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'Why Can't We Have Another Baby?'

Angie and Kelly Malchose weren't even trying to get pregnant when they conceived their son, Jordan. So five years later, when the Malchoses, of Dickinson, North Dakota, decided to go for baby number two, they expected instant success. But to their dismay, months passed and there was still no baby.

Finally, Angie, 29, checked in with her obstetrician, who diagnosed secondary infertility -- the inability to get pregnant after having given birth one or more times. "When he told me this was a common problem, I was shocked. I didn't think infertility applied to people who'd already had kids." In fact, according to RESOLVE, the national infertility association, secondary infertility accounts for more than half of all infertility cases. And as the Malchoses discovered, the struggle can take a devastating toll on moms and dads.

Unraveling a mystery

Doctors consider a couple infertile when they can't conceive after a year of unprotected sex (though most physicians include women who suffer repeat miscarriages in the definition). According to the Mayo Clinic, 10 to 15 percent of all couples are infertile. But many experts say people should seek medical advice after 6 months -- not 12 -- especially if the woman is over 35. "As you near forty, you don't have time to waste -- and you should see your ob-gyn or a specialist sooner rather than later," says Leon Speroff, M.D., professor of obstetrics and gynecology at the Oregon Health & Science University, in Portland. Unfortunately, parents may be slower to seek help than childless couples, figuring if it happened once, it'll happen again. And ob-gyns may take a wait-and-see approach with patients who already have a child.

While there are no hard-and-fast figures, most cases of secondary infertility stem from the female half of the equation. The most common glitch? Aging eggs. Women are born with a finite number of eggs, which can suffer chromosomal damage over time. A defective egg is less likely to be fertilized or, if it is, to result in a viable embryo. This explains why a woman's fertility starts to dip noticeably when she hits 30, taking a plunge after 35. A 27-year-old has a 75 percent chance of conception after 12 months of unprotected sex; over age 35, the chance drops to 40 percent.

Vicki and Pat Daly of New York City believe their plan to add to their family was curtailed by Vicki's biological clock. She was 39 when she had Julia, who's 8. "Three years later, we tried again, but nothing happened," says Pat. "When the infertility doctor didn't find anything overtly wrong, we assumed that we'd waited too long. It was so upsetting." (Because sperm production never stops, men don't experience a dropoff in fertility until their 50s or 60s -- and even then it's minimal.)

Passing time also means that a mom may have developed a medical condition she didn't have before. An underactive thyroid, for example, can trigger infertility by nudging the body's hormonal balance out of kilter. Endometriosis, a disease in which tissue that normally lines the uterus migrates into the abdomen, can prevent conception by causing adhesions on the ovaries or Fallopian tubes that may make them function improperly. Women in their 30s and 40s are also prone to fibroids, benign growths in the uterus that can prevent an embryo from latching onto the lining of the womb.

Men's fertility can also be compromised by such conditions as prostate infections, sexually transmitted diseases, and diabetes, or even alcohol abuse. Jeanne Ryan of Shaker Heights, Ohio, stopped using birth control after her younger child turned 2, expecting to conceive within a couple of months, as she had with her son and daughter. When she and her husband finally went to the doctor a year and a half later, they discovered that he had varicoceles (enlarged veins in the testes), which were thwarting sperm production. "We're still hoping that a good sperm might leak through, but basically, we feel blessed to have two children and don't think we'll pursue aggressive treatment," she says.

Occasionally, parents can't conceive again because they've been marginally fertile all along and were simply lucky before. And some couples fall into the frustrating category of "unexplained infertility." Fortunately, this is a rare diagnosis among those with kids. "If a couple was able to get pregnant before, in most cases something specific must have changed," says A.F. Haney, M.D., professor of obstetrics and gynecology at the University of Chicago School of Medicine.

Mary Garner Ganske, a mom of two, writes frequently for Parenting. She lives in Ohio.

The daily ups and downs

One of the toughest challenges infertile parents face is that they can't insulate themselves from the world of families and kids. While childless couples can say no to birthday parties and baby showers as they cope with their infertility, moms and dads don't want to isolate the child they already have. Things that used to provide pleasure and support -- playgroups, mom-and-tot classes -- may suddenly become painful, as the other moms show up expecting or with new babies. "You can't get away from it," says Susan Brown* of Minneapolis, who's been trying for three years to have a sibling for son George*, 4. "Everywhere I go, I see pregnant bellies -- at preschool, in the park. My best friend is pregnant, my sister is pregnant, and the mother of the little boy I watch in the afternoon is pregnant. I'm constantly hearing complaints like 'I'm soooo sick in the morning.' It drives me nuts -- I'd kill to have that problem."

Women experiencing secondary infertility also field more than their share of unwelcome comments, such as "Don't you think it's time to have another child?" Eleanor Chandler* of Southborough, Massachusetts, who's been unable to conceive since giving birth to her son, now 7, is the target of countless insensitivities. "Someone once said to me, 'You're not a real parent until you have two or three kids.' For not being a real parent, I've sure changed a lot of diapers."

Infertile couples may also find that their marriage suffers as they confront their problem. As a rule, men don't share what they see as their wives' obsession with getting pregnant again, says Joann Paley Galst, Ph.D., a psychologist in New York City. "They don't like to dwell on failure and would prefer to move on with their lives," she says -- and this can tug couples apart. "Even though I wanted another child and felt frustrated too, I had an easier time accepting that I couldn't change anything and it wasn't going to happen. Vicki continued to grieve," says Pat Daly. "I felt a bit tuned out by Pat at times," says Vicki, "but gradually I came to accept our situation as well. Now I think we've both made peace with it."

Some couples feel guilty that they can't give their child a sibling. "It's not fair to Jordan. What happens when we get older and he doesn't have anyone to help him take care of us?" asks Angie Malchose. Children themselves may unwittingly add to their parents' despair. "George has this imaginary brother he plays with. And he asks me almost every day if there's a baby in my tummy yet. It breaks my heart," says Susan Brown.

Pursuing infertility treatments can compound a couple's guilt by siphoning money away from the child they already have. They're rarely covered by insurance, and the bills can easily top $10,000, making parents wonder whether the money might be better spent on other things, from college tuition to a down payment on a house.

Trying to juggle parenthood with the rigors of treatment -- daily ultrasounds, injections, and blood tests that must be carefully timed -- can also be problematic. And kids can be confused and worried by the psychological ups and downs their moms go through. "I went on Clomid during the summer and quit after one cycle," says Eleanor Chandler, who plans to try again in the fall when her son is back in school. "It made me emotionally crazy, and I didn't want him to see that. I couldn't even take him to see fireworks on the Fourth of July because I had to get a shot at exactly ten p.m. so that my egg would be released at the right time. If trying to have another baby is going to interfere with his childhood, I'm just not going to do it."

In the end, whether a couple chooses to pursue a course of infertility treatments, make peace with the number of children they have, or adopt, the goal, says Galst, is the same: to accept the decision so they can move forward and have a rich and rewarding life with their family -- no matter its size.

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