"We Can't Get Pregnant Again"

Our first child -- one of those babies jokingly referred to as an "accident" -- was not quite 2 when my husband and I decided we wanted another. At the time, it didn't seem arrogant to think of this as a decision and not merely a hope. After all, if I could conceive without meaning to, how hard could it be toget pregnant on purpose? We'd just grin at each other one afternoon during the baby's nap, and a few weeks later a little blue line would magically appear in the window of a pregnancy test.

Two years and two miscarriages later, we had learned a sad lesson in human biology: Fertility is not always within our control.

Like many couples who easily conceived and carried their first child, we faced a shocking diagnosis: secondary infertility. Medically, the term refers to parents who, after 12 months of unprotected intercourse, have failed to conceive another child, but most experts also include recurrent miscarriage in the definition. And in human terms, the result is the same: a blank space in a family where a child is longed for.

Indeed, one of the best-kept secrets of the fertility industry is that nearly a quarter of couples seeking treatment are already parents. Some of these patients had trouble conceiving the first time, so they know what they're up against when they try again. But many others, like my husband and me, have been stunned to learn that, "in fertility, past success is no guarantee of future success," as Michael DiMattina, M.D., director of Dominion Fertility and Endocrinology, in Arlington, Virginia, puts it.

Yet, according to Dr. DiMattina, people suffering secondary infertility are only half as likely to seek treatment as those facing primary infertility. Partly, Dr. DiMattina says, this reluctance stems from emotional denial. "Previously fertile people tend to think, If I just give up coffee or reduce my stress, it will happen." Though such measures undoubtedly enhance general health, he says, "they won't cure infertility." To complicate matters, busy ob-gyns often assume there's no medical reason when patients who have previously demonstrated their fertility take an unusually long time to conceive. Unfortunately, such a wait-and-see approach can allow an untreated problem to become an untreatable one.