didn’t live next door, you’d have nobody to play with.’ I called their mother, and she told me her kids felt jealous because my son had more toys. She had explained to them that while Daniel had lots of toys, they had sisters and brothers—something Daniel didn’t have.”

Guilt may take other forms. Studies show that many moms and dads with fertility problems criticize themselves about the quality of their parenting. They may wonder if some curse has been cast on them for being terrible parents the first time. When their child misbehaves, they may think, “No wonder we’re not supposed to have another.”

Along with guilt often comes fear. Many parents worry their children will be lonely, lacking family connections. They may become overly protective or unusually ambitious for their single child. They may also worry that their only child will die or bear the sole burden of caring for them in their old age.

Add to this the expense. Few employers’ health plans cover infertility. Companies often label such treatments “elective,” placing them in the same category as cosmetic surgery. Yet more than 90 percent of fertility problems stem from a diagnosable medical cause.

Many couples find that secondary infertility also complicates the adoption question. They worry about real or perceived equality in homes with a biological/adoptive mix. Some agencies turn away couples with a biological child, and many have a ceiling on parental age.

“Couples confronting secondary infertility need empathy and validation of their pain,” says therapist, Judy Calica. “They need the freedom to grieve their losses and they need support in resolving their crisis.”

And crisis it is. Stacia, describing the emptiness she feels over being unable to conceive again, says, “This is the most difficult thing I’ve ever dealt with. I know I will always feel like I’m just not finished.”

This article first appeared in Dallas Family.

For more information on infertility:

Drawing on Glahn’s decade-long struggle with infertility treatment and Cutrer’s medical expertise, these books explore the spiritual, marital, emotional, medical, and ethic issues surrounding infertility. The authors bring their unique male/female, doctor/patient, and clinical/theological combination of perspectives. 

The Infertility Companion: Help and Hope for Couples Facing Infertility   

When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility. 

Listen: 

• Sandra Glahn, Mother's Day Message at a Dallas church (scroll to May 8, 2005 and download) 

• Sandra Glahn, WWJC, Northland Notebook, Deluth, MN (scroll to September 7, 2005)

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