When Helen, 37, and her husband Paul, 40, decided it was time to start trying for a second child, they assumed they'd be pregnant within a couple of months, as was the case with their first child, Mia.
"Mia was 18 months old and we didn't want too big an age gap. A couple of my mum friends were pregnant again and it just felt like the right time. We were pretty relaxed about it," remembers Helen.
However, three months became six, then nine, and by the time they'd been trying for 12 months with no luck, Helen was worried.
We'd conceived Mia quickly so I assumed getting pregnant second time around would be just as easy. We saw our GP, who ran blood tests on me and organised a sperm test for Paul. Results came back normal, which was both good and bad – if there was nothing wrong, why weren't we getting pregnant? We were booked into to see a specialist but just before our first appointment, I discovered I was pregnant. We'll never know what caused the delay. Feeling so out of control of the situation was frightening – I consider myself very lucky to now be seven and a half months pregnant with our second child."
How common is it?
Secondary infertility is defined as the inability to conceive, or carry to term, another baby following the birth of one or more biological children. It affects around one in seven UK couples, according to Mr Raef Faris, consultant gynaecologist and IVF specialist at The Lister Fertility Clinic.
"Typically, the women I see are between the ages of 36-44 and have been trying to get pregnant again for six months or more. There are several reasons a woman may have trouble getting pregnant second time around. It may be to do with her age – a decline in the number and quality of eggs (ovarian reserve) can be a factor. There may be scar tissue in the fallopian tubes or uterus following a Caesarean section or other abdominal surgery that prevents the egg from either reaching the uterus or implanting. Sometimes there may be existing issues such as endometriosis that was present when the first child was conceived but is only proving problematic this time around."
Stress, chronic tiredness and simply not having enough sex are other common factors than can delay the patter of tiny feet, according to fertility specialist Zita West.
"Women particularly become obsessed with the age gap between children, which means they start trying for a second before their bodies have fully recovered from the birth of their first. And rather than taking comfort in the fact they got pregnant quickly first time around, it becomes a massive source of frustration that it's not happening this time, which adds to the stress," Zita says.
Fertility experts have long suspected that stress hormones makes it harder to conceive, with a 2010 study by researchers at Oxford University finding that a hormone called alpha-amylase was consistently higher in women who struggled to become pregnant.
"I felt I had no right to moan to friends who were still trying to get pregnant with their first baby"
A secret struggle
Not being able to share the emotional burden can take its toll too, as Helen discovered.
"I didn't want to make my mum-of-two mates feel awkward and I felt I had no right to moan to friends who were still trying to get pregnant with their first baby," she says. "I also felt guilty that Mia wasn't 'enough' – that somehow she had failed to fill the baby-shaped longing in my life. It wasn't that at all. I simply felt our family would be complete with two."
Overcoming secondary infertility involves many of the same treatment plans as for primary infertility, says Professor Faris.
"Every case is different and the treatment must be tailored accordingly," he explains. "For instance, I take a history to see if I can identify any obvious causes, after which we run blood tests to check hormone levels, assess the woman's ovarian reserve and perform an ultrasound scan to make sure the tubes aren't blocked. We also check the uterus for any abnormalities. Treatment depends on what we find. For instance, if the woman is older and has fewer good quality eggs, or her tubes are blocked we would start IVF (where the egg is fertilised outside the womb and surgically implanted back into the mother). If there is an issue with her partner's sperm, we might try Intra-cytoplasmic sperm injection, or ICSI, where a single sperm is injected directly into the egg. If there is a lack of ovulation we can induce this with drugs such as Clomid, and recommend timed intercourse or artificial insemination to coincide with the moment the egg is released."
Bear in mind too that after the birth of your first child, your hormones may take a while to settle down, says Zita West. "This can mean where once your periods were like clockwork (and therefore it was easier to pinpoint ovulation) they are now erratic, or absent," she adds. Both Professor Faris and Zita West maintain they are seeing women who, if they were in their late 20s or early 30s, wouldn't need medical intervention.
"With all the time in the world, most couples will fall pregnant," says Professor Faris. "But older women may need help simply because time is against them. For instance, at 44 or 45 there's only a 1 percent chance of success even with treatment, whereas at 40 or 41 it's more like 20-30 percent. So time is of the essence."
Tips for when you're trying again
Cut back on caffeine and alcohol
Both reduce fertility in both men and women: one study showed that drinking as little as one cup of coffee a day can halve your chances of conceiving.
Get your balance of essential fatty acids right
Many of us consume too much omega 6 at the expense of omega 3, which causes an imbalance in the body. But omega 3 is what reduces inflammation, which means the body is in a more optimal state to conceive. Two portions of oily fish per week will help.
Take the right supplementsInitial studies on conception and pregnancy formulations containing folic acid, iron, vitamin B12 and vitamin D showed that the women who took them were more likely to get and stay pregnant than those who just took folic acid.
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