Lonely...With An Only

By Laura Koss-Feder

After an easy first pregnancy with Sabrina, now 4, April and Richard Simanoff of Huntington, N.Y., were mystified and heartbroken when their attempts to have a second child brought nothing but grief. Since 1999, April, 34, a homemaker, has had five miscarriages. Countless medical tests have found no definitive cause. This unexplained secondary infertility--as the inability to conceive or bear a second child is known--has propelled the Simanoffs onto an emotional roller coaster. They say they feel guilt over not being able to give Sabrina a sibling, anger when people ask when they're going to have their next child and, most of all, a sense of not belonging.

"I'm a stay-home mom, but I can't relate to that world, since [those moms] all have more than one child," says Simanoff, who will try some new treatments this fall to help her maintain a pregnancy. "You're just so isolated in dealing with secondary infertility that you have to create an environment that makes you feel better in any way you can."

While infertility is an emotionally and financially draining disease that afflicts about 10 million men and women, those people hit with secondary infertility face a unique anguish. Couples are often in shock or denial when they can't conceive or carry a second child, especially if their first pregnancy went smoothly. They also feel caught between the world of the fertile and the infertile, with no place to turn for support or empathy. "Friends and family dismiss secondary infertility as a loss, figuring you should be grateful if you already have one child," says Diane Clapp, psychiatric nurse and medical-information director for Resolve, a national infertility-education and -advocacy organization based in Somerville, Mass.

Although no hard statistics are available, infertility experts and reproductive endocrinologists say the number of people suffering from secondary infertility grows every year. Clapp estimates that there are 3 million people coping with secondary infertility, up from about 1.8 million in 1995. Physicians and therapists who specialize in counseling infertile couples have seen as much as one-third of their practice become devoted to those with secondary infertility, up from as little as 10% just five years ago, according to a study at Cornell University.

Dr. Stephen Corson, director of the Women's Institute for Fertility, Endocrinology and Menopause in Philadelphia, suggests two reasons for the rise: people are waiting longer to have babies, and more couples in their second marriage are trying to have children. In fact, 52% of men with secondary infertility were married before, according to a survey of 578 infertility patients that Corson conducted last year for the American Society for Reproductive Medicine.

Just as the root causes of secondary infertility differ, so do reactions to it. Elizabeth Raab, 46, a Cataumet, Mass., geriatric case manager, is one of 12 children. It took her and her husband Michael, 41, a mechanical engineer, a year to conceive their first child, Michael Jr., in 1989. But after trying to have a second child for two years, Elizabeth realized she was undergoing early menopause. "I didn't want to believe that this could happen, since I came from such a large family and just figured that I would have a lot of kids," she says. She reacted by becoming overprotective of Michael Jr., now 13. When he was two years old, the Raabs had a fence put in their backyard. Afraid Michael would tunnel under it, she had special wiring put in the ground to prevent this from happening.

"I had to step back and realize this was over the top," she says. "My husband and I would try to take 15 minutes out of each day to just talk about what we were feeling [and] put everything into perspective. The bottom line was to enjoy our son as much as possible and focus on him and not the guilt or the pain." They adopted their second child, Alex, now 7, from Guatemala in November 1993. And Raab, with the help of Resolve, launched her own support group in 1991 in nearby Hyannis, just for those with secondary infertility.

Some couples feel guilt about not being able to give their child a sibling. Karen Licato had to hold back tears when her son J.R., now 11, got up in front of his first-grade class during a parents' observation day and told his classmates he had a brother. "Everyone else in class had a brother or a sister, and our son felt he had to say the same thing," says Licato, 44, a Plainfield, N.J., homemaker. "This broke my heart, and when we talked about it, J.R. and I sat down and had a really good cry afterward."

Licato and her husband Jeffrey, 41, eventually conceived their second child, Tommy, 3, through in-vitro fertilization (IVF). But that can bring guilt of its own. Women who need to spend hours at the doctor's or have bed rest can't be the moms they want to be. And children may be worried by their mothers' going to the doctor so often. April Simanoff has explained to her daughter why she goes to the doctor so much, and she takes the child along on some appointments. "Sabrina is so used to my going to the doctor that she just thinks it's a part of normal, everyday life," Simanoff says.

Secondary infertility in a second marriage has a whole other layer of tension. A spouse who already has a child may not be as willing to undergo fertility treatments or choose adoption as is the spouse who is childless and desperately wants a family. "Couples need to agree upon a course of action, if any, and just how far they will go to have a child together," says Dr. Harriet Simons of Wellesley, Mass., author of the book Wanting Another Child: Coping with Secondary Infertility.

Susan Harlow, 45, who has a 25-year-old daughter from a previous marriage, tried to conceive a second child through fertility drugs and inseminations for the first eight years of her 13-year marriage to Jim. A diagnosis was made of pelvic adhesions and blocked Fallopian tubes. The high cost and low predicted-success rate dissuaded the Harlows from trying ivf. Although this was a struggle for both, it was a lot harder for Jim. "My wife always had her daughter Melissa to fall back on, and I just felt like I had to go at this alone," says Jim, 43, an auditor for the State of Oklahoma. "I'd have trouble going to a mall, for instance, because there are just too many kids there, and Susan couldn't understand that." Today, however, the couple shower three cats and one dog with affection. Says Jim: "Finding something you can focus on as a couple, other than your infertility, can help make all the difference."