Valerie Samson* was 22 and planning her wedding when she found out she was pregnant with her first child. “It was definitely a surprise,” says the Montreal mom, who had planned on waiting a few more years to start a family. Her daughter was born in 2002 and, two years later, Samson and her husband were ready to start trying for baby number two. About a year later, Samson got pregnant but miscarried at four months. They continued trying for the next five years. “It took me a long time to realize that maybe we needed help—that it wasn’t going to just come naturally,” says Samson. “I kept thinking, ‘We had a baby, so there can’t be anything wrong.’”
In 2010, tests revealed that Samson had polycystic ovary syndrome (PCOS), a hormonal disorder that interferes with ovulation and often causes infertility. With that news, the Samsons joined the ranks of couples with a diagnosis of “secondary infertility,” which is the inability to get pregnant or carry a baby to term after previously conceiving and giving birth to a child without any reproductive assistance. For Samson, her diagnosis brought disappointment—that she would not likely be able to conceive another child without assistance—but also relief. “For years, I had been feeling like a failure as everyone around me got pregnant,” says Samson. “It was good to finally know that it wasn’t my fault.”
It’s difficult for researchers to come up with exact numbers on secondary infertility, but according to estimates from a 2012 study based on data from a 2010 Statistics Canada survey, about one in six Canadian couples who already have one child fail to get pregnant after one year of intercourse without contraception (the infertility rate for couples who don’t have a previous child is closer to one in five).
A diagnosis of secondary infertility often comes as a shock and can be emotionally devastating. Most parents don’t expect to have any trouble growing their families, and the frustration, stress and grief of trying—and failing—to conceive can take a heavy toll on the entire family.
For couples like the Samsons, the cause of secondary infertility is clear and had likely been there all along—meaning they just got really lucky with baby number one. For others, tests may reveal other physical causes, such as damage to the mother’s Fallopian tubes, which can sometimes be caused by a sexually transmitted infection that could have been contracted after her first child was born. But according to Dr. Heather Shapiro, president of the Canadian Fertility and Andrology Society and a fertility specialist at Mount Sinai Fertility in Toronto, the main cause of secondary infertility—or “secondary sub fertility,” as she says it should often be called—is the age of the mother. “People say to me, ‘I got pregnant easily before, so why isn’t it happening now?’” says Dr. Shapiro. She tells women, “Even though you feel like the same person, you are functionally a different person because your ovaries age and the difference between, say, 34 and 38 can be very big.” Women over 35 who are trying to have a second (or third or fourth) child should consider consulting a fertility specialist after only six months of trying instead of the recommended one year for younger women, she says.
“The good news,” says Dr. Shapiro, “is that women who have already had a child are statistically more likely than women without children to have success with fertility treatments and get pregnant again.” But those treatments come with steep investments of time and money and can have serious physical and emotional costs for women and their families.
Lisa Ayuso and her wife, Vicki Stacey, conceived their daughter, Frances, through donor insemination when Ayuso was 32. Five years later, when they decided to try for a second child, Ayuso found that the process was much harder to manage. She worked an early shift, and the ongoing appointments added a great deal of stress to her workday. And now that she was over 35, she left every appointment feeling like “a dinosaur.”
Ayuso was thrilled when, despite her age, she got pregnant on the first try. But then, at her 12-week ultrasound, they were devastated to learn that there was no heartbeat. Ayuso kept trying for another seven months after the miscarriage and her mental health suffered. “I became a different person: introverted and self-loathing,” remembers Ayuso. “I definitely took on the failure of it, and it bled into everything else in my life and my relationships.”
Judith Daniluk, a professor of counselling psychology at The University of British Columbia in Vancouver who has spent 34 years counselling and researching women and couples dealing with infertility and who has experienced secondary infertility herself, says many people mistakenly assume that infertility is somehow easier or less stressful when the couple already has a child. “There’s an assumption that it shouldn’t be as intense, but it often is,” she says. “The feelings of angst and desire for a child are no different.”
Daniluk says that many people dealing with secondary infertility don’t get the support they need from friends, family members or even medical professionals. “Their distress isn’t taken as seriously,” she says. “People will tell you that you are lucky to have one child or should be happy with what you have and just get on with it.”
The Samsons, who went on to have three more children via in vitro fertilization (IVF) after Valerie’s PCOS diagnosis, have fielded disapproving comments from extended family who questioned their decision to go through IVF multiple times. They asked not to be identified in this article because they never told even their close family members that their fourth child was conceived through IVF. “I didn’t want to hear them question me about why I was forcing my body to have another kid,” says Samson, “so we just told them it was a surprise, like our first.”
In social settings, many couples who are struggling with secondary infertility find that having one kid already can lead to insensitive comments and assumptions about their plans or ability to have another child. Less than a year after her miscarriage, Ayuso’s wife, Vicki, took over trying to get pregnant and was successful right away. “Not everyone knew I had tried, and I had barely told anyone about the miscarriage,” says Ayuso. “People just assumed, ‘Oh, how nice that you’re both taking turns being pregnant.’ All of my struggle was kind of invisible.”
Montreal mom Amy Millan, who has been unable to conceive a second child after having her daughter, Delphine, in 2011, when she was 38, says people need to think twice before they make potentially hurtful comments or ask women and couples about their reproductive status. “I think we need a new etiquette around this,” says Millan, “because you never know what people are going through.”
She says that since having her daughter, people she barely knows will question her about when she is going to give her child a sibling. “This woman at my bank asks me every time I go in,” says Millan. “It is so infuriating and rude.” Like many women, Millan felt isolated and alone while she was undergoing fertility treatments and after suffering an ectopic pregnancy, so she is in favour of women talking more openly about infertility, pregnancy loss and miscarriage. “But it’s a very private struggle,” she says, “and we have to trust that if the people around us who are going through it want to bring it up, they will.”