When you can't have baby number two

When planning to grow your family, fertility problems can come as a real shock. Photo / Getty Images

When planning to grow your family, fertility problems can come as a real shock. Sarah Murray reports on why more and more women are finding it so hard to conceive baby number two.

When mum of one Kirsty Fletcher moved her son out of his nursery she initially kept his room "as is". The room had all the usual nursery paraphernalia, as well as a bookshelf brimming with colourful books and toys, and a Dr Seuss quote stuck to the wall. The quote is still there, but the bookshelf is empty and a queen bed has replaced the cot, change table and nursing chair. "It's our spare room now," says Fletcher. "I guess I changed it enough to be a functional spare room. But not enough that I couldn't make it a nursery again in an instant."

For Fletcher, 32, turning that room back into a nursery again is her most heartfelt dream. With one son, Mackenzie, now 5, Fletcher has been trying to have another baby for more than four years. But her plans have so far been thwarted by a condition called Secondary Infertility — a very blanket term for a very personal experience. And as for most families facing it, it came as a real shock.

"I didn't even know it was a thing," she says. "I was completely naive to what infertility was like before I had my son because I got pregnant straight away. But once you have one, why would you think you can't have another?"

It's a question more and more parents are asking themselves. Generally Secondary Infertility is "the inability to get pregnant or carry a baby to term after previously conceiving and giving birth to a child". Exact numbers on the condition in New Zealand are scarce as the Ministry of Health does not collect infertility treatment data by diagnosis. But international records from a Statistics Canada Survey show the number of those suffering from it is one in six.

When I meet Dr Mary Birdsall in the Auckland Clinic of Fertility Associates, the ultrasound machine hums in the background. Her framed degrees from the University of Auckland and Oxford are strung up on the wall, and a hefty box of toys lies in wait in the corner.

"Yes, that's right," says Birdsall nodding when I mention my surprise at seeing toys in a fertility clinic. "We have a big number of people coming to see us because they're having trouble making baby number two." The number is so big in fact; she estimates at least 50 per cent of their client base are suffering from Secondary Infertility. The condition itself is rather ambiguous and can be caused by a range of issues such as impaired sperm production, fallopian tube damage, ovulations disorders or complications related to prior pregnancy or surgery. But the biggest factor? Age.

"I think Secondary Infertility is on the increase because we're starting our families later. So people don't have the opportunity to have the number of children they set out to have," says Birdsall. "Maybe a couple got together in their 30s, had a couple of years to make baby number one and then baby number one isn't a good sleeper, so by the time that child is 2 they're only just thinking of making another baby. For some women, their biological clock has run out."

Fletcher, a relief teacher in Christchurch, was 26 years old when she had her son Mackenzie, and 28 when she started trying for number two — not old by any standard. Currently the median age for women in New Zealand to give birth is 30.3 years, almost five years older than their counterparts in 1970 who were giving birth at 24.9 years. After "trying" for a year and a half, in which time she had two miscarriages, Fletcher decided to go to see someone. The test results came back saying she had low AMH levels, meaning her egg reserves were low, so she started a round of drugs, first clomiphene and then Letrozole to try and stimulate ovulation and boost her fertility. When they didn't work she was told IVF was the only option.

Kirsty Fletcher plays with her son Mack, 5, at their home in Christchurch.

"Everyone thinks IVF is going to work — especially on paper. I was young, my husband was young, we didn't have any problems, we don't drink or smoke and we had a child already. Why wouldn't it work?"

And yet, so far it hasn't. You can hear the exasperation in her voice as she tells her story. They've almost completed four rounds of IVF, had four further miscarriages and what she calls two chemical pregnancies. On top of the IVF she's tried weekly acupuncture, intralipid infusions (a treatment administered intravenously to help prevent implantation failure), had a pipelle biopsy to encourage the lining of her uterus to grow thicker, and done both the Bondi and Colorado protocols which involve blood-thinning injections, steroids and antibiotics. She's currently seeing a reflexologist. What can make an already stressful situation even tougher though is the financial burden. While women with secondary infertility are eligible for public funding for IVF, due to the point system in New Zealand they are ranked down if they already have a child. This means either a longer wait (time most women don't have) or funding it themselves. Fletcher opted for the latter and estimates, with the IVF and other treatments, they've spent about $50,000 so far.

Secondary infertility is a difficult space to be in. With a child, it's only natural that you're surrounded by other children, but also often well-meaning friends announcing pregnancies and what may seem like a never-ending supply of babies. "Sometimes I feel like I can't escape," says Fletcher. "The first question any mum from school or preschool ask is 'do you have any more kids?' When you say 'no' I can see it's not the usual response. It's when people make comments about how hard their life is with three children, and then they look at me. I'm thinking, 'Do they think I've got it really easy because I've only got one?' They don't realise I'd do anything to be in their position."

The IVF process; the appointments, the procedures, the tests and setbacks are exhausting — especially while running after a child. And the emotional impact can be confusing as the desire to grow a family isn't something that's easily abandoned. Birdsall agrees: "I think it's a real source of heartache and stress for an enormous amount of people because society doesn't recognise it as an issue. They're getting more supportive towards primary infertility, but Secondary Infertility? Not at all. I think society can be really dismissive and harsh for couples for whom baby number two isn't arriving," she says. "And for some people Secondary Infertility is even worse than primary infertility because and you don't feel like your family is complete."

Added to that, the experience can be incredibly isolating as women don't fit into the typical infertility mould. Fletcher joined online IVF and fertility groups but says while it was helpful when asking about procedural questions she didn't always feel like she fitted in.

"Most people there don't have any children. I have one, so I kind of felt guilty that I've got one already. It was probably me putting that on myself because I didn't really openly talk about the fact I had a child already." But it was through one of the fertility groups that Fletcher found a Secondary Infertility group where women are not only supportive, but on the same page. "When people write comments it's often exactly like how I'm feeling. Like when Mackenzie turned 5 and started school, it was such a huge milestone that you don't think you'll get to without having another child at home. And a lot of people also felt that and made similar comments."

While the only explanation for Fletcher's Secondary Infertility is low egg reserves, Ryl Gormack, 45, knew exactly what had caused her. Following the loss of a baby she had what she thought was a routine D&C (dilation and curettage), a surgical procedure that scrapes any remaining tissue from the uterine wall after a miscarriage. But the doctor went too far. "At certain points of your cycle your lining is meant to be around 10-16mm thick. A month after the surgery my lining was 1-2mm. Everything was gone," she says. "At that stage I was completely infertile. I was scarred shut." Gormack, who at the time had one daughter, was diagnosed not only with Secondary Infertility but also Asherman's Syndrome, a condition characterised by the formation of scar tissue inside the uterus. She had eight procedures and surgeries in two years, took on "bucketloads" of estrogen, went to genetic counselling after they found out a part of one of her chromosomes was flipped before finding out her husband had what she calls "some wonky swimmers". Gormack got pregnant again but lost the baby. "I thought 'oh my God' are we ever going to be able to have another baby?"

Ryl Gormack at her home in Waikanae.

"Some people would say 'oh you're lucky to have one child, be grateful," says Wellington-based Gormack. "Even we got to thinking that way. We thought if we can only have one, we will live out our dreams and accept that. But I always remembered a doctor once said to me: "It doesn't matter if it's your first baby or your sixth, it's still got that emotional tag to it because it's what you desire, it's what you want."

Desperate for their second child, Gormack and her husband started looking into adoption, however a month after they attended an adoption evening she naturally conceived her long-awaited second child, Joe, now 8. But it was a long, lonely road to get there. "We only had each other to rely on. And Kate [now 12] was sick a lot as a toddler so we lived in the after-hours clinics. She needed help getting to sleep at night and I just couldn't do it. I couldn't do the quiet time because my head was bursting with the loss of the babies, the procedures, the what ifs and it was too hard. So I gave that job to my husband so I could watch TV and be in another world for a bit."

Even when pregnant with Joe, Gormack was so nervous she refused to buy any baby clothes until he reached the 28-week mark. "I knew it was then that he could survive if I gave birth early."

Like so many mothers facing Secondary Infertility Gormack, who helped found the International Asherman's Foundation, worried about the potential age gap of her children. "But it's worked out fine," she says of the four-year age gap. "That's the important message — it doesn't matter how big the gap gets because you're a family, you learn to work with your own dynamic. I think people can have fixed ideas but when it comes to infertility you have to let go of those fixed ideas. You have to allow things to happen and not give up hope."

But realistically, is there hope for these families? "Absolutely," says Birdsall. "There is good hope. They've had a baby before so its shown their bodies can do it," she says.

Understandably, for Fletcher, hope is waning. "It's just been fail after fail and it doesn't seem to be working," she says. "We've had the surrogate conversation because if this next transfer doesn't work it's a very real thing we'd have to go down if we want another child."

"I often say to my husband, even when IFV is finished, I don't know how not to have this in the back of my mind. I'm 32 with unexplained infertility and most people could probably keep trying to have a baby until they're 40. There is still a small chance we could get pregnant naturally. I don't know how to not secretly hope for the next eight years that maybe it will work," she says. "I just don't know how to turn that off."