You probably either know of or are the couple that conceived easily with the first baby.

You know, the woman who stopped birth control and was literally pregnant the next month. Maybe that’s why you find it hard to believe that this same couple can struggle for months and, maybe even years trying to get pregnant with their second child.

While there has been increasing press attention surrounding infertility due to celebrities and public figures discussing their own challenges, there are still stigmas, shame and sadness surrounding the topic. And despite the increased attention to the topic of infertility, there are still not a lot of women who choose to discuss their inability to get pregnant with a second child.

Secondary infertility is as real as primary infertility and carries the same mental and physical burden for couples who hope to grow their families.

Why don’t women want to share their struggles with secondary infertility?

I think part of it has to do with feeling guilty or ashamed. Women who have one child and are struggling to conceive a second may feel like they should consider themselves lucky to have one child, especially when there are so many couples who struggle to conceive their first baby. But I want to echo what others have already said, you should not feel guilty or ashamed for being sad, angry or frustrated about struggling to conceive additional children.

Secondary infertility is as real as primary infertility and carries the same mental and physical burden for couples who hope to grow their families.

The diagnosis can be especially frustrating for a couple who previously had no trouble conceiving their first child.

What is secondary infertility, what are some causes and when is it time to see a fertility specialist?

Primary infertility is defined as the inability to conceive a child after 12 months of appropriately timed intercourse. Secondary infertility is the same definition except that it occurs in women who have successfully had a live birth in the past.

The diagnosis can be especially frustrating for a couple who previously had no trouble conceiving their first child. But, as I like to say, infertility does not discriminate. It does not matter if you have had a previous child with no difficulty, if you are healthy or if you exercise daily. It does not care what your ethnicity, religion or socioeconomic background is—infertility can affect anyone.

What are some causes of secondary infertility?

One important cause of secondary infertility is female age. We know that female age is the number one predictor that can impact a woman's chance of conceiving. As women, we are born with all of the eggs we will ever have, approximately 1-2 million at birth.

By the time we reach puberty we have approximately 300,000 eggs remaining in our ovaries and each month that number decreases as a new group of follicles (with a microscopic egg inside) are recruited for the next cycle. This continues monthly until we have no remaining eggs and we go through menopause.

This means that we know that as woman age, the quantity of eggs remaining will decrease, slowly at first starting around age 35 and then faster in your late 30s to early 40s. At the same time, the quality of the remaining eggs also starts to decline and this is why you see more miscarriages in women over the age of 40.

So when a woman who became pregnant easily in her early to mid-30s carries a baby to term and then decides she wants another baby a couple of years later, the few years that have passed could have an impact on her chances of easily getting pregnant. Even though health-wise she may be in the exact same condition as before, her egg quality and quantity have likely already been impacted to some extent.

Other cause of secondary infertility are similar to those of primary infertility and include:

  • Polycystic ovary syndrome (PCOS) or other ovulatory disorders
  • Uterine abnormalities such as fibroids, polyps or anatomic defects
  • Fallopian tube blockage
  • Hormonal imbalances
  • Endometriosis

If you had a cesarean section or any abdominal or pelvic surgery since you last conceived it is possible you could have developed scar tissue causing a distortion of the normal pelvic anatomy and possibly blockage of the fallopian tubes.

Additionally, if you gained or lost a significant amount of weight since your last pregnancy, you may have difficulty conceiving again.

When should you see a fertility specialist?

It is recommended that you see a fertility specialist after you have been trying to conceive for more than 12 months if you are less than 35 years of age or after 6 months if you are over 35 years of age.

If you have a known condition that may prevent you from conceiving naturally (such as the ones mentioned above) then it may be necessary for you to seek a consultation sooner rather than later.

Don’t wait to seek out expert care.

Don’t feel ashamed for needing help conceiving another child.

I think women need to know that each pregnancy and delivery is its own separate entity and that just because things went one way does not mean they will be the same the next time.

We need to continue to raise awareness that this is a real medical diagnosis that may require medical treatment and that there is no shame or guilt that should be associated with secondary infertility.

What can be done to treat secondary infertility?

Treatment options for secondary infertility are basically the same as they are with primary infertility.

There are options for oral medications combined with intrauterine inseminations (IUI) where a doctor can inject a partner or donor sperm sample directly into the uterus. There is also in vitro fertilization (IVF), a more aggressive form of treatment that involves stimulating a woman’s ovaries to make many eggs, retrieving those eggs and fertilizing them with sperm in the embryology laboratory and subsequently transferring an embryo into the woman.

The best treatment for a couple will depend on several factors, including female age, her ovarian reserve, partner semen analysis and any known causes of infertility.

Read: 9 Unique Challenges of Secondary Infertility

No couple should have to struggle alone with secondary infertility and we need to continue to raise awareness that this is a real medical diagnosis that may require medical treatment and that there is no shame or guilt that should be associated with secondary infertility.

When we are armed with knowledge about our health, we have the power to make informed decisions regarding it.

Secondary infertility is real, it is heartbreaking and it is time to shed light on the diagnosis.