Getting Pregnant For Dummies. Sharon Perkins

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the midnight oil trying to rock Junior to sleep? Again, even subtle changes such as a shift in your sleep patterns can wreak havoc on your system, which can leave your fertility in less than fighting shape.

Another thing to consider and discuss with your OB/GYN is any lasting effects from your previous pregnancy(ies). Could you have developed adhesions as a result of a caesarian section? While it is possible to develop adhesions, this is relatively uncommon. One study reviewed the literature and reported a 10 percent increase in infertility after a C-section. However, if the delivery was complicated, then subsequent pregnancies may be difficult. For example, retained placenta requiring a D&C, especially if there was an infection, may cause uterine scarring. Did you have problems with excessive bleeding that may indicate unresolved issues? Make sure that you check out as normal from your last foray into baby making before jumping into the next.

      The other large category of problems in secondary infertility is the status of the pelvic organs: Are you having abnormal bleeding (especially between periods) that may be indicative of a fibroid or a polyp in your uterus? Have you had any kind of abdominal surgery since your last delivery (appendectomy, gall bladder surgery, ovarian cyst removal)? All surgery is associated with a risk of scarring (adhesions), which may either block the fallopian tubes or pull them away from the ovaries so that they cannot pick up the ovulated eggs. The good news is that all of these conditions can be identified with the use of appropriate diagnostic tests that your doctor can order.

      

Throughout the process of secondary infertility, make it a point to take optimal care of yourself through nutrition, rest, and exercise. You will need to be in tiptop shape to handle children in multiple forms; this would be a good time to start the process.

      Changes in partners

      No, we’re not suggesting you go out and look for a new partner if you’re not getting pregnant the second time. But you may be focusing on the wrong part of the equation, if you’re only thinking about what‘s different with you this time around. Remember, primary infertility is split fairly evenly between women’s issues, men’s issues, and those issues that are shared by both. If you have changed partners since your last child, perhaps the problem lies with your other half. Has he recently taken up running marathons? Has he developed a passion for spending hours in the Jacuzzi? Has he built a Finnish spa in the backyard that he loves to sit in and binge-watch Netflix?

      Just as with you, your partner’s health status can change over time as well, having a less-than-desirable effect on his contribution to the baby mix. If you’ve been checked out in all areas, maybe it’s time to check, or recheck, dear old dad.

Dealing with the Emotional Pain

      “I’ll be happy when …”

It’s easy to place caveats on joy, particularly when it comes to getting what you want. Remember when you thought/said/prayed/swore that if you could only conceive this one child, you would never ask for anything again? Like many “foxhole prayers,” it’s easy to forget previous promises. It’s human nature.

      While some couples are more relaxed the second time around, others bring the same intensity to conceiving number 2 (or number 3!). As with everything in life, it’s how you see the situation … is the cradle half empty or half full?

      Longing for another child

      “Another child is a bonus,” a friend once said in describing her desire to have another child. She and her husband are forever grateful for their beautiful daughter, and their one and only has given them their dream and a wonderful life to go along with it. This friend has not conceived again since her four-year-old daughter was born, but she has stood by her promise. While she may occasionally dream of giving her child a sibling, she is ultimately happy and satisfied.

      While this mindset may be an ideal, it is certainly not shared by most and more often forgotten by many. Secondary infertility can, and often is, every bit as painful as the first go-round. Some friends have said that it can be even more difficult. Suddenly, you are thrust into the world of children where everything seems to come in pairs, if not higher multiples. The “lonely only” child is regarded by many in the child-abundant world as somehow missing out, whether it be in social interaction or family dynamics.

      

You can’t miss out on what you don’t have. Children without siblings tend to be higher achievers, quite social, and often leaders in society. And you can certainly have spoiled, lonely, or maladjusted children, even amongst large sibling groups. “I don’t want my only child to grow up spoiled,” whine many parents. Yet, upon having baby number 2, many of these families find that indeed they don’t have one spoiled child anymore, they now have two! Remember, history repeats itself. Don’t assume that another child will miraculously convert you … or your parenting skills. That’s a job that you have to do, whether with 1 child or 20.

      Losing support the second time

      Another emotional dilemma of secondary infertility can be the lack of support from those who once mopped your tears. “Be thankful for the child you have,” family and friends may snap at you impatiently. It’s hard to explain that you’re immensely grateful and through the joy of conceiving, delivering, and raising your first son or daughter, you have awakened your own inner parent, one that dreams of adding to the flock.

You can’t quantify pain, particularly not that of another. Many women grieve as much for the inability to have child number 3 as others do for number 1. Dreams are highly personal and don’t generally adjust themselves too easily to life’s ups and downs. But, explaining that to family and friends who don’t understand can be as challenging as any other aspect of secondary infertility. Even “classic” forms of support, including the internet, often disregard those suffering from secondary infertility, claiming that at “least” they have a child.

      

Dr. R says, “I once had a patient who consulted me at age 40. She had four children but wanted to have another. I was much younger then and far smarter than now, so I found this almost inconceivable — pun intended. As so often happens, she taught me invaluable information about the desire to have children. After much discussion and negative predictions, we attempted IVF. It did not work. Again, after considerable consultation and negative predictions on my part, we did IVF again and again and again. And guess what — on that fourth try she conceived and now has child number 5. This single case report is in no way endorsing endless IVF, but it does demonstrate the medical limitation to predicting the outcome. And it emphasizes that each individual has a different drive for children. As a follow-up, she knew when she started to try for number 5 that that would be the last. And true to her plans, five was enough — she did not return for number 6. She thanked me after the delivery because she acknowledged that she knew I did not think it would work. I tried to tell her how much her willingness to work with me helped so many patients who came after her.”

      You are not alone. Look for specific friends and organizations, whether online or in person, that address some of the issues of secondary infertility. You may be surprised, upon getting to know other parents in your child’s playgroup, to find that others have or are dealing with the same issues.

      After a particularly painful second-trimester loss of a second child, Jackie was swinging her daughter Ava in the park one day in between two pregnant mothers (just for the record, Jackie was there first!). As Jackie quietly bemoaned her fate, feeling sorry

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