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And Baby Makes Three: When Couples
Experience Secondary Infertility
As a child, Cheryl Crisp always imagined that she would
have four children someday. As part of a happy family with
three other siblings, she was the child who most loved to
play with baby dolls and was singled out to inherit an antique
doll from her grandmother. Never once did she picture herself
as childless or question the possibility that she might have
trouble conceiving.
At age 31, now married to her husband, John, Cheryl learned
the pain of infertility when John experienced problems with
his sperm count. Through in vitro fertilization at Saint
Barnabas Medical Center, they were overjoyed to became the
proud parents of daughter, Abigail, three years later. When
Abigail was a year old, the couple decided to undergo in
vitro fertilization again, but to their dismay, discovered
that Cheryl, now age 36, had begun early menopause and could
not produce eggs. They were now experiencing a condition
known as secondary infertility, the inability to conceive
after having a child.
"It was devastating," Cheryl recalls. "My siblings have
been a lifeline for me many times and it is so important
to me that Abigail is not alone in the world. People say,
she has cousins, but it's not the same thing. I even had
someone say, 'Isn't this a sign that you should only have
one child.' I think if you have the resources and the desire
to have another child, then you should try."
Infertility is defined as the inability of a couple to achieve
conception after a year of unprotected intercourse; six months
if the woman is over age 35. Whether experiencing primary
or secondary infertility, the difficulty generally relates
to egg quality. While the problem with Cheryl's eggs occurred
because of perimenopause, the main cause of poor egg quality
is usually the advanced age of the mother, says David Sable,
M.D., Director of the Division of Reproductive Endocrinology
and Infertility at The Institute for Reproductive Medicine
and Science of Saint Barnabas.
All women run out of good eggs at some point and that point
varies by the individual. Parents hoping for a second child
have often reached the age range where egg quality becomes
questionable. At age 25, a healthy female has a less than
one percent chance of infertility. By age 30, that same woman
now has a one in seven chance of infertility. By age 35,
one third of females will experience infertility, and by
age 37 that number rises to one half. In 1995, over 3.3 million
Americans who reported having impaired fertility had at least
one child, according to the American Society for Reproductive
Medicine.
"When you hear the fertility statistics, you can see how
a couple who conceived easily at age 25 could find themselves
with secondary infertility when they try to have another
at age 35," Dr. Sable explains. "All women will run out of
good eggs at some point and that point varies by the individual."
The patients treated for secondary infertility at Saint
Barnabas are a diverse and growing group. Some delayed having
a second child because of lifestyle or career decisions,
others have remarried and hope to start a family with a new
partner. Still others, like the Crisps, experienced infertility
problems when trying to conceive their first child and have
similar or new problems to overcome to have a second child.
Dr. Sable reports that secondary infertility patients experience
a similar level of stress and frustration as those who have
difficulty conceiving a first child, although it is a different
type of stress. Often, they are often not viewed as sympathetically
as the latter group by friends and family, which adds to
the pain of secondary infertility.
"Someone invariably tells them they should be thankful to
have one child, and that is very unfair and upsetting to
these patients," says Dr. Sable. "Infertile parents know
how wonderful it is to have a child and are reminded every
day of what they are missing as the first child grows out
of babyhood. The first child may also be asking, 'Why don't
I have a sister or brother like my friends,' which is very
painful."
Occasionally couples with secondary infertility are treated
with hostility by those who have not been able to conceive
at all, making the search for a sympathetic support group
more difficult. However, Dr. Sable adds, many people with
primary infertility "understand how painful it is not to
have a child when you want one," and do not begrudge those
with secondary infertility their dreams of another baby.
"I remember when we were having fertility problems the first
time and a cousin of mine was experiencing secondary infertility.
I'm afraid I was very snippy with her when she talked to
me about their situation." Cheryl recalls. "Now that it's
happening to me I can see how hard it is to go through it
and have apologized to her."
At the Institute for Reproductive Medicine and Science of
Saint Barnabas-one of the nation's leading fertility centers--the
principles of treatment are the same for both primary and
secondary infertility. First, a basic evaluation is done
to determine the problem. In addition to problems relating
to egg quality, a smaller portion of couples experience secondary
infertility as a result of scar tissue from a previous birth
or a new condition such as an ovarian cyst or a hormonal
imbalance. Treatment may include anything from a full spectrum
of options, from medical and surgical therapy through assisted
reproductive technologies such as in vitro fertilization
(IVF).
The Institute continually reports pregnancy rates that are
among the highest in the United States. The most sophisticated
laboratory procedures are performed by a highly trained team
of embryologists led by reproductive pioneer Jacques Cohen,
Ph.D., internationally renowned embyologist and Scientific
Director of Assisted Reproduction. Dr. Cohen has over 20
years experience in this area and has supervised more than
15,000 assisted reproductive technology (ART) cycles.
The Crisps decided to use a donor egg to become pregnant
with their second child and are currently waiting for a match.
While a few people in their lives are astonished that they
would go through the time and effort of such a procedure,
many others have been very supportive, Cheryl says. Her sisters,
each of whom has several children, have been particularly
steadfast in their backing.
"Their hearts are broken for us," Cheryl relates. "They
know that it is so important to me that she [Abigail] not
be alone."
For an appointment with The Institute for Reproductive Medicine
and Science of Saint Barnabas, call (973) 322-8286. For information
on becoming an egg donor, please call 1-800-824-3123. Visit
cdc.gov for the latest Clinic Specific Report by the Society
of Assisted Reproductive Technology (SART).
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