Many of the preconceived ideas about infertility focus on images of couples without children. However, those without children are not the only ones who can suffer from this challenging and emotionally-draining experience. Secondary infertility is when a woman or couple have already conceived and given birth to one child, but have difficulty conceiving a second child. It is to some extent a hidden problem, invisible behind the family group that already exists. It is nevertheless a very real issue, calling for real, evidence-based solutions every bit as much as primary infertility.
In this article, we take a look at key aspects of secondary infertility, including how common it is, the additional problems that can arise, when you should seek help through NHS-funded or private fertility treatment, and the stages of fertility treatment if you do decide to take this route.
How common is secondary infertility?
Primary infertility is when you are suffering from fertility problems and you have never been pregnant before. Secondary infertility is when you are struggling to get pregnant but you have had a pregnancy before, even you did not make it to a full-term pregnancy.
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. There’s some element of truth in the myth that if you have had one child, you’ll therefore find it easy to have a second, but only a small element. For each couple or woman experiencing the dashing of their hopes for the family size they had always wanted and expected, it still comes with a great deal of bewilderment, pain and disappointment.
This sense of loss can be exacerbated by misplaced comments from well-meaning friends and relatives. Suggestions that it’s time to expand your family and provide a baby brother or sister for your first child, or even direct questions about why you’re not pregnant yet, can be extremely painful.
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 to feel their existing child is ‘enough’ or that they have not sufficiently ‘counted their blessings’. You might be telling yourself that because you’re so lucky to have the one wonderful child, it’s somehow selfish to want more.
These feelings, while unjustified, are perfectly natural. They can add to the already emotionally-draining situation of struggling to conceive, especially when you may have assumed it would be easy. When these thoughts, as well as the simple longing for another baby, are at the top of your mind, it is understandable to find it difficult to give your full attention to the unquestionably demanding task of looking after a child, especially if they are small.
If you feel your struggle is becoming more serious, it is always best to seek support whether it’s through friends, relatives, a professional counsellor or your GP.
When should you seek professional 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 to seek fertility treatment, you may be able to access these through the NHS 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, and is often strict. 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 a visit to IVI, 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 female partner, whether she is producing enough eggs, and for the male partner, 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 you to have difficulty conceiving that requires specialist treatment. In the case of secondary infertility in particular, your fertility consultant will want to consider whether there is any underlying cause connected to complications during previous pregnancies.
Once your current status and medical history have been established, there are four main types of assisted fertility treatment that could be appropriate. These are Intrauterine Insemination (IUI) and In Vitro Fertilisation (IVF), with or without an Intracytoplasmic Sperm Injection (ICSI) procedure, as well as the options with egg and/or sperm donation.
What are the stages of fertility treatment?
There are several stages involved in a fertility treatment depending on your individual circumstances. When you opt for private fertility treatment, these vary from treatment to treatment, from the very straightforward to the most technically complex. Here is a brief summary of what they could involve, and what you should expect.
Intrauterine Insemination (IUI)
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 recommended for couples whose reasons for subfertility or secondary infertility are unknown, or those who have 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) with or without Intracytoplasmic Sperm Injection (ICSI)
IVF is a very well-established technique for creating embryos by fertilizing eggs with with sperm inside a laboratory. The resulting embryo(s) can then be transferred to a 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 recommended for patients for whom previous simpler treatments, such as IUI, have failed or for women of advanced maternal age, women who suffer from advanced endometriosis or fallopian tube injuries and for men suffering from severe male factor infertility.
Egg donation is the process whereby a woman uses the eggs from a donor in order to have a baby. The donor’s eggs are fertilised with sperm, from the male partner or from a sperm 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 non-identifiable information about the donor. At age 18, they have the legal right to obtain full personal details, including contact details. This is a carefully regulated process overseen by the HFEA. Please read the HFEA’s guidance for donor-conceived individuals to find out more details.
The use of donated semen is recommended for lesbian couples, single women and for couples where the male partner does not produce sperm; 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 for secondary infertility
We know that when you experience secondary infertility, it can be a lonely, stressful and emotionally and physically draining. 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. Seeking professional help in the form of counselling when you need it is also extremely important. At IVI, the psychological well-being of our patients is paramount to us. We offer an in-house counselling service to all patients 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 speak to one of our consultants about any problems you are experiencing or any other aspect of the services we offer, do get in touch. You can call us on 0800 52 00 161 from anywhere in the UK, or fill in your details using our online contact form and we’ll call you back as soon as possible.