Getting pregnant once doesn’t guarantee a next time
Monday, February 21, 2005
What do “infertile” couples look like? Maybe they are wealthy yuppies who put career goals before family wants. Or maybe they are a same-sex couple trying cutting-edge reproductive technologies. Or maybe they are a couple pushing a stroller with a biological child or two inside.
It’s unlikely that the last image was one you conjured up. But, according to the National Center for Health Statistics, infertility is a very real issue for more than 3 million American women who already have one child. So-called “secondary infertility,” or the inability to conceive after one or more successful pregnancies, can plague any woman.
Invisible condition Secondary infertility is often called the invisible problem because it’s not well known or recognized.
“Most people think you either have infertility or you don’t, and once you have children that means you don’t have infertility,” says Dr. Michael Zinger, an infertility specialist at Edward Hospital in Naperville.
In fact, secondary infertility is a condition that’s growing for the same reason all types of infertility are growing: Women wait longer to have children.
“The older [women] get, the harder it is to become pregnant, says Dr. Norbert Gleicher, infertility specialist and founder of the Center for Human Reproduction in Chicago.
Women who encounter secondary infertility are usually older than patients seeking treatment for primary infertility (couples without children). Gleicher warns that even with treatment, doctors “cannot be miracle workers,” and advises any woman—mother or not—over the age of 35 who has not become pregnant after six months of trying to see her doctor. For women under age 35, doctors recommend trying for a year before seeking medical assistance.
Time is the enemy The medical reasons for primary and secondary infertility are identical, since the passage of time impacts everyone.
“In infertility treatment, often the biggest enemy that we have is time,” Zinger cautions. Quality and quantity of both eggs and sperm can decline or change—in as little as six months’ time.
Having had a child has little or no impact on a couple’s ability to conceive in the future. “Things change,” explains Dr. Carolyn Coulam of the Sher Institute for Reproductive Medicine in Chicago. “As a group, [secondary infertility patients] are not statistically more likely to get pregnant” just because they have conceived before.
While the playing field is level medically for both types of infertility patients, emotionally, their experiences can be far from similar.
First, the couple has to admit there’s a problem. Zinger says that while his primary infertility patients push for a quick treatment timeline, patients who are already parents don’t always have that same sense of urgency. They often want tests repeated, not trusting the first results. False reassurances from friends and family—even sometimes from their primary doctor—can reinforce their denial.
“You’ve had one before, you can have one again,” is a familiar refrain heard by those having trouble getting pregnant a second time. LaGrange resident Julie McNamara, 32, had no problems conceiving her 2-year-old son, but hasn’t been able to get pregnant a second time. McNamara went to her general practitioner who shrugged, “Don’t worry about it. You need to get a job.”
She is now under the care of a reproductive endocrinologist.
Greater alienation Secondary infertility patients “really aren’t part of the fertile community, nor are they part of the infertile community,” says Dr. Jan Elman Stout, a Chicago psychologist specializing in infertility counseling and chair-elect of the American Society for Reproductive Medicine’s Mental Health Professional Group. That may alienate them, she says.
Unlike those with primary infertility, these couples don’t receive much pity. Countryside resident Dawn Dion, 38, mother of a 3-year-old, once had a woman say to her: “I’d have more sympathy for you if you didn’t already have your son.”
Stout says it’s not unusual for secondary infertility patients to feel as though their support from others is limited. “Patients do talk about encountering bias from family and friends, not necessarily in their desire to have another child, but when they’re working hard at it.”
With secondary infertility, couples must not only work through their own emotions, but they must also consider how it all affects their child.
Parents often feel guilty for thinking that their one child isn’t enough, Stout says. Dion, however, says she feels more guilty about about not giving her son a sibling, a feeling that is compounded by the difficulty of going through the infertility treatments.
She says she’s going through it for her son, although she adds: “I feel bad, simply because I’m putting [my son] aside and I don’t even know if it’s for a good reason.”
The treatment toll Indeed, fertility treatments can be a hardship. For starters, there are logistical concerns. Simply finding time for treatments is difficult as couples juggle parenting duties, Stout says.
The impact of treatment itself can also be physically challenging. The roller coaster of emotions, combined with hormonal changes, may cause depression. Dion’s young son has seen her cry a few times, and she wonders if it’s fair to him.
Depending on the age of their child, couples with secondary infertility must decide when and if to tell the child about their struggles. For example, smaller children who see their mother taking shots or having blood drawn may become scared and wonder if she’s sick. Older children might sense the stress in the family and wonder why they aren’t enough to make their parents happy.
“If there’s any open or public talk about this between their spouse or themselves, their child is picking up on it. They ought to have direct conversations with their child to help them understand what’s going on,” Stout advises. Talking to children openly can be an opportunity to teach them that problems should be dealt with, not buried.
The financial cost of treatment can add to the stress. Many insurance policies offer only limited options for treatments, forcing dedicated baby-seekers to tap into their own savings. Deciding to commit resources to building the existing family takes on new meaning when you already have a child. For example, do you put money toward attempting to conceive a sibling or open a college fund for the child you already have?
Huntley resident Cindy Principata, 42, knows first hand about both primary and secondary infertility. It took her and her husband five years to conceive their daughter, now 3, and they started trying for another baby three months after her birth. Since insurance doesn’t cover it, they aren’t pursuing medical treatments right now.
Principata says her husband is content. “He’s fine with just one. He wants to focus on retirement.” But Principata notes, “If my husband’s insurance covered it, I’d be at that fertility clinic in no time.”
Only child syndrome According to RESOLVE: The National Infertility Association, parents of one child can feel as though they are failing if they don’t provide that child with a built-in playmate. In addition, they sometimes have more acute fears that something will happen to their only child and they mourn each passing stage of childhood. In other cases, the parents simply dislike the concept of only children.
“There can be a really strong perception in our society that an only child is spoiled, a brat, can’t get along with others, can’t get along with age-mates, is too adult,” says Stout. “Research shows that only children fare very well, but there’s a great deal of myth and worry about that kind of thing.”
Dion says of one-child families: “People assume you wanted it that way.” In addition to her infertility stress, Dion had been caring for her mother who was diagnosed with Alzheimer’s. When her mother recently passed away, it was Dion who had to make the funeral arrangements. “I’m an only child, so I’ve had to deal with my mom’s situation all alone. I’m particularly sensitive to not wanting [my son] to be an only child,” she says.
Many of the families Stout counsels have a dream of their ideal family size and they feel “there is a missing person in their family” if the size falls short, she says.
Coping strategies Another unique challenge for secondary infertility patients is that they must be part of the parent scene daily. Hearing others talking about how easily they conceived or complaining about being pregnant can sometimes be too much to bear.
“I came to the point where I just started avoiding it,” McNamara says. “Every playgroup I’d go to, it’d be all this pregnancy talk, and I’m sitting here going, ‘I’m going in for surgery.’ ” Dion also left a playgroup because it became a constant reminder of her inability to have another child.
Dion and McNamara have found solace in a new playgroup called “Parenting After Infertility,” organized by the Illinois chapter of RESOLVE: The National Fertility Association.
Some families find solace online or through counseling. “If, for days on end, it seems like you’re crying, having difficulty sleeping, eating, caring for your child—you really need to go see somebody,” says Stout. Counselors can also help couples sort through the infertility issues and emotions that impact their relationship.
Different perspective “I’ve learned a lot about anybody who goes through infertility, and to be more compassionate about it,” says McNamara. “I used to be the one to say, ‘So, when are you getting pregnant?’ Now I don’t say a word.” If she is asked about her situation, McNamara shares her story because she knows the other person might be having trouble, too.
Infertility for Principata has given her greater appreciation of the moment. Although she dreams of having more children, she enjoys her daughter as much as she can. The one-shot experience makes it all that much more poignant.
Simple milestones become bittersweet, such as when she switched her daughter out of the crib and into a toddler bed. “It was like, OK, she’s out of the baby bed. We don’t need the little baby bed anymore. That’s it.” Principata’s voice softens. “That’s hard.”
Jill S. Browning is a writer living in Downers Grove. She has three children, all of whom were born on the same day.