Intro

We’ve all been there: gathered around a family dinner, catching up with old friends, or mingling at a party, when someone inevitably turns to the woman who already has one child and asks, “So, when are you having another? Do you want more?” Seemingly innocuous questions, often intended to show interest or make conversation. But for many, these seemingly harmless queries can stir up a whirlwind of emotions and unspoken pain.

The Unseen Struggle

Secondary infertility—defined as the inability to become pregnant or carry a pregnancy to term after previously giving birth—affects millions of women globally. According to the CDC, about 11% of couples experience secondary infertility. Yet it is often misunderstood, due to the assumption of many in society that if you’ve “done it once, you can do it again”.

Struggles conceiving a sibling for your child are extremely common, in fact it is estimated that around 50 percent of all cases of infertility are secondary infertility. 

The societal expectation that women can and should easily have more children often overlooks the complex, deeply personal realities many face. 

When we ask women if they want more kids, we’re often assuming several things: that they can conceive again without difficulty, that they want to, and that they’re not grappling with any form of other issues. These assumptions can be not only inaccurate but also harmful. For women experiencing secondary infertility, each inquiry can feel like a reminder of what they long for but cannot achieve, sparking feelings of inadequacy, frustration, and shame.

Common Causes

Secondary infertility is a complex issue that can stem from both female and male factors. Here’s a closer look at the causes and how they break down:

The Statistics

• Female Partner: About 33% of infertility cases are due to issues with the woman.

• Male Partner: Another 33% of cases are linked to the man.

• Both Partners: The remaining 33% arise from a combination of problems in both partners.

Women and Secondary Infertility

Egg Quality or Quantity

A woman is born with a finite number of eggs, which decreases over time. As she ages, the quality and quantity of her eggs diminish, reducing the likelihood of natural conception. Women are most fertile in their mid-to-late-20s. After 35, fertility declines more rapidly. This natural aging process means a woman who had no trouble conceiving her first child might struggle with her second as she grows older.

Fallopian Tube Issues

Damage or blockages in the fallopian tubes can prevent eggs from traveling to the uterus. These blockages might result from infections, surgeries, or conditions like endometriosis.

Uterine Problems

Scarring from a C-section or the presence of fibroids can interfere with implantation and pregnancy.

Endometriosis

This condition, where tissue similar to the lining of the uterus grows outside it, can affect the ovaries and other reproductive organs, leading to infertility.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder causing irregular menstrual cycles and elevated androgen levels. It often leads to the development of small cysts on the ovaries, which can prevent eggs from being released.

Lifestyle Factors for Both

An increased BMI, overall depletion and certain medications can disrupt ovarian function and reduce fertility.

Men and Secondary Infertility

Sperm Issues

Male infertility often results from sperm problems, such as low sperm count or poor sperm quality. Low testosterone levels, blocked ducts, and certain medications can cause a low sperm count.

Sperm Abnormalities

Abnormal sperm shape or motility can hinder the sperm’s ability to reach and fertilize the egg.

Azoospermia

This condition occurs when a man has no viable sperm, often due to genetic issues, hormonal imbalances, or blockages.

Varicocele

A varicocele is like a varicose vein in the scrotum, raising the temperature of the testes and potentially disrupting sperm production.

Anti-Sperm Antibodies

Both men and women can develop antibodies that mistakenly attack sperm, making conception difficult.

Breaking the Silence

The stigma surrounding infertility often leads women to suffer in silence. While primary infertility has slowly begun to find its place in mainstream conversations, secondary infertility often remains shrouded in silence. With judgment from those around us of the implications for our existing children on the sizes of our families, the “only child” concern, be that through choice or circumstance.

So, how can we shift the narrative? It starts with mindfulness and empathy. Before asking about family planning, consider the potential implications of your question. Instead of focusing on whether someone will have more children, try to engage in conversations that celebrate their current family dynamic, whatever that may be.

For instance, instead of “When are you having another?” you could say, “Tell me about your family!” This opens up space for the woman to share as much or as little as she feels comfortable with, without the pressure of expectations.

Educating ourselves and others about secondary infertility is crucial. By understanding that this condition is a real and challenging issue, we can foster a more supportive environment. 

Celebrities and public figures who have bravely shared their own struggles with secondary infertility, such as Courteney Cox and Brooke Shields, have begun paving the way for more open dialogue. 

Support groups, like those from organization REVOLVE, both online and in-person, can provide invaluable resources for people facing secondary infertility. These communities offer a space for sharing experiences, advice, and emotional support. Encouraging women to join these groups can be a lifeline, helping them navigate their journey with others who truly understand.

The Bottom Line

In our quest to connect and show interest in each other’s lives, let’s be mindful of the questions we ask and the potential impact they carry. By normalizing conversations around secondary infertility and approaching family planning topics with sensitivity and respect, we can create a more compassionate and supportive society.

Remember, every woman’s journey to and through motherhood is unique. Let’s honor that journey with understanding, empathy, and an open heart. So next time you feel tempted to ask a woman if she plans on having more kids, pause and consider a kinder, more inclusive approach. Because sometimes, the best way to show we care is by simply listening and being there.