Why a second child can be hard to conceive

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iol life dec 29 IVF

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Following a break-up from a boyfriend of seven years, she feared she might never become a mother and at the age of 30 decided to give away her eggs because she wanted 'a part of me out there'.

When Charlotte Claydon’s son, Thomas, turned two, she and her husband, Tim, decided it would be the perfect time to start trying for an addition to their family. Just 29, healthy and with living proof that she could conceive, she assumed it would be just a matter of time before she had some happy news to share with family and friends.

“We had this idyllic plan that another baby would come along within three months,” says Charlotte, now 39. “As each month passed I just thought it would happen next time. I was young and I didn’t really start worrying until nine months had passed.”

Concerned, but not unduly worried, Charlotte visited her GP. She left feeling reassured. Her doctor told her that if she could have one baby with no problems, then there was no reason why she shouldn’t fall pregnant with another.

His advice? Relax, stop stressing and let nature take its course.

But nature had other ideas. Returning to her doctor after another nine months, Charlotte explained her desperation, but, because she already had a child, didn’t feel she was being taken seriously.

Eventually, her doctor acknowledged that she might be suffering from fertility problems, but it was only through her own research that Charlotte discovered what she was suffering from had a name: secondary infertility.

Far from being alone in struggling for a second child, she found that the condition - which often remains unexplained - is believed to affect as many as one in five couples.

Just a few weeks ago Radio 2 Breakfast Show presenter Chris Evans gave an insight into the agony of the struggle to have a second baby.

He revealed in his Mail on Sunday column that his wife, Natasha, 31, was pregnant again nearly three years after the arrival of their son, Noah, but explained it had not come easily.

“Like a lot of couples, becoming pregnant this time was not easy, to the extent that it was beginning to feel like it may never happen,” he wrote.

“Tash’s first pregnancy was practically textbook, so naively we thought a follow-up kid would be a cinch. Not so, however.

“Tash did fall pregnant 18 months ago, but the pregnancy became ectopic, we lost the baby and, quite frankly, we almost lost my wife.

“After that, Tash’s situation was different and we were forced to go down the route of IVF. There have been a few false starts before striking gold.”

While the ectopic pregnancy doubtless contributed to the Evanses’ struggle, the feelings they experienced are something Charlotte can relate to. She, too, turned to IVF for help; the five-year struggle cost her and her husband £20,000 before she finally fell pregnant ... naturally.

So what had changed? Why did a baby finally arrive after so many years of frustration? Charlotte’s doctors simply don’t know.

While one in six couples will experience the heartbreak of primary infertility - where the woman is unable to conceive or carry a baby to term for known or unknown reasons - secondary infertility (SI) remains far more mysterious.

Rarely discussed, poorly researched yet, seemingly, on the rise, it’s a condition that leaves many fertility specialists scratching their heads. Worse still, it often garners little sympathy because those affected do, at least, already have one child.

Consultant gynaecologist Peter Bowen-Simpkins, director of the London Women’s Clinic, says: “The common view is ‘you should be thankful for what you have got’, but in my experience, people who can’t have a second baby are very, very distressed because they’ve been able to do it once and they can’t do it again.

“For the majority of couples, it is just as stressful and upsetting as if they had never got pregnant in the first place.”

Fellow consultant gynaecologist Dr Stuart Lavery, of Imperial College Healthcare, agrees. “I think there is considerable trauma in trying for a second baby, and we as a society underestimate it.”

One explanation for the rise in secondary infertility is delayed motherhood. The average age of women giving birth in the UK is now 29.4 and more women over 40 are having babies than ever before.

“In all of us, men and women, the older we are, the more likelihood there is of things going wrong,” says Dr Lavery.

In women, egg quality can deteriorate while hazards such as polyps, cysts, endometriosis and fibroids can appear at any time. Men, in turn, may find that their sperm count and quality has declined.

Lifestyle factors also come into play: alcohol, stress, weight gain or weight loss can all reduce fertility, especially if these have drastically altered since the birth of the first child.

Specialists such as Dr Lavery treat SI very differently to primary infertility. “The couples have already proved everything works, therefore we have to look at what’s happened to make it more difficult this time around,” says Dr Lavery.

“Normally with baby number one, we say you should be trying for about a year before seeking help, but if number two has not happened after six months of trying, we recommend taking action.”

Charlotte, a student support manager from Stevenage, Herts, did take action, but the heartache of her secondary infertility was compounded by the discovery that NHS fertility treatment is not available to those who already have children.

Throughout her private treatments, which included IVF and IUI (artificial insemination), Charlotte also found there was little sympathy for her plight even among friends and family. “My mother would say to me: ‘You’ve got a child already, you’re lucky’,” she says.

“It was an emotional rollercoaster. Every time a procedure failed, I had to cope with the physical demands my body was under and the emotional strain, which was made worse by this sense of guilt from knowing that while I was desperate for a second child, other people were struggling to have even one.

“A very close childless friend was going through IVF at the same time as me. I felt that while everyone was very sympathetic towards her, when my attempts failed the response was: ‘Oh, never mind, at least you’ve got Thomas’.”

In early 2005, Charlotte’s attempts to have a baby left her in hospital with ovarian hyperstimulation syndrome, a dangerous complication that occurs when the body reacts against IVF drugs.

“My stomach was bigger than it had been at 32 weeks pregnant, but by that time you don’t care - if they say you’ve got to parachute off Mount Everest to have a child, you would probably do it,” she recalls.

“I vividly remember my mum saying: ‘You’ve got to stop these endless attempts for another child because you are going to kill yourself, and the child you do have will be without a mum,’ “

Charlotte decided to have one more try at IVF, but first she decided to visit acupuncturist Gerad Kite. After just four sessions, she was pregnant with son, Max, who arrived in April 2006. Clementine, now four, followed completely unplanned a year later.

“I think the huge difference for me was how I felt emotionally,” says Charlotte.

“I don’t know how my feelings changed so quickly, but after one session I remember thinking: ‘It doesn’t matter if I don’t have another baby.’ Once I stopped obsessing, it happened.” Midwife and fertility consultant Zita West believes the busy lives of modern women play a significant part in secondary infertility. She points out that just getting over having a first baby can take 18 months, and the additional stresses of work, sleepless nights, finding time for sex, only fuel the problem.

“Women have an idea about how many children they want and when they want to have them,” she says. “But sometimes your body just won’t follow the schedule you’ve planned for it.”

She advises women to try to avoid allowing their condition to take over their lives as this increases stress levels which can impact on fertility. “Mind over body is the biggest factor. Anything a woman can do to regain equilibrium will help her chances of conceiving,” she says.

Mr Kite, who treated Charlotte, agrees. He says he’s helped more than 300 women with secondary infertility to conceive - the majority are over 35 and starting to panic.

Mr Kite thinks that today’s women have become too focused on ‘the plan’. “Before IVF, there was a greater acceptance that babies come when they come,” he says. “Now everyone has a timetable. They’re going to have their first child at 32 and second at 34.

“When it doesn’t work like that, people don’t step back and accept: I’m not in control of this.” The only thing we have control over is how we look after our bodies.” It’s a heartbreaking deadlock Catherine Warrilow, from Abingdon in Oxfordshire, still cannot see a way out of.

She has been struggling to have a second child for two years, and is trying not to let her quest dominate her life.

The 32-year-old, who runs her own PR business, and husband, Tim, a 32-year-old civil servant, were on a four-month worldwide holiday - an extended honeymoon - when they conceived son Noah, now three, back in 2007.

“We’d planned to start trying officially when we got home in January,” she says. “But it was November and we were in Kuala Lumpur when my period was late and I discovered I was pregnant - it was pretty much the first month of not using contraception.

“I had been quite concerned about not being able to have children, for no reason other than I wanted it so much, so for it to happen straight away was incredible.

“We knew we wanted to have two children around 18 months apart, so we started trying again when Noah was one and felt sure everything would be OK.”

As each month passed with no joyful news, Catherine told herself she had been very “lucky” the first time round, and that there was nothing to worry about.

But after six months she decided to go to her GP. “I was aware that our circumstances had changed,” she says. “We weren’t travelling in beautiful places with no money worries - I had a new business, my husband had a demanding job, we had a big mortgage, a house to run and a one-year-old to look after.

“That was the pep-talk stage. The GP told me not to worry, to be healthy, to give it time.”

Reassured, Catherine, who writes a blog about being a mum, titled babygenie, tried to do just that. But soon the endless cycle of hope and disappointment, monitoring when she was ovulating and carefully timing intercourse was taking its toll.

So after a year of trying, Catherine returned to her GP and was sent for an ultrasound scan that revealed a small cyst on one of her ovaries. A laparoscopy - where doctors examined the inside of her abdomen with an internal camera - followed, and then a further ultrasound, but the cyst was shown to be harmless and doctors could find no medical reason why she couldn’t conceive.

It came as both welcome and confusing news. Where do you turn and what do you do if there’s nothing obviously wrong with you? “You want a reason - that’s the hardest thing to deal with,” says Catherine. “You go through a bitter stage of thinking: ‘How can that person who has a really unhealthy lifestyle fall pregnant and I can’t?’”

There was also the guilt. “I’ve got a really good friend who has been trying to have her first baby for three years, and when we talk it’s always in the back of my mind that she doesn’t have what I have. I feel that sometimes she must think how selfish that I’m moaning when I already have a son.

“We are very lucky to have Noah, but when the maternal instinct kicks in it’s overwhelming, and it’s just as strong the second time round as the first time.” - Daily Mail

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