One & only
What happens when your longed-for baby number two doesn't happen easily - or at all? Many couples struggle silently with the burden of secondary infertility. Kathy Donaghy reports
It was a shock when Pauline Harley (42) found out she was pregnant with her first child at the age of 19. She and her boyfriend Ed, just a year older, had only been dating for a couple of years.
And as all their friends prepared to go travelling the world, Pauline and Ed, both from Dublin, prepared for parenthood. Their son Ian, now 21 and in his final year of college, was born and they became a family.
Ian was 10 when Pauline suffered her first miscarriage. The pregnancy wasn't planned and Pauline was worried because her job at the time didn't pay maternity leave.
When she lost her baby eight weeks into the pregnancy, she was flooded with a wave of emotions - blame and guilt for focusing on how they were going to finance things.
"When I miscarried I got into a cycle of 'it's my fault' even though a few weeks into the pregnancy I felt it would be brilliant for us," she says.
She and Ed decided to try for a baby again and Pauline found out she was pregnant again really quickly. She lost this baby at seven weeks. A subsequent pregnancy ended even earlier, at six weeks.
Pauline went to her GP and this was where she heard the term "secondary infertility" for the first time. "I remember thinking 'what's that?' I just assumed infertility was not being able to get pregnant at all. I thought to myself 'what are you talking about?'."
Pauline was diagnosed with antiphospholipid syndrome, a rare blood-clotting disorder which can cause pregnancy-related complications including miscarriage.
She was put on aspirin to thin the blood and twice more tried to get pregnant. In all she suffered seven miscarriages and after this she and her husband came to the conclusion that they could take no more. "I got to the point where I was fearful of facing another miscarriage," says Pauline.
Over that seven-year period where Pauline was pregnant and then suffering miscarriage after miscarriage, she says she grieved deeply. "It took me a long time to accept it. I felt it was a flaw in my make-up as a woman that was causing this. I think I took it for granted that it was my God-given right to bear another child. Ed was longing for another child as well - I didn't cope with it for years," she says.
"It took me until I had an emotional and physical gun pointed to my head to deal with it. I was grossly overweight and was sick with Crohn's disease. I was resorting to numbing my emotions with nicotine and binge drinking when I'd go out. I couldn't make sense of it".
When Pauline looks back, she recognises that the level of self-blame and lack of self-compassion was phenomenal. "We talk nowadays about bullying but we don't think about how we bully ourselves. I realised that if I kept beating myself up my other ailments were going to spiral out of control. It was do or die for me," she says.
"My husband is patient and supportive and I realised I couldn't bring other people down with me. We had Ian, who is a blessing, and we had kept him sheltered from what was going on because we didn't want it to affect him," says Pauline.
In May 2014, Pauline had part of her womb removed as the recurrent miscarriages had caused so much damage. She says this was the final part of making sense of the puzzle. Losing her job a few months later presented her with an opportunity to reinvent herself and she returned to college to train as a life coach.
"That brought me to a new understanding of who I was and where I was going. I felt I'm never bringing myself down again where I would blame myself. The biggest thing was telling myself the truth: there's things you can control and I let go of all that I couldn't," says Pauline.
"It's hard to stay in the moment when something like recurrent miscarriage is happening to you. But you have to make affirmations around staying in the moment every day. You have to let go of what you can't control," she says.
Her advice to anyone going through something similar is to believe with conviction that it will all eventually work out. "People may never get their baby, but what can you do about it? Believe whatever way it works out, it's the way it's meant to be. I know I didn't feel like that at the time. Forgive yourself. Take it one day at a time," says Pauline.
According to Dr Phil Boyle, one of the country's leading fertility doctors, there's no one single reason for secondary infertility. He says it's a multi-factorial issue and what's causing it for one person is not what's causing it for another.
Dr Boyle, who runs Neo Fertility, based at the Beacon Court, Dublin, says the busyness of life is most certainly a factor. "If you've been too busy for too long, you run out of the reserves your body needs to build the reproduction hormones," he says.
Specifically, Dr Boyle states that the hormone DHEA, produced in the body's adrenal gland, is used up if you're too busy.
Dr Boyle says for couples who have a baby, they're already experiencing the demands of parenting and they're sleep-deprived. And because a lot of people want to have their children close together, they may be trying for a second baby when they are already under pressure.
"When people have moved away from their extended family, it ups the stress level and their body says 'another baby - you must be joking'."
Dr Boyle says the trend for people to have babies when they're older and more financially able to afford a family is also playing a part in what's causing secondary infertility.
However, he says there are things you can do to maximise your chances of getting pregnant - the right nutrition and making sure you take exercise are important factors.
"A lot of people would argue that our food isn't as nutritious as in the past. It's important to make sure your diet is loaded with all the nutrients you need and you also need to try and take some time for yourself."
In terms of other things people can do to increase their chances of conceiving, he says reducing caffeine and getting rid of the alcohol are important steps to take.
Dr Boyle recommends to his patients, both men and women, to take a comprehensive fertility supplement containing high level doses of multi vitamins and minerals when trying to conceive. He says Proceive's advanced fertility supplement, has higher levels of nutrients than most other brands and it's easily absorbed in sachet form. By taking a supplement like this for three months before trying for baby, you will ensure that most mineral deficiencies will be covered, he says and he recommends an omega fish oil as well.
He says it's a big burden for women to carry the hopes of getting pregnant every month only to be let down. "Identify your favourable days for conception and enjoy your relationship - and don't lose sight of each other. A baby is the fruit of your love, not your labour."
He points out that the intensity of emotions around trying for a baby are right up there with bereavement and says being able to surrender and move towards acceptance in the midst of a fertility cycle is important.
Consultant nutritionist Gaye Godkin, who has worked in the area of fertility nutrition for many years, says diet and lifestyle are key when it comes to fertility.
She says poor diet, caffeine, alcohol, smoking and stress all wreak havoc with the body's hormones and people need to take a long hard look at their diet and lifestyle when trying for a baby.
The nutritionist says certain nutrients can make a huge difference to enhancing your chances of getting pregnant, but people really need to get good professional advice in cleaning up their diet. "You need to cut out trans-fats and processed foods and if there's a weight issue, get it under control. This doesn't mean opting for 'low-fat' but by eating healthy fats. Cut down on the amount of meat you're eating and incorporate a diversity of protein in your diet. When I say protein I mean increased plant protein like pulses, beans, lentils, nuts and seeds. Have lots of vegetables and increase your fish intake, particularly oily fish," says Gaye.
"Male and female hormones are made up of fats. Fats are hugely important raw materials that are components of both the sperm and all sex hormones. Cell membranes are made from the various fats and sugars consumed in the diet. A diet high in sugar and processed fats known as trans-fats interfere with the delicate signalling that occurs on these membranes.
"There is no safe limit for trans-fats in the diet. These are artificial fats made from margarine or re-heating polyunsaturated fats. Aim to eliminate doughnuts, white bread, certain pizza, chips, deep fried foods, pastries, biscuits and cakes, unless they are made from butter."
She also warns against falling into the trap of being led down the road of "fads". "I see people with fertility issues and they are at their most vulnerable. If I said stand on your head and drink snake oil they'd do it. They are googling things and will try anything. I really don't think you should take advice from angel-ologists or reiki-ologists on what to take," says Gaye.
"Possibly the biggest anti-nutrient consumed is alcohol. Alcohol is detrimental to both sperm health and female eggs. In excess, it can create havoc on the very delicate female hormone orchestra. Alcohol causes cellular damage to the body and increases oxidation and free radical production. Male sperm is particularly affected by the amount of alcohol consumed.
"Alcohol is rapidly converted to glucose in the blood. Excess circulating glucose damages sperm cells and causes weight gain. Furthermore, alcohol destroys a vital B vitamin called folate in the body - this vitamin is necessary for healthy DNA replication in sperm. Rich sources of folate include lambs liver, green vegetables, avocado, and green lentils," says Gaye.
Getting enough sleep is also crucial when you're trying for a second baby, says Gaye. "Sleep deprivation and exhaustion are hard on the body. Good quality sleep is very restorative and essential for conception. Couples trying for a second baby may have a young child who doesn't sleep well. This can be exhausting. The sleeplessness of life with a small child is hard. In order to support the immune system and reduce stress, getting sufficient sleep should be a priority for couples trying to conceive," she says.
For more information, see gayegodkin.ie; neofertility.ie. and proceive.ie
What is secondary infertility?
- Secondary infertility is the inability to become pregnant or to carry a baby to term after previously giving birth to a baby. Secondary infertility shares many of the same causes of primary infertility. There is no one single cause of secondary infertility.
- One in six couples in this country will face fertility issues with between 20 and 25pc of couples presenting at fertility clinics suffering from secondary infertility.
- Author of Conquering Infertility, Dr Alice D Domar, says that having a child already doesn’t make going through infertility any easier. And she says anger, sadness and anxiety are common among parents struggling to expand their family.
- The US National Infertility Organisation Resolve says secondary infertility is a diagnosis that comes with its own set of stigma and support needs. “Sadly, couples with secondary infertility tend to receive far less social support from others than couples who have primary infertility because the couple already has a child or children. But the need for support should not be ignored. A couple can be extraordinarily thankful for their existing child and still long for more children,” it says.