Breaking the silence around secondary infertility

I once heard a woman describe secondary infertility as, “the black sheep of the infertility world.” She had fallen pregnant naturally with her daughter within a couple of months. But when the time came to expand her family, and to give her a daughter a sibling, she faced infertility. Because she already had a child, she was often asked, “Why do you want another child? You already have one.” And then the guilt would set it. Yes, she already had a child. She knew how fortunate she was. Yes, she knew she had something thousands of women longed for. But did that make her selfish for wanting a second child?

If only it were that simple. She adored her daughter. She loved being a Mum so deeply that she longed to experience it again. She also wanted her daughter to have a sibling. And there’s nothing wrong with that.

Secondary infertility is defined as the inability to conceive or carry a baby to term after previously giving birth without fertility issues. It can feel confusing and emotionally heavy, especially when the first pregnancy happened without trouble. But if you’re experiencing secondary infertility, there are options like IVF, sperm and egg donation, and surrogacy.

I was once read on Instagram, “Secondary infertility is isolating. It feels like you don’t belong anywhere.” That feels spot on. Unfortunately, there is a stigma around secondary infertility. Many women I’ve spoken to have struggled to fit into the infertility community and haven’t received the empathy or support they deserve. There’s sometimes this perception of secondary infertility that you should just be grateful for what you have.

There are many reasons secondary infertility can occur. Age is a key factor. For some couples, secondary infertility comes as a consequence of getting older. As women get older, egg quality and quantity decline, especially after thirty-five. A woman who conceived easily in her twenties, may find that after thirty-five, she has fewer good-quality eggs. Some of the other reasons may include ovulation issues such as PCOC, which can cause irregular or absent ovulation. Medical conditions or medications can also contribute to secondary infertility, such as thyroid issues, autoimmune conditions or treatments that affect hormones. And finally, sperm quality can also decline with age, even if the change is more gradual than egg quality.

As featured in Wish for a Baby Australia

Surviving the Two-Week Wait: What Really Helps

When you’re in the thick of infertility treatment, it can feel like your life becomes one long stretch of waiting. First, you wait months just to see an IVF specialist. Then comes the endless fertility tests. Once testing is done, you start your IVF cycle medication and wait for your egg collection. After that, you wait for your embryos to be created. Finally, you have your embryo transfer. It’s waiting layered on waiting. And if you’ve been through the gut-wrenching experience of a miscarriage, there’s often another three-month wait before you’re physically – and emotionally – ready to try again.

But perhaps the hardest wait of all is the two-week wait.  

Also known as the TWW. The time between your embryo transfer and the day of your pregnancy blood test. Ask anyone going through IVF, and they’ll tell you how awful this time is. How it agonisingly crawls by. It’s impossible not to think about whether you’re pregnant. You want it so desperately that the thought consumes you. The anxiety can feel suffocating. And then there are the physical symptoms.

I remember early on in our IVF journey, I was convinced I felt pregnancy symptoms during my TWW. I had twinges I was sure were implantation. Then, two days before my pregnancy blood test, the nausea hit. I even dry-retched into the kitchen sink one morning. So when my blood test came back negative, I was shocked and devastated. What I didn’t realise, and what many IVF specialists don’t always explain, is that IVF medication, especially progesterone, can mimic pregnancy symptoms. A cruel trick. So the bloating and nausea I was experiencing was nothing more than my progesterone pessaries. As if the process wasn’t hard enough already.   

The TWW can be an intensely emotional time, fuelled by anxiety and amplified by medication that can cause mood swings and fake pregnancy symptoms. And you have the added burden of the medication causing mood swings and mimicking pregnancy symptoms. So how do you get through?

Here’s what helped me during my TWWs:

1.     It’s OK to not be OK. This period is incredibly hard. It’s normal to feel overwhelmed, angry, emotional or upset. It’s OK to feel so many emotions and not be ok.  

2.     Don’t test early. This is a hard one. The temptation to take a home pregnancy test is huge. But false positives, and false negatives, are common. I learned this the hard way. After our second IVF transfer, I tested early and got a positive result. I was pregnant but my hCG was too low. I was told I would miscarry. It turned out to be a ‘pregnancy of an unknown location’. Given the pregnancy wasn’t viable, and it would have been dangerous if it continued, I had methotrexate to end my pregnancy. A devastating time. From then on, I always waited until the day of the blood test.

3.     Prioritise self-care. Self-care isn’t optional during the TWW – it’s essential. Do things that bring you comfort or distraction: binge a TV show, book a massage, or have a weekend away. I found going to the movies was the perfect escape. Whatever helps you feel good or takes your mind off the wait is worth doing.

4.     Skip baby showers and gender reveal parties. These are hard enough when you’re dealing with infertility but during the TWW, they can be unbearable. Give yourself permission to decline these events. Protect your emotional wellbeing.

5.     Counselling. If you’re seeing a therapist or a fertility coach, make sure you schedule a session or two during this time. Talking things through can make a huge difference.  

6.     Surround yourself with support. Similar to self-care, make sure you surround yourself with friends and family who support you and make you feel good. People who make you feel safe, understood and cared for. It can also be incredibly comforting to talk to someone else going through fertility treatment – someone who truly gets it. The online #TTC community is also a wonderfully supportive space.  

Common infertility misconceptions

Infertility is a reproductive disease – a medical condition that affects millions worldwide. And yet, it is often suffered in silence and widely misunderstood. While awareness has grown in recent years, there are still many misconceptions about infertility that persist.

Here’s some common infertility misconceptions.

1.     Infertility only happens as you age

There are many causes of infertility including endometriosis, male infertility, the endometrium lining and PCOS. While your egg reserve does decline with age, women of all ages can experience infertility.

When you first start your fertility journey, a specialist will test your AMH. The Anti-Mullerian Hormone (AMH) blood test is the level of AMH in your blood and helps predict approximately how many eggs you have left. However many women can show a healthy egg reverse and still have difficulty conceiving. There can be many reasons for this. For example, it may be the endometrium lining. A thin endometrium lining isn’t due to your age; it’s often genetic and difficult to treat. For some women with a thin lining, the only option is gestational surrogacy.

2.     It’s mainly a female issue

Many people assume infertility is only a women’s issue, but that’s not true. Around 40% of infertility cases are due to male factors, 50% to female factors, and 10% is a combination of both. Despite this, stigma around male infertility remains strong, leaving many men feeling ashamed or isolated.

3.     Stress causes infertility

Anyone experiencing infertility has heard, “You just need to relax”, “Take a holiday” or “It will happen when you stop thinking about it.” Comments like these are hurtful and dismissive. If only falling pregnant was as simple as relaxing or taking a holiday. A lot more awareness is needed to debunk this myth. Stress reduction can support your wellbeing, but it does not treat infertility.

4.     Women can’t get pregnant after 35

While fertility does start to decrease with age, there is no sudden “fertility cliff” at 35. Declines become steeper around 38 and again at 40, but many women conceive naturally or with assistance beyond these ages. Options such as surrogacy, egg donation and sperm donation also expand pathways to parenthood. 

5.     You just need to be fit and healthy to conceive

Plenty of people conceive easily regardless of their health, while some of the fittest individuals struggle. Being in good physical and mental shape can help with resilience and overall wellbeing, but it does not guarantee fertility.

6.     Having a child means you won’t have any fertility issues in the future

Sadly, this isn’t true for everyone. About 1 in 10 women experience secondary infertility –

difficulty conceiving or carrying a pregnancy after previously having a child without issues.

7.     IVF guarantees a child

Sadly, this also isn’t true. While many people expect IVF to solve all fertility issues quickly, the reality is that it often takes several IVF transfers before achieving a viable pregnancy. IVF is an incredible tool, but it rarely works on the first attempt. Setting realistic expectations can make the journey more manageable.  

#article featured in Wish for a Baby Australia