Secondary Infertility

"So when are you going to have another one?"

For a long time, that was a painful question for me to answer. More often now, since I'm over 40 and my daughter, Miriam, is a teenager, I'm asked: "Do you have any other children?" My reply always catches in my throat: "No, she's my only one."

I've spent the last 15 years brushing off the subject of pregnancy with a shrug, a light-hearted comment, or a curt remark, often while fighting back tears. Before I had Miriam, I endured a variety of fertility treatments, and my husband, Joe, and I were thrilled to finally hold Miriam in our arms. We figured our infertility problems were over.

Joe and I figured wrong. We staggered through treatments—this time bearing the extra medical expenses on one less income, since I quit my job to stay home with our daughter—before we decided to stop. Because we still longed for another child, we opted to pursue adoption. But our adoption plans either went awry or were prohibitively expensive.

I've discovered I'm not alone. I'm one of more than half a million women in the United States who know the joy of parenthood while experiencing the heartbreak of reproductive failure. I have secondary infertility.

Caught In-between

Like most people, I assumed that despite my initial fertility struggles, because I bore one child, I could have more. But secondary infertility's even more of a shock to those who've had no previous problems. "If someone would have told me I'd be infertile four years ago, I would have laughed my head off," says Lesley, an Illinois woman. "How could someone who got pregnant twice without trying be infertile?"

Perhaps the bitterest irony of secondary infertility is having to live in a nether world between larger families and childless couples. Helane S. Rosenberg and Yakov M. Epstein, authors of Getting Pregnant When You Thought You Couldn't, put it this way: "You have lost your membership in the primary infertility group by attaining the dream (they) still long for . . . . Yet you feel you do not really belong to the world of the fertile." They call secondary infertility the "loneliest kind," a depressingly apt description.

In addition to this sense of isolation, I'm aware of a constant inner turmoil, a tug of war between joy in the child I have and heartache over the ones I don't. For years I tortured myself, thinking I must be dissatisfied with my daughter and greedy for wanting more. Rosenberg and Epstein explain that "few couples experiencing primary infertility feel their desire to have a child is inappropriate … on the other hand, couples with secondary infertility often feel that one should be enough. … The inability to have more children can be just as psychologically and socially devastating as being childless against your will."

This isn't unique to single-child homes, I've discovered. Harriet Fishman Simons, in her excellent book Wanting Another Child, relates the conflict as a mother of two: "I didn't feel I had the right to want more when so many people had no children."

Well-meaning friends and relatives unwittingly contributed to my anguish with not-so-subtle comments that implied I was obliged to provide siblings for my daughter. My mother, an only child, hated not having brothers or sisters, and felt no qualms in telling me I shouldn't let that happen to her granddaughter. To her credit, when Mom finally understood that wasn't possible, she backed off. Still, I've sometimes felt as though I should apologize to everyone for producing only one child.

In It Together

According to research, men and women deal with secondary infertility in starkly different ways. Harriet Fishman Simons' investigation shows a wife is significantly more depressed by her infertility than her husband, mostly because by nature, a man doesn't have to live with a monthly physical reminder of failed conception.

This has certainly been true for my husband, Joe, and me. Joe's had an easier time accepting the fact that there will only be the three of us. For five years after we gave up on medical intervention, I was consumed with my infertility, alternately talking, crying, and raging about it to Joe, who finally confessed he hardly ever thought about it. He thinks it's "unfortunate" we have no more children. I don't resent Joe's calm, stoic attitude; I wish I shared it!

But my greatest struggle throughout this ordeal has been the fear that if my daughter ever died, I'd be childless forever. I've had to prayerfully, deliberately reject my anxiety and not pass it on to my daughter, allowing her the freedom she needs to develop apart from me.

Where Is God?

My biggest comfort is knowing that God completely understands. He's shown me over and over that he's a loving Father who cares more about me, my family, and our situation than I ever could. I've chosen to place our lives into his capable hands, acknowledging that he's in control, not me. I've learned, as the apostle Peter commands, to "cast all your anxiety on him because he cares for you" (1 Peter 5:7).

But I've also wrestled with Psalm 127:3-5, which says, "Sons are a heritage from the Lord, children a reward from him. Like arrows in the hands of a warrior are sons born in one's youth. Blessed is the man whose quiver is full of them." Rather than looking at these verses as the comfort God means them to be, I often took them as a harsh judgment that I didn't "deserve" another child. I have to keep reminding myself that my standing before God doesn't hinge on how many children I have. I've also mourned that I'm not what Psalm 128:3 describes: "a fruitful vine within (my) house; (my) sons will be like olive shoots around (my) table." It's likely there'll be no more "olive plants" around our dinner table. But I'm grateful God's not taken aback by my emotions, that he forgives and heals, that he grieves with me. While God hasn't taken away what the apostle Paul describes as my "thorn in the flesh," he assures me his grace is sufficient even for this situation (2 Corinthians 12:7-10).

Resolution and Acceptance

After 11 years of secondary infertility, I wish I could say I was totally "over it," but I know there'll forever be an ache inside me for the children who might have been. Barbara Eck Menning expresses it best in her book Infertility: A Guide for the Childless Couple, in which she states, "My infertility resides in my heart as an old friend. I do not hear from it for weeks at a time, and then, a moment, a thought, a baby announcement or some such thing, and I will feel the tug—maybe even be sad or shed a few tears. And I think, There's my old friend. It will always be a part of me."

Just recently, I experienced a sharp pang of envy when the only other family I knew dealing with secondary infertility completed an international adoption of two girls. I worked my way through that, confessing my jealousy and receiving God's comfort, but at the baby shower, I had to slip out as my eyes began to fill. I was happy for them, but incredibly sad that it would never happen to us.

But God gently prods me to keep moving forward. When I lament that others have what I want, I falter in running the course God's set before me (Hebrews 12:1, 2). So I stumble on, firmly holding with one hand onto the One who gave his life for me, and with the other hand lightly grasping another gift he graciously bestowed upon me, my precious daughter.

Penny Schlaf Musco, a freelance writer, lives with her family in New Jersey.

If someone you know is struggling …

1. Don't ask, don't tell. Be careful about asking about further childbearing plans, or remarking about how you wish you had her dilemma so you didn't have to use birth control. While you mean to be supportive, your words can be hurtful. Kids don't necessarily appreciate uninvited remarks either. My daughter sometimes gets annoyed when people tell her she's "lucky" not to have any siblings; she doesn't always feel that way.

2. Avoid stereotyping. There are many misperceptions about infertility, such as a couple just needs to "relax" in order to conceive. A "Christian" version of this is that God's punishing them for unconfessed sin, or that they're not trusting him enough. These are cruel assumptions that imply the problem is their fault and the solution within their control—conclusions that are not supported by medical fact, life experience, or Scripture.

3. Validate her as a mother. One of the most hurtful comments I received came from a friend's neighbor, as a group of us moms were good-naturedly grousing about our kids: "What do you know about childrearing? You have only one child!" It takes just one child to become a mother. Accept the problems, frustrations, and concerns your friend has with her smaller family even if you think she has it easy because you have twice as many at your house.

4. Provide practical support. Trying to balance infertility treatments, a career, and parenting is a daunting task. Offer a sympathetic ear, prayers, and your babysitting services. Those things can go a long way.—P.S.M.

Where to go for help

What to Expect When You're Experiencing Infertility
by Debby Peoples and Harriette Rovner Ferguson (Norton)How to Be a Successful Fertility Patient
by Peggy Robin (Quill)The International Council on Infertility Information Dissemination
Box 6836, Arlington, VA 22206
703-379-9178
www.inciid.org