Trying Again?

Just because you've had one baby doesn't mean the next one will come easily.


Jan Abraham became pregnant easily with her daughter Jordana. But it was a different story when she and her husband, David, tried to conceive a second time. “My husband and I were dismayed when I couldn’t get pregnant again,” Abraham says. “I knew I had to act quickly since I was 37 and we had been trying for almost a year, so we went to see a fertility specialist. “Fertility treatment is not a day at the beach — I had various invasive procedures including a laparoscopy [a surgery to examine the fallopian tubes] — but they didn’t find anything wrong,” says the Philadelphia resident. “Finally, after two courses of Perganol [human menopausal gonadotropins, a medication given by injection to stimulate egg production] and one miscarriage, I became pregnant with my two beautiful twin girls. The treatment turned out to be well worth it, but our marriage had to be strong to go through it, because I was crying about half the time. Also, our insurance didn’t cover the treatments, so the cost became an issue.” While women who have difficulty conceiving a second child may feel isolated, they’re not alone. They are among the 3.3 million who have been unable to become pregnant again after having previous children, according to the Centers for Disease Control and Prevention’s (CDC’s) 1995 National Survey of Family Growth (the most recent year for which data are available).

What is infertility? Be definition, infertility is a couple’s inability to conceive after having at least one year of unprotected sex. The main reason for secondary infertility is that the quality of a woman’s eggs declines as she grows older, according to Jamie A. Grifo, M.D., Ph.D., director of the Division of Reproductive Endocrinology at the New York University Medical Center Program for IVF, Reproductive Surgery and Infertility in New York. The survey by the CDC supports this finding: In 1995, 4.4 percent of 15- to 24-year-olds were infertile, 6.6 percent of 25- to 34-year-olds were infertile, and 8 percent of 35- to 40-year-olds were infertile. “Since couples are delaying childbearing, by the time they try to conceive their second child, there is a larger percentage of eggs with chromosomal abnormalities that cannot lead to a successful pregnancy,” Grifo says. Other possible reasons for secondary infertility include disease in the man or woman; decreased sperm count; blocked fallopian tubes; or a large weight gain or loss, which can throw off a woman’s ovulatory cycles, according to Sandra Ann Carson, M.D., professor of obstetrics and gynecology at Baylor College of Medicine in Houston and co-author of The American Society for Reproductive Medicine’s Complete Guide to Fertility (NTC Publishing Group, 1999).

Unique stresses Couples who suffer from secondary infertility face their own unique stresses, says Harriet Fishman Simons, Ph.D., a therapist in private practice in Wellesley, Mass., and the author of Wanting Another Child: Coping With Secondary Infertility (Jossey-Bass, 1998). Simons says that parents who have difficulty conceiving a second baby are caught between two worlds — one in which other people don’t hesitate to ask, “So when is a baby brother or sister coming?” and another world of childless, infertile couples who might offer little sympathy. Parents unable to have a second child can feel as if they are letting down their first child by not providing a sibling. At the same time, they can feel guilty that the first is somehow “not enough.” But it is helpful for parents to realize that the data on the development of single children are positive. “Children are very adaptive,” Simons says, “and may not reflect their parents’ feelings about the family unit.” If parents are undergoing infertility treatment, the time and emotional commitment involved can make them feel as if they’re not as available for their first child as they would like. To make matters even worse, their children may symbolize their inability to have another baby. “While for some the existing child can be a poignant reminder of the loss,” says Simons, “many take comfort in the fact that they are parents and report that their enjoyment of their children keeps them going.”

What to do? If you and your partner are not able to conceive after having a year of unprotected sex, your first step should be to consult with an obstetrician-gynecologist who can do an initial work-up and refer you to a specialist. But if you are over the age of 35, says Carson, you should wait only six months before talking to your doctor. Also know that Resolve, a national organization, is a helpful resource on infertility. It can provide support and referrals to doctors (617-623-0744;