When One's Not Enough

Reports on celebrities’ desire for children and their dramatic ways of obtaining them are constantly hitting the headlines. Angelina Jolie and her mission to be the matriarch of a 'rainbow' family, Madonna and her struggles to adopt babies from Malawi – more often we read about it and shrug it off as yet another PR ploy.

But news that Sex in the City star, Sarah Jessica Parker, was so desperate for a second child that she turned to a surrogate, highlighted a problem suffered by millions of Australian women. Unexplained secondary infertility - whereby women, like SJP who has a six-year-old biological son with husband, Matthew Broderick, find that conceiving naturally second time around just doesn't happen.

"It's a modern pressure that a perfect family will be '2.4' children born three years apart," says Sovra Whitcroft, a consultant gynaecologist who runs the Surrey Park Clinic, a specialist hormone practice in Guildford, NSW. "It can cause huge distress, confusion and real problems for the woman and the family when having a second baby just doesn't occur."

In general, 84 per cent of couples having regular sex, without contraception, will conceive within one year, and half of the remainder will conceive within two years. The word ‘infertile’ only comes into play if pregnancy hasn’t occurred after this time. So it’s not surprising then that the question of fertility wouldn’t even cross the minds of a couple trying for a second child – which makes it all the more shocking and distressing when they discover there’s a problem.

But what’s the cause? "There can be a variety of reasons for secondary infertility,” says Whitcroft, who points out that underlying medical conditions can kick in after the birth of the first child. “A woman's tubes can become blocked after the first delivery, or underlying insulin resistance, when our bodies do not process insulin properly, can result in polycystic ovaries and poor quality eggs. This leads to a higher rate of infertility, miscarriage and problems during pregnancy." Mental and emotional issues, such as post-natal depression or anxiety following a traumatic first-time delivery, as well as low sperm count in the male can also be contributing factors.

Whatever the reason, secondary infertility is thought to be increasing and affects as many as one in five couples.

And the distress felt by many mothers may be compounded by lack of sympathy or support from others. "Friends and family can unwittingly cause hurt by constantly asking, 'when are you going to have another one?' and not realising there's a problem,” explains Whitcroft. "And mothers may feel huge guilt that they don't regard their first child as enough. If they get completely taken over by wanting another - as some do - it can cause real division and resentment between the couple and in the family."

Some also believe that parents of single children should be content in having one child, compared with those who suffer the heartbreak of total infertility.
"There is this attitude - 'isn't one enough for you?' and that can even be found amongst medical professionals,” says Zita West, a fertility consultant and midwife who runs Britain's largest integrated reproductive health practice in London. "But women, who feel their family isn’t complete until they can provide a sibling for their child, simply can't let go of that need and will explore every avenue hoping for success."

West says around one in 10 women who visit the practice is suffering from secondary infertility, and that the numbers may be rising because many women are delaying motherhood. "If they have their first child later in life, when it comes to trying for another not only might they have to deal with declining fertility, but they’re also more likely to be exhausted from caring for the first child while trying to juggle a career and childcare.”

After failing to conceive a second time, Sarah Jessica Parker, 45, reportedly donated her own eggs so that a surrogate could give birth to her twin daughters.

Jane Frankland, 41, is a volunteer at Surrogacy UK, an organisation set up in 2002 with the aim of providing information and support for those interested in surrogacy. She has suffered secondary infertility and has acted as a surrogate on two occasions. "I don't think you can know what it feels like not to be able to have a second child until you’ve experienced it,” she explains. "The grief is heightened because after loving one child you know just what you are missing by not being able to create another."

She's about to embark on her third surrogacy for a woman suffering secondary infertility.

"Mums of one may feel enormous guilt that they can't provide a sibling for their first child, and worry that he or she is missing out on all that extra companionship and love,” Frankland says. "It can be like a knife in the heart when your child asks, 'When can I have a brother or sister?' Going to the school gate is also quite jarring as you’re forced to see other mums either pregnant with a second baby or with a little one in a pushchair, or notice children rushing up to greet their baby brothers and sisters. It's like a club you feel completely excluded from."

To ensure that you and your partner have the best chance in conceiving, we recommend the following:
:: If you haven’t conceived after a year of regular intercourse, without contraception, then make an appointment to see your GP. Infertility is a joint problem so it’s ideal to see your doctor together with your partner.

:: Early diagnosis and treatment of secondary infertility is especially important in older couples, particularly in the case of women over the age of 35, who should make an appointment after six months of trying to get pregnant.

:: If you have a history of amenorrhoea (no periods), oligomenorrhoea (infrequent periods), pelvic inflammatory disease (PID), or if either you or your partner has had treatment for cancer, you should also seek medical advice sooner rather than later, as you may need to be referred to a specialist.

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