No matter how unpopular this opinion might sound, your infertility, primary or secondary, is NOT your fault.

Life comes with many surprises; some good, some bad. However, one surprise that no one ever wants to have is the realization that at their (otherwise normal-seeming) childbearing age, they cannot become parents. Still a bigger surprise is when after successfully conceiving earlier, they cannot conceive or bring to term another baby. Primary infertility is difficult and devastating for couples but at the same time, secondary infertility has its own challenges.

What is secondary infertility?

The World Health Organization (WHO) defines secondary infertility as follows:

“When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth, she would be classified as having secondary infertility. Thus those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so, are then not unable to carry a pregnancy to a live birth would present with secondarily infertile.”

So, in short, anyone having trouble becoming a parent for the second or third time while already successfully doing it at least once will fall in this category.

Reasons for secondary infertility

The reasons for secondary infertility can be as many as for the primary infertility and some more. Most often the main reason is the advanced age of one or both parents. This may come as a surprise but 35 and above is considered an advanced maternal age from reproductive health perspective.

With our current lifestyle, most of the times it is not possible to plan a big family until we are financially, professionally, and mentally prepared for it. This can cause a delay in planning a second child, hence difficulties in conception.

            Some of the common reasons for secondary infertility can be as follows:

Ovulation Related:

Pregnancy happens when sperm meets egg. Women release eggs during ovulation generally 14 days after their cycle starts. However sometimes, due to several reasons, the ovaries are unable to release the egg. This can result in anovulatory cycles (a cycle without an ovulation). It is impossible to get pregnant when there is no egg to meet the sperm.

The major cause of the ovulation related infertility is PCOS (polycystic ovary syndrome), where due to different hormone disorders the ovaries are unable to release the eggs and eggs end up turning into small cysts on the ovaries. The good news is that PCOS is treatable and majority end up conceiving with the help of proper monitoring and medication.

The other reason for an ovulation related infertility could be a very low or insufficient ovarian reserves. This can be determined by performing different ORTs (ovarian reserve tests) mainly FSH (follicle stimulating hormone) test and AMH ( anti-mullerian hormone) test.

Fertilization related:

After ovulation related problems, the next major reason for the secondary infertility could be difficulty in the fertilization of the egg. Here is the part where both male and female factors can play a role in the conception.  Say, that the ovulation occurred successfully, and a healthy egg was released. Now it’s the job of the sperm to travel through the fallopian tubes to meet the egg to fertilize it.

For this to successfully happen, the sperm should be at the right place at the right time. An egg can only live up to 12 or 24 hours while the life span of the sperm can be five days. So, it is important that the intercourse happens within the timeframe (2 or 3 days before the ovulation until the day of the ovulation). If the fallopian tubes are fully or partially blocked it becomes difficult for the sperm to meet egg and hence fertilize it.

Likewise, if the sperm is not in good shape and cannot travel all the way from the uterus till the fallopian tubes to find the egg, fertilization won’t happen. All this can result in the wasted egg with no conception. To find out whether there is a fallopian blockage mainly two tests are performed. One is HSG (hysterosalpingogram) which is an X-Ray where a dye is inserted in the fallopian tubes to see any blockages in the passage.

The second test is a keyhole surgery, Laparoscopy, where a minor surgery is performed to take pictures of the fallopian tubes to ascertain their condition.

Implantation related:

After fertilization of the egg, the next stage is its successful implantation in the uterine wall where the uterine lining nourishes it and the woman can start feeling the first signs of pregnancy due to the secretion of the HCG (Beta human chorionic gonadotropin) into blood. However, many pregnancies fail at this stage. If it happens during IVF, it is called recurrent implantation failure (RIF).  

This can happen for many reasons but mostly implantation fails due to endometrium related issues. The implantation related infertility is only discernible in assisted conception while in natural conception, it goes un-noticed until there are noticeable symptoms of endometriosis or other related diseases.

Unexplained infertility:

Here is the most annoying twist. You might be having everything working just fine and not fall in any of the above mentioned categories but still be unable to conceive. This is termed as unexplained infertility. One-third of all the infertility cases fall under unexplained infertility.

This situation is more frustrating in a way where you don’t know what you are supposed to do to make it happen. However, unexplained infertility is treated by focusing on both male factor infertility and female factor infertility. The treatment follows the same protocols as the other two types of infertilities (male factor and female factor).

Coping with secondary infertility

It is hard. There is no easy way to say it. All of us who have jumped on every bandwagon they could find on the internet to enhance their chances of pregnancy can relate to it. All of us who can decipher the coded words like TTC, EWCM, DTD, DPO, BFP, and BFN know that they have been trying long enough to make it happen.

We have done yoga for fertility; in a studio, if we can afford it, on the video if we cannot; we have done acupuncture if we can afford it, or thought about it if we cannot, and we have dreamed and dreamed and dreamed some more about IUI or IVF if cannot afford it or tried it unsuccessfully if we can afford it…. But it is not working…. Actually, nothing seems to work.

Your dietary habits have improved, your day starts or ends with some kind of deliberate physical activity, and you have even tried to force yourself to stay positive and happy amidst all the gloom because hey! stress can cause infertility by messing with your hormones….  But that stick you just peed on, still shows one line (ughhh). So, what next? Another month’s grind may be? Or we can try and make a different routine from this month on (easier said than done but no harm in trying, right?)

Divert your attention:

Are there certain things that you have put on hold until you could get ‘this’ thing done? Switching to a better job, starting a degree, joining a gym, or changing your skincare regime (yes, introduce that retinol please) maybe? Start doing it now.

As they say, it will happen when it will happen. All other things that you have planned for your future are still there looking for your attention. A big family was one of those, but it wasn’t the only one. So, get on with the rest of the stuff. If nothing else, it will give you a suitable diversion that you need to feel calm and peaceful. 

Don’t beat yourself up (or your spouse):

Why didn’t I do it when I could? How could I deprive my child of another sibling just because I had other plans? Why is my husband/partner so chill about it? No matter how unpopular this opinion might sound, your infertility, primary or secondary, is NOT your fault. If you cannot make it happen now despite all your best efforts, there is no guarantee you could have done it in the past when you were not even mentally prepared to do it. You should have a baby when you want it and you have every right to delay it if you think you are not properly prepared for it.

Focus on your achievements:

Did you do something extra-ordinary while you were waiting to plan a second or third child? By extra ordinary I mean, were you focusing on your health, home, or child(ren). Were you trying to ease back into the office life? Were you moving to another city? Or were you just figuring out your new role as a mother or wife? Try to think about all this and appreciate how far you have come from that. Fertility does not define your success. You define your success. If you feel better than yesterday emotionally, professionally or physically, all this was worth it.

Grieve if you have to:

Now that you have read all the reasons why you should not consume your entire life with the thoughts of your inability to conceive, there is no harm in venting your feelings. Cry your eyes out if you feel like it. Spend whole day in bed if you don’t feel like getting up. Stuff your mouth with all the cakes and donuts and grieve.

Pent up feelings do more harm than good. Once you let yourself express it completely, you will be able to think about the whole situation with a clearer head. The deprivation might never go, that stabbing feeling in the chest, that lump in the throat might return from time to time, but you will be in a better position to enjoy the blessings that you already have in your life.

Ignore most of the ‘well-meant’ advice around you:

Everyone has a different mechanism to cope with a situation as personal as infertility. What worked for one, most probably won’t work for the other. You are the better judge of what will suit your emotional situation at that time. There will be plenty of amateurish advice around you like;

 ‘well, look at the bright side, you have at least one’,

‘there is this tonic that one of my colleagues tried to conceive. Maybe you should too’,

‘oh, don’t you value the child you have? Why do you need another?’

Ignore that. The fact that they mean well and are only trying to help you is of no value when it will end up making you feel worse.

Seek counselling:

The decision to go for counselling is the best thing that you can do to yourself at this stage. You might hesitate as many of us usually do by underestimating the emotional catastrophe we are confronted with. But if you go for it, you will never regret it.

It is all fine to go to a girlfriend or sister or mother to share your feelings and to unburden your heart, but a professional counsellor does a little more than just listening. They work in a professional environment with all the required skills and knowledge at their hands so they might be able to better guide you on how to deal with this situation.  

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