Like many parents of toddlers, Hannah and Zeke* were excited but apprehensive about trying to have a second child. Their 2-year-old daughter Bea was delightful but challenging in all the typical ways young children can be. Nonetheless, they had always imagined having two children and really wanted their daughter to have a sibling. They had conceived spontaneously and quickly with Bea and planned to start trying for a second child when she turned 2 1/2, so their kids would be about three years apart. After almost a year of trying to conceive on their own, Hannah and Zeke were referred to a reproductive endocrinologist who diagnosed them with secondary infertility.
Defining Secondary Infertility
Secondary infertility refers to the inability to conceive a child or carry a pregnancy to term after having previously conceived and given birth without the intervention of fertility treatment. Hannah and Zeke, like the nearly 11% of patients diagnosed with secondary infertility, were shocked by their diagnosis. Many patients report never being told about the risk factors for secondary infertility and some have never even heard of the diagnosis. In reality, secondary infertility is about as common as primarily infertility and can have similar causes. The most common reasons couples are diagnosed with secondary infertility include advanced maternal age, impaired sperm count, health changes or certain health conditions or medications and complications from previous pregnancies such as scar tissue – and, for some couples, the cause is unexplained.
Emotional Impact of Secondary Infertility
Couples navigating secondary infertility often experience a range of feelings and reactions. For example, Hannah and Zeke described feelings of shame for wanting a second child, and a sense of isolation from peers, many of whom were growing their families. Hannah often spoke about how hard it was to see so many of her friends from the mom’s group she joined when Bea was born, as several were pregnant again when she was struggling to conceive. Their experience is not unique, as secondary infertility comes with its own emotional challenges and, unfortunately, with its own stigma. Many parents who have successfully conceived before might feel a profound sense of shame or guilt, isolation, anger or frustration. Grief is also common after receiving a diagnosis of secondary infertility. This grief is best understood as disenfranchised grief, meaning grief that goes publicly unacknowledged, understood and unsupported.
Caring For Your Mental Health
Navigating the emotional journey of secondary infertility can be challenging but it is essential to prioritize your mental health along the way. The following tools can help.
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Make time for your emotions:
Couples diagnosed with secondary infertility are forced to navigate the dance of parenting while grieving and processing complex emotions. It is important to give yourself space to attend to your feelings. Consider additional child care, attending support groups during school hours or trading off caregiving with a family member so you can have some time for yourself.
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Set and Communicate Your Boundaries:
- Healthy boundaries support our relationships with others and with ourselves by making it clear on how we want to be treated, what we want to share with others and how we want to spend our time. Be direct with others on what you are willing to share about your diagnosis, what support you need and what types of comments feel intrusive to you.
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Say No:
- It is important to give yourself permission to opt out of situations and activities that feel triggering or difficult for you. Say no to the baby shower, opt out of the newborn visit and send a card instead. You will be better able to preserve your relationships with others as well as your mental health if you take care of yourself in this way.
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Communicate With Your Partner:
- Each member of a couple experiences secondary infertility differently – the emotions, the physical requirements, the triggers are not the same. It’s important for each member of a couple to have the space to process in their own way and be able to communicate this openly to your partner. This will help you stay connected and remember you are on the same team.
Secondary infertility can be a difficult and isolating emotional experience. It’s important to care for yourself, get clear information about your diagnosis and then get the support you need. In addition to the strategies described above, support groups and professional support from a trained therapist specialized in infertility counseling can help.
*All names changed to protect patient privacy.
Dr. Emma Basch is a licensed clinical psychologist based in Washington, D.C. She is the founder and director of Dr. Emma Basch & Associates, a group practice specializing in the mental health needs of women and families. She is a vice president of the DC Metro Perinatal Mental Health Collaborative and a clinical instructor in the department of psychiatry at The George Washington University, and she teaches and writes frequently about perinatal and reproductive mental health.
