Most of our preconceptions about infertility focus on an image of the childless couple or woman. But these are not the only people to suffer from this confidence-draining experience. Secondary infertility is when a woman has already given birth to one child but has difficulty conceiving a longed-for second child. It is to some extent a hidden problem, invisible beyond the family group that already exists. It is nevertheless a very real issue, calling for real solutions every bit as much as primary infertility.
In our IVI blog article, we take a look at some aspects of what happens with secondary infertility: its frequency and whether it brings any additional problems, when you should seek help in the form of fertility treatments on the NHS or through private fertility treatment and, when you do, what are the stages of fertility treatment.
How common is secondary infertility?
Primary infertility is when you are suffering from infertility and you have never been pregnant before. Whereas secondary infertility is when you are suffering from infertility and struggling to get pregnant but you have had a pregnancy before, whether it was successful or not.
Overall, infertility affects around 15% of the population in the UK, or about 1 in 7 couples. Secondary infertility on the other hand affects approximately 5%, which equates to roughly 1 in 20 couples. So there is some element of truth in the commonly held myth that if you have had one child you will therefore easily have a second, but only a small element. For each of those couples or women experiencing the dashing of their hopes for the size of family they had always expected, it still comes with a great deal of bewilderment, pain and disappointment.
This sense of loss can be exacerbated by well-meaning but thoughtless friends asking whether it isn’t time to provide a baby brother or sister for your first child, or coming right out and asking you point blank why you aren’t yet pregnant again.
Parenting while trying to conceive: an added complication?
On top of veiling the visibility of a secondary infertility problem, your role as a parent can add its own stresses to a difficult situation. Many people have a feeling of guilt that they ought not to feel their existing child is ‘not enough’ or that they have not sufficiently ‘counted their blessings’. You could be telling yourself that you’re so lucky to have the one wonderful child that you have, it’s somehow selfish to want more.
These feelings, while unjustified, are perfectly natural and can add to the already difficult situation of a failure to conceive, especially when you too may have assumed it would be easy. When these thoughts, as well as the simple longing for another baby, are uppermost in your mind, it can be difficult to give your full attention to the unquestionably demanding task of looking after a small child.
When should you seek help for secondary infertility?
The National Institute for Health and Care Excellence suggests it is time to consult your doctor if you have been having regular, unprotected sex with your partner for one year without a successful conception. This reflects our normal advice, but we would add that this applies where the woman is aged up to 35. For women or couples where the woman is over 35, a six-month timescale is a more practical proposition. These timescales apply equally to cases of either primary and secondary infertility. Your first port of call should be your GP who will be able to refer you for further tests.
If it turns out that you need some types of fertility treatments, you may be able to access these through NHS funding in certain circumstances. However, as we often hear in the context of the ‘postcode lottery’, fertility treatments funded by the NHS vary across the UK and waiting lists for treatment can be very long in some areas. The eligibility criteria can also vary. Your GP will be able to advise about your eligibility for treatment. For some people in some areas, the best course of action could be to seek private fertility treatment.
What types of treatment are available?
Whether through your GP referral or through one of our IVI clinics in the UK, the first step would be to take a full medical history of both you and your partner, and to carry out some initial tests. These will determine for the woman, whether she is producing enough eggs, and for the man, whether he is producing sperm of sufficient quality and quantity. These tests and the consultation with your doctor will help you determine whether there is an issue causing your infertility that requires specialist treatment. Especially in the case of secondary infertility, your medical specialist will want to consider whether there is any underlying cause arising from complications with your first pregnancy.
Once your current status and medical history have been established, there are broadly four main types of assisted fertility treatment that could be appropriate. These are IUI (intrauterine insemination) and IVF (in vitro fertilisation) either with or without ICSI (intracytoplasmic sperm injection), as well as the options with egg donation and/or sperm donation.
Options available and the stages of fertility treatment
Depending of course on your individual circumstances, when you opt for private fertility treatment, there are different stages of fertility treatment available, from the most straightforward to the most technically advanced. Here is a very brief summary of what they could involve.
IUI is one of the simplest of all forms of assisted fertility treatments. During this procedure sperm is prepared in the laboratory and is then placed directly into the woman’s uterus, increasing the chances that the sperm will reach and fertilise the egg. It is indicated for couples where the reasons for subfertility or secondary infertility are unknown, where the woman has ovulation problems or an abnormality of the cervix or where the sperm count or motility is reduced. To see more about the technique, have a look at our video about intrauterine insemination.
In vitro fertilisation (IVF) or IVF with intracytoplasmic sperm injection
IVF is the well-established technique for creating embryos by fertilizing the egg with sperm in a laboratory. The resulting embryo(s) can then be transferred to the woman’s uterus. The fertilisation process can be carried out using a conventional IVF technique or by intracytoplasmic sperm injection (ICSI), in which a prepared sperm is micro-injected directly into the egg. IVF, or IVF with ICSI using sperm from the male partner is indicated for patients for whom previous simpler treatments such as IUI have failed, for women with advanced endometriosis or fallopian tube injuries and for severe male factor infertility.
Egg donation is the process whereby a woman uses the eggs from a donor in order to have her own child. The donor’s eggs are fertilised with sperm, from the woman’s partner or a donor, to produce embryos. These are then transferred into the womb, making pregnancy possible.
The donor could be a known person, an altruistic donor or an egg sharer. If you were considering this fertility treatment, you would need to be aware that the legal framework surrounding anonymity is different in the UK from that in some other European countries such as Spain. In the UK, any children born as a result of egg donation have the right, from age 16, to obtain certain summary personal information about the donor and at age 18, to obtain full personal details.
The use of donated semen is recommended for lesbian couples, single women and for couples where the man has no sperm or is a carrier of certain genetic diseases or infection, or where his semen has chromosomal abnormalities. In the UK, the legal framework around donor anonymity and the rights of any children born as a result of sperm donation are the same as for egg donation.
Getting support when you experience secondary infertility
We know that when you encounter secondary infertility, it can be a lonely and stressful experience. It helps enormously if you can confide in family and friends. As well as pre-empting those well-meant but thoughtless comments, having friends who know what you are going through really can lighten the burden. We at IVI also offer a counselling service that can help you through this difficult time. As part of our ongoing patient care, counselling is routinely offered at any time before, during or after treatment. Even if you feel fine, you may find it useful to talk to somebody impartial about your situation.
If you’d like to talk about this, or any other aspect of the services we offer, do get in touch. You can call us on 0333 015 9774 from anywhere in the UK, or fill in your details using our online contact form and we’ll call you back.