When One Isn't Enough Health Article

The causes— and the cures

The culprits behind secondary infertility are almost always the same ones that lead to primary infertility: irregular ovulation, endometriosis (which can block the fallopian tubes or ovaries) and fibroids, says David Adamson, M.D., a fertility expert and clinical professor at Stanford University in California. "Unfortunately, a lot of physicians say, 'You got pregnant. Don't worry,'" he says. "They're slow to refer patients to specialists." And that lack of urgency from doctors may be the most vexing simply because many causes of infertility can be treated fairly easily if discovered early. But the longer women have to wait, the less likely they are to become pregnant, naturally or otherwise.

In about one in 10 cases of secondary infertility, however, the problem is a consequence of prior pregnancy. Postpartum infections, even those that are treated, can block tubes or cause scar tissue, which may foil conception, says Dr. Adamson. Similarly, levels of the hormone prolactin may not normalize after birth, which can interfere with ovulation. "These problems are rare but real," Dr. Adamson says.

Mancini learned the probable culprit behind her miscarriages a year ago: a rare blood-clotting disorder, likely triggered by childbirth, that can hinder blood flow to the placenta. Though that condition could be treated, Mancini has also been diagnosed with premature ovarian failure, which makes another pregnancy nearly impossible. She and her husband are now considering adoption. More typical of secondary problems is the three-year infertility odyssey of Jinah Tak-Lau, 37, a pre-school teacher in Glenview, Illinois. She had been diagnosed with endometriosis in 1994. With her condition, she expected trouble conceiving the first time and was thrilled when she got pregnant at age 29 with her son, Kendrick, within three months of trying. But when she and her husband tried again a year and a half after her first child was born, their good fortune ran out. She spent the next 18 months undergoing treatment, including surgery to remove scar tissue and a failed IVF cycle.

Devastated, Tak-Lau quit her job to reduce stress, spend more time with her son and get her body in better shape to bear another baby. She started exercising, dropped 20 pounds and even consulted an herbalist before reentering the high-tech infertility world a year and a half later. After a second cycle of IVF, the couple conceived a daughter, Sophia, now 2 years old. "Finally," she says, "we feel complete as a family."

Still, other families learn to feel complete as three instead of four. That was the case for Margie Klayman, 41, a teacher supervisor in Mansfield, Massachusetts. "When I couldn't get pregnant a second time, my husband said, 'Let's love what we have and have a life.'" With time, Klayman also focused on the benefits of one: "We enjoy doing things on our own, and when Lili goes to bed at night, we can still do that," she says. "Plus, we're in our 40s, and our daughter can be exhausting!"

Beth Howard is the author of Mind Your Body: A Sexual Health and Wellness Guide for Women (St. Martin's Griffin).

*Name has been changed to protect privacy.