From the outside Sarah* has it all; a top job in finance, a devoted husband and a beautiful four-year-old daughter. But she’s hiding a painful secret: for three years she has tried and failed to conceive a second child. “We got pregnant almost straight away with our daughter,” explains Sarah. “So we assumed it would be just as easy the second time around.” However, when that didn’t happen, Sarah got increasingly concerned.

“My best friend had her son around the same time we had our daughter. We didn’t plan to be pregnant at the same time, it just happened that way. When she got pregnant with her second son, I felt a rising panic that it wasn’t happening for me. She has now given birth to her second son, and is talking about having a third, and I’m grieving because I won’t have that.” As well as the pain of longing for a second child, Sarah has had to deal with comments from strangers. “Everyone from the old lady in the supermarket to my mother-in-law asks me when I’m going to get a move on and give my daughter a brother or sister,” says Sarah. “People have no idea how hurtful those kinds of comments can be. One friend told me I’d better hurry up, or I’d have a ‘lonely only’ – a comment that stung so much I cried myself to sleep that night. To make things worse, my daughter is now at an age where she keeps asking if she can have a brother or sister. The guilt I feel over not being able to give her that is overwhelming.” Compounding her guilt, says Sarah, is the sense that she should be satisfied with what she already has. “I have a beautiful daughter and I know I am incredibly lucky. Plenty of people struggle to get pregnant at all. But I don’t feel my family is complete. Then I feel guilty for feeling like my gorgeous, talented, smart daughter is not enough.”

Sarah is not alone. Secondary infertility affects a growing number of couples; in fact, it now accounts for three out of five fertility cases). However the condition – defined as the inability to conceive or carry to term a second or subsequent child – is rarely discussed and under-researched. And it comes with a unique stigma: the perception that you should be happy with what you’ve got; that you are not qualified to feel the pain of infertility in the same way a couple suffering from primary fertility does. “There is a lack of understanding around secondary infertility, especially if the couple conceived easily before,” explains fertility expert Dr Marilyn Glenville, (www.marilynglenville.com), author of Getting Pregnant Faster. “There is not as much emphasis put on secondary infertility because you already have a child and so the sense of urgency and emotional pressure on conceiving is deemed not to be the same as experienced by a woman who is trying to conceive for the first time.”

She adds, “It can be hard for women with secondary infertility because many people – and especially those with primary infertility – do not understand the emotional impact of secondary infertility. They think the women with secondary infertility should think themselves lucky that at least they have one child. But this anguish can be just as strong as for women struggling to conceive for the first time.”

The reasons behind secondary infertility are varied, but it can be caused by medical complications arising from the first pregnancy. “Many of the causes of secondary infertility can be the same as primary infertility and for some couples they may have been very ‘lucky’ to have had the first child. But problems can occur in both the man and the woman that were not there when they conceived before. For example, a woman’s thyroid gland may not be operating efficiently since the birth of a child, and healthy thyroid function is critical for fertility. Also, if a woman needed a caesarean in a previous birth this may affect her ability to conceive again. Research has shown that 12 per cent of women who had a previous C-section took longer than a year to conceive again compared to 7 per cent who had a vaginal birth.”

The rising age at which women become mothers is also thought to be a big factor. “Age can affect both men and women in terms of fertility, although it has a stronger link to female fertility,” says Dr Glenville.

Lifestyle factors are also thought to contribute to the condition, especially if you are dealing with the stress and exhaustion of fertility issues while coping with the demands of an existing child and work. “Lifestyle can play a huge part. For example, changes in diet because there is less time to cook healthy food,” says Dr Glenville. “This may result in being overweight, which can affect a woman’s fertility, and there may have been a change in weight since the previous pregnancy. For men, being overweight also impacts on their fertility. Lifestyle issues such as stress, smoking and alcohol intake may also be different from before, and are contributing to secondary infertility.”

Then there is the impact of stressing about your ability to conceive; about the age gap between your first and second child; the stress caused by the first child asking why he or she doesn’t have a brother or sister; and other people telling to get a move on…

“Stress in itself from work, financial pressures, etc can have an impact on secondary infertility, and then there is this added pressure and tension from the stress of not getting pregnant again,” says Dr Glenville. “Women with secondary infertility feel that their bodies have let them down, and are in a constant state of grief and feeling like a failure.” There is a tendency to think, ‘Why, if my body has done this before, can’t it do it again?’ “Women need to be careful that trying to conceive does not become an obsession. This can happen with primary infertility too, but with secondary infertility there is also a child or children to consider. The woman may end up missing what she already has because her focus is on what she hasn’t got.”

If you are affected by secondary infertility, Dr Glenville advises addressing your stress levels first and foremost. “It is important to get help with stress as it can affect ovulation or even cause amenorrhoea [absence of periods]. It can also lower sperm count. Also, think about getting some emotional support, especially if it is affecting the relationship with your partner, which may make it more difficult to have sex as often as needed.”

The emotional toll of secondary infertility cannot be underplayed. Think about it: your house is cluttered with cots, buggies and baby clothes that you’ve clung on to, waiting for baby number two – serving as a constant reminder of the empty hole in your family. And, unlike the case in primary infertility, there is a lack of support out there. The infertility forums are geared towards women without children; women who view you as greedy or selfish.

The good news is that there is hope. With simple lifestyle tweaks, you can up your chances of conceiving naturally. Dr Glenville suggests improving your diet and fitness for at least six months (a year if you are under 35) to try to improve your chances before asking for medical tests like sperm analysis, hormone levels and thyroid function. “Research has shown that making changes in your diet and lifestyle for both you and your partner can increase your chances of conceiving either naturally or with IVF,” says Dr Glenville.

“Many women I see in my clinic are told that they have ‘old’ eggs, and that is devastating terminology. It is true that the eggs in a woman of 35 are older than when she was 20 but it is possible to change the quality of those eggs to either give her the chance of conceiving naturally or achieving success on an IVF cycle if she has to go down that route,” Dr Glenville adds.

“Three months is the magic number to change the quality of your eggs, because it takes approximately that long for the follicles on your ovaries to develop before one is mature enough to release an egg at ovulation. With men, it also takes at least three months for a new batch of sperm cells to mature, ready to be ejaculated. Men produce sperm all their lives so it is always possible not only to improve the quality but also the quantity with lifestyle and nutritional changes.”

A good supplement programme can also boost your fertility. “The most important nutrients for fertility are zinc, folic acid, selenium, vitamin E, vitamin C, omega-3 fatty acids for you and your partner – plus two amino acids, arginine and carnitine, specifically for boosting male fertility.

In my clinic we check to make sure that a client is not deficient in the most important nutrients for fertility. Give yourself time to improve your fertility by eating a healthy diet, taking some key supplements and reducing your exposure to toxins, like alcohol and smoking, which can damage fertility.”

She adds, “Men also need to think about reducing hot baths, too much driving and even using a laptop on their knees. We know that professional drivers have lower sperm counts and higher numbers of abnormal sperm, and also research has shown an increase in scrotal temperature in laptop users when the laptop is balanced on the knees rather than using a table.”

There are also alternative therapies to consider. “Acupuncture and hypnotherapy can be used alongside the dietary and lifestyle changes in order to improve the chances of conceiving. If you have not conceived within six to 12 months, it will probably be suggested that you do IVF or even ICSI [where the sperm is injected directly into the egg].”

Above all else, don’t bottle your feelings up. Talk openly with your partner, and seek counselling if necessary, says Dr Glenville.

As for Sarah, the mum of one struggling to conceive, she advises, “Stop feeling guilty for longing for another child. When you struggle to do something as natural as having a child, it cuts at the most basic human level. You shouldn’t apologise for that.”

*Name has been changed