Secondary infertility affects about 20 per cent of new patients presenting to Sims IVF in Dublin, says Dr John Kennedy, medical director at the clinic.
The causes of SI can be similar to primary infertility (PI), which is the inability to conceive for the first time, having tried for more than a year.
Dore has experienced how well-meaning but ill-thought-out questions add to the frustration and exhaustion secondary infertility (SI) can cause a family.
Anyone who has suffered through primary infertility knows the pain and uncertainty of not conceiving, but secondary infertility brings the pain of its own. Kennedy says the stress is compounded by already caring for one child and getting comments about siblings.
Kennedy explains one major misconception when it comes to secondary infertility. "If you have had a pregnancy, irrespective of how that turns out, be it a miscarriage, or a healthy child, that means you do not have primary subfertility any more. People often don't realise that.
"However, having a child ticks certain boxes; you can say certain things about that person. They have an ability to conceive; they have the ability to carry a baby to term and to deliver that child. It rules out genetic conditions that will stop you from ever having a child.
"When a couple who have been able to conceive suddenly aren't able to, it could be that tubes are blocked by an infection or previous surgery or as a result of the first pregnancy. Checking that the anatomy is right, that the sperm and the egg can proceed unimpeded to the uterus, is very important," he says.
"The biggest difference between a woman who has had a child and is trying to conceive a second child is that she is older the second time around and the longer the gap, the less relevant the first pregnancy becomes.
"The egg numbers and quality diminish and that can pose a problem and the same thing can happen with sperm in terms of count and movement."
For this reason, sperm and eggs are checked first. "The investigations for a couple who are trying to conceive a first child or subsequent children are broadly similar. You have to start from first principles: work on the sperm, the egg and the housing.
"If you have had a child before there is a bit of a move away from immunology issues and rejection issues and more of a movement towards making sure the eggs and sperm are still there and that the tubes are open."
Dore went through many of these tests, having tried to conceive her second child for over a year. "The stress starts as you become obsessive with the whole thing: you are either preparing for ovulation, or you're waiting to see if you are pregnant. Everyone around me was popping them out, and I wasn't getting pregnant.
"I started to get very nervous, thinking Rachel could be an only child which we really didn't want."
She says she was surprised to be affected by SI. Most people think that when they have had one child, subsequent offspring will be easily conceived. Obviously, this is a misconception that friends and family hold also.
"It's the obvious question that is asked of newly married couples or people with one child. You don't hear people asking someone with four, are you going again? We got many questions, and if they got me on a bad day, they got a very blunt and real answer. I would say we are trying, we're really struggling, and it's challenging for us. People have to be aware of these things. Fertility is kept quiet, and not many people speak out."
Having gone through all the routine tests, Becky and her husband Maurice were told they had unexplained infertility, something she found very frustrating. "I almost wanted them to find something wrong. They told me to lose weight, which I did, about a stone and a half."
Kennedy says that lifestyle, including being overweight, can have an impact on fertility. "Things like lack of exercise, diet, smoking, alcohol and caffeine all can have an impact, and we're less able to compensate for that. I think stress plays a role. The irony is that not getting pregnant is a stress in itself, so it's like a self-fulfilling prophecy.
"If you're in a very stressful environment, looking at ways to manage your reaction to stress is the way to deal with it. There are loads of different ways to do that and things like acupuncture, reflexology, massage, meditation and mindfulness are very powerful tools for couples in that situation," he says.
"Women in their mid-30s are surrounded by pregnancy, it's happening in their family and workplace, and it makes it very difficult," he says.
Dore says her husband found this aspect of it more difficult than she did. "He wasn't very good at birthday parties or Christenings . . . things like that."
At this stage, the couple decided to have IVF. Treatment options for secondary infertility are largely the same as for couples who have primary infertility. "Couples can try themselves with an aid: there is intrauterine insemination where you are bringing the sperm closer to the egg by bringing it in at the top of the womb when we know the egg is being released. And then there is IVF," he says.
Source: Irish Times
Additional Note: Aisling Killoran from Conceive with Ease provides fertility counselling and finds that sometimes if a woman has had a traumatic birth on her first child, it can leave an imprint of this trauma, which can prevent a woman from conceiving naturally again. I have had many clients come to me with secondary Infertility/fertility issues, and the first thing I ask them is, how was their birth and nine times out of ten, there were complications!
In addition to seeking medical help around conceiving, it's also equally important to address the first birth's emotional aspects!