Jill Valentino, 38, a grade school teacher in New York's Hudson Valley, was one of those lucky women who got pregnant the first time she tried. She gave birth to a healthy baby girl in spring 2006 and envisioned giving her daughter a sibling a few years later. But things weren't so simple the second time around.
After years of timing intercourse and months of taking ovulation-stimulating medication, Valentino finally saw a reproductive endocrinologist. The first thing he told her was the she "was old," says Valentino. He also dismissed her concerns because she already had another child. After a string of failed fertility procedures, Valentino found a new doctor, and she and her husband underwent their first in vitro fertilization (IVF) cycle when their daughter was 7.
Throughout her five-year quest to conceive a second child, Valentino says that she often felt isolated, guilty, and ashamed. "I didn't know that there was a name for what I was going through and didn't really talk about it much," says Valentino. "Until I started Googling, I had never even heard of secondary infertility." But once she'd found a name for it, she realized that she was not alone.
Although it's not often talked about, secondary infertility – difficulty getting pregnant or carrying a pregnancy to term after the birth of a biological child – is common, affecting millions of women of childbearing age in the United States, according to the Centers for Disease Control and Prevention's National Center for Health Statistics. It also comes with a unique set of challenges.
What makes secondary infertility different
"Many women going through secondary infertility have a vision of what their family is going to look like," says Leslee Murphy, LCSW, a psychotherapist who specializes in women's health and is a consultant for Houston IVF. When that doesn't happen, they go through all sorts of complicated and conflicting emotions tied to this loss of control, especially if they got pregnant easily the first time, like Valentino, and expected things to go smoothly the second time around too. "While they want to be in the moment and enjoy the child that they have, there's also this pull to continue their quest of having that second child," says Murphy.
Jen Noonan, 39, a licensed professional counselor and author in Denver, Colorado, took ovulation-stimulating medication to conceive her first child, a son born in October 2010. It took her just about a year, and because she wanted two children spaced two years apart, she and her husband starting trying again just before their son turned 1. She conceived within a few months but miscarried at 12 weeks.
She expected to be pregnant again soon after this loss, but when that didn't happen, Noonan's feelings of despair and isolation began. They intensified as she and her husband tried more invasive and expensive fertility procedures. "It felt like it just went on and on," she says. "It was devastating."
Noonan, like Valentino, switched to a new reproductive endocrinologist and opted for IVF. Both women had an unsuccessful first cycle but a successful second. Valentino's second daughter was born in July 2014, and Noonan had a second son in September 2014. Yet despite these successes, both say the ordeal was incredibly painful and isolating, and each woman wrote about her experience separately – Valentino in a story on Redbook magazine's website and Noonan in a memoir published in September.
"Even in the infertility community, a lot of people are playing the comparison game," Noonan says. She was told repeatedly in person and online that she should be grateful for the son she had and stop complaining.
Patricia Harteneck, PhD, a senior psychologist specializing in infertility, depression, and anxiety at the Seleni Institute, has seen this phenomenon in her work. "There is a stigma attached to secondary infertility," she says. "There's more judgment and criticism and less empathy."
Which is why, says Harteneck, it is important to find coping strategies to help with the emotions of secondary infertility. Here are a few that may help you or someone you love:
Find a doctor that supports you. When dealing with secondary infertility, some doctors, like Valentino's first, don't take patients' concerns seriously. It's essential to see a reputable reproductive endocrinologist early in the process, one who understands your desire to expand your family and is also committed to getting to the bottom of what's going on, even if you easily conceived a first child.
Join a support group that welcomes women with secondary infertility. Infertility support groups are there to support whatever emotional process you're going through, even if you already have a child, says Harteneck. Murphy runs one of these in-person groups in Houston, and says at the start of each session she is very clear that there will be women in the group dealing with both primary and secondary infertility. If the group isn't blindsided by this information, it generally isn't a problem, she says.
But Noonan heard from women online who felt they'd been through more than she had. Trying different groups – in person or online – and being upfront about your situation as well as your need for empathy and support will help you find one that's the right fit.
Consider counseling with your partner. During secondary infertility, there might be differences in what the two partners want, says Murphy. In Valentino's case, she says that her husband would have been fine having just one child, but she felt compelled to keep trying for another. Partners might also disagree about their stopping point. If IVF doesn't work, couples can consider using donor eggs or sperm, a surrogate, or adopting. During these conversations, a counselor can educate, mediate, and get both partners to agree on a plan of action, including setting a limit on how much to spend on fertility treatments before they reevaluate or call it quits, says Murphy. "You need two yesses," she continues. If one partner wants to proceed or try a procedure and the other does not, resentment, frustration, and anger can result. A counselor can help couples work through these difficult conversations in a respectful and empathetic way.
Reframe negative thoughts. Allowing yourself the time and space to grieve is important, but it's also important to look at your situation in a different way, says Murphy. If you're worried about raising an only child, it might be worth considering the people that you know who are only children and talking to them or reading articles or books about the experience of only children.
Focus on family life. Making an active choice to be emotionally present when you're with your family is important, says Harteneck. Set dates not only with your partner, but also with your child and with the family. Keep traditions intact and create new ones. "Continue your little rituals, says Harteneck, like going to the park or putting your child to bed. "Focus on those simple things."
Take care of yourself. Although you can't control when and if you get pregnant and have another child, you can control how you take care of yourself. Both Murphy and Harteneck recommend using relaxation techniques, such as yoga or mindfulness, and committing to other positive self-care practices, including journaling or talking to a trusted friend.
Be prepared for uncomfortable conversations. When you have one child, people are undoubtedly going to ask when you're having a second. Being caught off guard can be upsetting, so it's best to develop a script ahead of time suggests Murphy. If you feel comfortable, you might say: "We're going through treatment and are trying to get pregnant," says Harteneck. "People typically respect that. But there's no need to get too involved," she adds. "You can just say that when you're pregnant, you'll let them know." Although the script may differ depending on who is asking, make sure that you and your partner agree on how much information to share.
Talk to your child in an age-appropriate way. If they're old enough, your child has probably noticed that you're away a lot and can see that you're upset, says Murphy. Rather than worry about them feeling that they're not enough, which can add onto your guilt, address what's going on in an age-appropriate way. "Kids need reassurance," Murphy says. "Be open and honest. Say that you want another child because you love [him] so much, and that sometimes doctors can help with this."
Both Valentino and Noonan relied on many of these coping strategies when dealing with secondary infertility, but it was only after they shared their stories that they could see just how moving and emotional their journeys were. "I can't believe I went through all of that and ended up with what I wanted," says Valentino. "I'm proud of my story."
Noonan, who started writing her book at her lowest point (right after her first failed IVF attempt) found the writing process to be therapeutic. Now that it's published, she hopes that others in a similar situation will find solace in her words. "I want to help others feel less alone," says Noonan.