When parents must change their plans

Secondary infertility a hidden problem for many

By CHERYL POWELL
Knight Ridder Newspapers

At the time, Leslie and Mark Csernyik didn’t realize how incredibly lucky they were to conceive their bright-eyed daughter after just three months of trying.

So the couple expected similar results when they decided the time was right to give Julia Marie a baby brother or sister.

More than two years later, they now realize that getting pregnant isn’t always easy the second time around.

The problem, known as secondary infertility, is more common than people think.

“It’s kind of a hidden group,” said Diane Clapp, director of medical information for Resolve, a nonprofit group based in Bethesda, Md., that offers support for men and women experiencing infertility.

“We certainly are seeing more secondary infertility, probably based on the fact that women are trying to get pregnant at an older age,” she said.

A couple is considered to have secondary infertility if the woman has previously conceived and fails to get pregnant again after at least a year of unprotected sex (or six months if she’s 35 or older).

Anywhere from 10 percent to 15 percent of couples face problems conceiving, said Dr. Francisco Arredondo, reproductive endocrinologist at University Hospitals in Cleveland.

“It’s a relatively common event,” he said.

In some cases, couples realize conceiving again could be difficult if they struggled to conceive another child or ended up seeking help from a specialist.

But for other couples, secondary infertility comes as an emotional shock if they got pregnant the first time after trying for a very short time — or perhaps not even trying at all.

For the Csernyiks, there were no warning signs that they’d have trouble bringing another baby into their family whenever they were ready.

Leslie was 29 when she had an amazingly easy pregnancy — no morning sickness whatsoever — and an uncomplicated delivery with her daughter.

“We wanted either two or three kids,” she said. “I always wanted them to be about two years apart.”

So, shortly before Julia’s first birthday, they started trying for another baby. But when their energetic daughter turned 2, they still hadn’t had any success getting pregnant.

Everyone, including her doctor, told the couple not to worry.

“We kind of got put into the category of, ‘You’re putting too much pressure on yourself. It happened once before, it will happen again,’ ” she said. “Because it had happened the first time so easily for us, everyone figured it would happen again.”

It wasn’t until 15 unsuccessful months passed that the Csernyiks went to Dr. David M. Nash, a reproductive endocrinologist with Reproductive Gynecology Inc. in Akron, Ohio.

Nash immediately ran a series of tests, which showed Mark has unusually shaped sperm. Consequently, the couple’s chances of conceiving without aggressive fertility treatments are about 1 percent.

When the Csernyiks packed Julia’s baby items and tucked them into a corner of their basement, they never thought there would be a good chance they would never use them again.

“I think the biggest thing with it being secondary infertility is it’s been a huge mental realization that I don’t have control over it,” she said.

People need to recognize and deal with the real grieving process that comes along with infertility, even if they already have a child, Arredondo said.

“A lot of people, including physicians, believe that people who have secondary infertility should not go through the same emotions because they already have a kid,” he said. “But emotionally, it’s the same. They have to go through the same grieving process.”

Some people minimize the loss, Clapp said.

“The secondary infertility patient feels a little reluctant to talk about how severe their pain is, because they feel like they’re being ungrateful for their first child, which isn’t true,” she said. “Recognize this is a loss. You had a dream for a particular family composition, and it isn’t happening.

“You should be able to validate how awful this is every month when your dream doesn’t happen.”

If a couple has been struggling to get pregnant for longer than a year, they should seek help from a reproductive specialist as quickly as possible, Arredondo said.

The initial evaluation includes a semen analysis, a blood test to evaluate ovarian function and an exam of the fallopian tubes, where fertilization takes place, he said. The tests usually are covered by insurance plans.

“If you think about it, we need a sperm, an egg and a place for them to date,” Arredondo said. “If there’s no place for them to date, they can’t meet.”

It’s also important to get a thorough patient history to discover if anything about the man or woman has changed since they previously achieved pregnancy, Nash said.

“The most important tool is probably history,” Nash said. “I ask them, ‘What is different between now and then?’ ”

Fertility treatments don’t have to be invasive or expensive, Arredondo said.

Some women who don’t ovulate properly, for example, can benefit from oral medications that stimulate ovulation, he said.

“If you grab 100 people who suffer infertility, only 1 to 2 percent will end up doing IVF (in-vitro fertilization) or ‘test tube babies,’ which is the expensive part of it,” he said. “A lot of people who could have been solved with relatively simple things do not seek help.”

To regain some sense of control over their family planning, Arredondo recommends couples have a plan about how far they want to pursue treatments.

Couples should consider this question: How much time, emotion and money do you want to put into it?

“Stick to a plan,” he said. “That would be a good way for them to be in control.”