Secondary fertility problems
By the BabyCenter editorial staff

We've been trying to have a second child for two years. Could we have a fertility problem?
Yes. Although primary fertility problems get most of the attention, more than 3 million people in the United States have secondary fertility problems. These folks already have a child but are unable to get pregnant or carry a pregnancy to term for the second time.

What causes secondary fertility problems and how are they treated?
The same factors responsible for primary fertility problems are to blame: pelvic scarring, blocked fallopian tubes, endometriosis, defective ovulation, or poor sperm quality or quantity, to name a few. Whatever the cause, the condition either developed or worsened since your first birth. Complications during labor and delivery could have triggered a problem. Or, if several years have passed, your fertility problems may be age-related. Treatments for primary and secondary fertility problems are the same.

I'm jealous of friends who have larger families -- then feel guilty that my son isn't enough for me. What's happening?
Although you love your son, you may feel deprived of the full family you always dreamed of having. Common reactions to secondary fertility problems include:
• Denial. You may think, "If I've been pregnant before, I can't possibly have a fertility problem." This mindset explains why so few couples with secondary problems seek medical treatment. Even those who had fertility problems before becoming parents sometimes assume they're cured and can't believe they might face more fertility problems.

• Envy. You may feel left behind by your friends whose families are growing and feel some jealousy at their success in having more than one child.

• Isolation. Parents dealing with secondary fertility problems often feel they don't fit easily into any one group. Since they have at least one child already, they can't find support with infertile couples, nor do they feel they can relate to parents who have had more children. And you may feel estranged from your partner; fertility problems can place enormous stress on a relationship.

• Sorrow. You may view your child's milestones — going off to kindergarten or learning to ride a bike — with a mix of joy and sadness, knowing you probably won't experience another child at this particular age again.

• Guilt. Being unable to give your child a sibling may weigh heavily on you, yet your desire for another child may also cause pangs of guilt. ("Why isn't my wonderful son enough?" you may ask yourself.)

• Anger. You may feel enraged that you're being denied something everyone else seems to do so easily — namely, enlarge their family.

• Anxiety. The treatment regimen — early morning blood samplings, ultrasounds, daily injections — poses special obstacles for parents of young children. Arranging childcare can be difficult and babysitting gets expensive. Going to a fertility clinic can be stressful. Some women don't want their child in a waiting room full of women with fertility problems because they don't want to flaunt the child in front of a group of women struggling to conceive, nor attract the inevitable stares. Financial pressures are another stressor. For instance, can you pay for fertility treatments and still save for your child's education?

All these are tough issues — part and parcel, unfortunately, of the painful experience of fertility problems. As with primary fertility problems, you and your partner will sail through some ups and, most likely, weather a lot of downs. Talk to others who have battled secondary fertility problems, and seek professional help — preferably a counselor familiar with fertility problems — if your emotions disrupt your life too much. Click here for more coping strategies.

My family and friends don't seem sympathetic. How can I find other people to talk to?
Resolve, a national fertility problems support organization, sponsors groups specifically for couples with secondary fertility problems (and, separately, couples with primary fertility problems). Sharing your feelings with others will help you cope, but don't join a support group that includes couples or women with primary fertility problems; talking with a group of childless women could be counterproductive for you. "While we were trying for a second child, I went to a weekend retreat in Boston for women with fertility problems." says Trish M. of Norwalk, Connecticut. "Almost everyone else was childless. I felt so greedy when I saw how desperate they were."

To get support from others in your same situation, visit BabyCenter's Secondary Fertility Problems bulletin board.

I worry I can't handle fertility treatments and still be a good parent. Any suggestions?
Feeling anxious and frustrated while undergoing fertility treatments is normal, but if these emotions affect your relationship with your child — perhaps making you irritable or preoccupied — consider counseling to help you release the feelings, as well as stress relief and relaxation techniques. Look for fun activities you and your child can do together. (See our article on games to play with your baby or visit ParentCenter for ideas on activities to do with your older child.) And reach out to friends and family or find a babysitter when you need a break from parenting. Your relationship with your child will be healthier as a result.