Finding out you're infertile can be agonizing, and reaching out to friends and family for support is natural. But when couples or individuals have had one child and face difficulties having another, they often get little or no sympathy from the people around them. This type of infertility is called secondary infertility, and it can be as painful as being unable to conceive a first child (primary infertility).

Even friendly queries from a relative or friend, like "When are you having another child?" can sting, especially when a couple has been trying for years to have one. If a couple does go through expensive fertility treatment, friends and family members may not understand the emotional and financial toll it can exact. Infertility support groups may not help because people dealing with secondary infertility may find that members are less understanding to anyone who already has a child.

It's no wonder that secondary infertility is considered an invisible dilemma, and that so many suffering from it feel shut out of the world around them.

Although exact numbers are difficult to pin down, experts estimate that there about 3 million people in America who suffer from secondary infertility. According to Resolve, a national infertility organization, that figure represents an increase from an estimated 1.8 million in 1995.

Why the apparent rise in secondary infertility? More people are waiting until they are older and financially stable to have children; the federal government has documented that the mean age of mothers at their first birth went up almost 4 years from 1970 to 2005, and that the percent of women in the workforce has risen by almost 20 points during the same period. In addition, some women and men marry later in life or want more children in their second or third marriages. At this point, age-related infertility problems may play a role. Not only are women less likely to conceive the older they are, but age can also affect a man's sperm count and viability.

That depends on the person, but those going through secondary infertility often feel as much grief as childless people who are infertile, according to Resolve. Parents who are desperate to have a second child may feel jealous, deprived, and angry about not being able to have more offspring, or they may blame themselves for not having had children earlier in life.

Although you may feel isolated from friends, try talking to them about your feelings. If you're avoiding baby showers, birthday parties, and other family gatherings because it hurts to be around people with large families, explain beforehand why you're doing it. Reassure them that this phase will pass in time.

Even if parents try to hide their emotions, depression or anger about secondary infertility can affect the way they treat their child. One or both parents may also become overly protective or have unreasonably high expectations about an only child.

A child may naturally be curious about regularly accompanying a parent to the doctor's office. Resolve suggests tackling these issues head-on. Clearly explain that you're not sick and nothing bad is going to happen to you. Depending on how old your child is, you may want to let him or her know why you're going to the doctor.

Although they may not want to convey their anxiety about not having another child, parents may unwittingly reveal their own sadness and worry. It's best to be open about these feelings, and assure your child that he or she has nothing to do with the problem.

Try to schedule "special time" with your child in between the periods when you're undergoing fertility procedures. Rent a movie, read a book together, or take a short trip -- basically enjoy and celebrate the time when your child is still young. Your child needs reassurance that your bond will remain close even if there's another child.

Secondary infertility can create stress even between the most loving of partners, whether they're undergoing infertility treatments or having scheduled sex to increase their chances of conception. If you're also dealing with the strain of financing fertility procedures and frantically juggling your schedule to accommodate medical appointments, it can affect your ability to become pregnant. Some partners feel ambivalent about going through expensive fertility treatments, but others are willing to go into steep debt in order to have a child.

In some second marriages, stress may simmer beneath the surface when one partner already has children from a previous marriage and one doesn't. Experts say the partner who lacks a biological child may feel more urgency to have a child than the one who already has one. This inequity can create feelings of jealousy and resentment.

The good news is that there are many options for people who want more children. Before fertility treatment, though, talk with your partner about how much you want or can afford. Depending on your prognosis and finances, you may eventually want to consider other options, such as domestic or international adoption.

Remember, every family goes through periods of anguish and grief. You may want to attend a support group for people dealing with secondary infertility. And if you or your partner is suffering from depression or anxiety, seek counseling to get you through these times.

-- Psyche Pascual is the book editor of Consumer Health Interactive and has covered health care for the Los Angeles Times.

References

First published December 19, 2002
Last updated May 27, 2008
Copyright © 2002 Consumer Health Interactive

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