When one baby is not enough
Conceiving the second time around isn’t always easy. Diane Parkes talks to an expert who explains why and what can be done to help.
They do not make headlines like those generated by Sex and the City star Sarah Jessica Parker, but millions of UK women share the same problem – secondary infertility.
Ms Parker, aged 44, has reportedly donated her own eggs so that a surrogate can give birth to her twin daughters in the summer.
Many women, like SJP, who has a six-year-old son with husband Matthew Broderick, find that conceiving naturally second time around just doesn’t happen.
“At least half the people seeking fertility treatment have been pregnant before, even if that pregnancy has ended in miscarriage or other problems,” said Dr Gillian Lockwood, medical director of Aldridge-based Midland Fertility Services.
One of the possible causes is family breakdown. If the woman is now with a new partner, it could be the man who is the problem.
“It takes two to tango and it could be that there is a problem with the man’s sperm,” she said. “People tend to think that it is the woman’s problem but in a third of cases it is the male and in another third it is both sides.”
The situation is further complicated by time. Just because a woman had a child at one age does not mean she can conceive a few years later, as fertility could have declined.
“Age is a very important factor in fertility,” said Dr Lockwood. “A woman’s fertility declines rapidly from her mid-30s. She may have succeeded with a first pregnancy but a delay in trying to conceive for another could have led to a decline in fertility.
“Women at this age are still looking good and feeling fit and healthy, it just does not occur to them that their fertility is declining. They have had a first child and it is only when they hit the panic button of 40 that they suddenly start worrying – but the chances for IVF are not very good as a woman ages and that is devastating for them.”
In general, most couples having regular sex without contraception will conceive within one year (84 per cent) and half of the remainder will conceive within two years.
This is why infertility is defined as the inability to become pregnant during the course of one to two years of regular, unprotected sex.
But after trying and failing, many couples then begin trying to find a cause and may face further delays waiting for appointments, as well as having to undergo tests and examinations. This can be an emotional hell for young parents.
Dr Lockwood said the emotional effects of secondary infertility on families could be massive.
“When a couple cannot have a second child, it can be more painful than not having been able to have a first, as they know what that experience of being a parent is.
“Sometimes they describe it as ‘wouldn’t it be lovely to have a little brother or sister for the baby we already have’ but it is also about their desire to have another baby and all of the experiences which go with that.”
Societal pressures can be difficult.
“People can be asking when they are going to have another child,” said Dr Lockwood. “Society in general, and the NHS in particular, are less sympathetic to couples experiencing secondary fertility than childless couples.
“There is a sense that if a couple already have a child they should be counting their blessings.
“If they are lucky enough to live in an area which does fund infertility treatment they would not be eligible for it if they already have a child, as that is intended for childless couples.”
If a couple do present to Midland Fertility Services experiencing secondary infertility they would undergo all the same investigations as a couple who have not conceived at all.
“We would look at issues like sperm count and whether there is any blockage in the Fallopian tubes,” said Dr Lockwood. “But it can be difficult because we cannot turn the clock back.
It is possible for problems in a first pregnancy to affect future chances of conceiving. Dr Lockwood said there was evidence that a Caesarean section could reduce rates of conception. But other problems can include blockages of a tube after a first delivery or polycystic ovaries.
“If someone has polycystic ovaries, then weight can be an issue. It may be that in the past they have had a pregnancy in spite of having polycystic ovaries but after having had a baby they have put on a couple of stone and that is making it hard for them to conceive.
“They may find that after losing that weight, which suppresses fertility, they stand a better chance.”
But for about 19 per cent of women, unexplained secondary infertility could be due simply to age.
Which is why Dr Lockwood says a couple experiencing difficulty conceiving a child, even if they have conceived in the past, need to look at the problem sooner rather than later.
“If a couple are trying conscientiously, and there are not any obvious lifestyle factors affecting their fertility and no obvious causes, then they would be advised to investigate the problem,” said Dr Lockwood. “For each month that goes past, the chances reduce.”
* For more information contact Midland Fertility Services on 01922 455911 and www.midlandfertility.com
