Secondary infertility: What can be done when it's time for one more to love?
Suzanne Ronayne at her home in Dunmore, County Galway. Picture: Ray Ryan
Sarah Ellis from Kildare is the proud mother of a five-year-old son.
“I got pregnant with him at the age of 35 when my partner and I had only been together for a year and weren’t actively trying to get pregnant,” she says.
“It was a happy accident. I’d always wanted children, so I was thrilled. My pregnancy was smooth and joyous, and when our son was born in 2019, everything was perfect.”
Ellis got pregnant again when she was 37. She remembers feeling elated at the thought of a second child joining the family.
“Unfortunately, I started bleeding when I was six weeks pregnant,” she says. “The hospital gave me a pregnancy test, which came back negative, and told me to go home and let nature run its course.”
That miscarriage was followed by three more, despite Ellis’ efforts to do everything she possibly could to hold onto her pregnancies.
“I’ve taken every supplement and removed as many toxins as I can from my life,” she says.
“I wash my family’s clothes in baking soda and vinegar. I don’t wear nail polish or any fragrances. I took progesterone in my last pregnancy. I’ve done everything I was told to, but none of those pregnancies made it past the eight-week mark.”
Suzanne Ronayne and her partner are also struggling to grow their family. Ronayne, aged 34, is from Galway. She has a nine-year-old son and has been trying to have another baby for the past three years.
“I miscarried at 10 weeks in May 2023,” she says. “I got pregnant again in July, but in September, we found out our baby was sick and were advised to terminate the pregnancy.”
Ronayne had to travel to Liverpool for the termination as her situation didn’t meet the legal criteria for undergoing it in Ireland.
“It was horrendous,” she says. “It was supposed to happen in Liverpool, but we were transferred to London at the last minute. Travelling to London in a taxi to terminate our longed-for baby — everything felt so out of our control.”
Conceiving again proved difficult, and when the couple investigated why, they discovered that Ronayne’s fallopian tubes were blocked.
“Probably due to an infection from that termination,” she says. “We’re devastated.”
Ellis and Ronayne both have secondary infertility. According to the HSE, one in six couples in Ireland experience infertility.
Dr John Waterstone, medical director of Waterstone Clinic, says 35% to 40% of these experience secondary infertility.
Primary infertility is diagnosed when someone who has never had children is unable to get pregnant after a year of having regular unprotected sex.
Secondary infertility, says Dr Waterstone, refers to problems experienced by someone who has previously given birth: “It can be frustrating and emotionally challenging because it’s so unexpected. Once you have successfully conceived and had a baby, you’d presume you could do so again without difficulty.”
Dr John Kennedy, medical director of Thérapie Fertility, says the pain of secondary infertility is compounded by the fact that it’s not spoken about.
Primary infertility gets most of the media attention, and those struggling with secondary infertility can interpret this as an unspoken message that they should be happy to have any children at all.
“People come to our clinic feeling guilty or greedy for asking for help conceiving,” he says.
“But they aren’t being unreasonable. Of course, their context is different from that of those who don’t have any children at all. They should be — and are — grateful for the family they do have. But it still hurts if they want more children and can’t have them.”
Jessica Bourke is a natural fertility specialist known as the ‘Fertility Detective’.
She believes the issue of secondary infertility is underacknowledged: “So many people come to me feeling bereft because they find it difficult to grow their families. I hear stories of people being told they should consider themselves ‘lucky to have even one child at their age’. Then there’s the heartbreak of their child asking why they can’t have a little brother or sister like their friends do or thoughtless comments from family and friends asking when they’ll have another. They might not talk about it openly, but there are lots of people who are finding this hard.”
Dr Waterstone cites age as the main cause of primary and secondary infertility: “This is even more of an issue with secondary infertility as the passage of time since her first pregnancy will inevitably mean that a woman’s egg quality will have diminished. This is particularly true if the woman was already in her late 30s when her first child was born.”
Dr Kennedy agrees: “The older you are, the more likely you are to run into problems conceiving, and maybe you were just really lucky to get pregnant the first time.
“Issues like endometriosis, which can affect fertility, also tend to get worse with age.”
A 2023 study suggested that having had a prior C-section could impact a woman’s fertility.
Researchers from the University of Borgen in Norway examined data from 42,379 mothers.
They concluded that women who had a C-section had a 10% decreased chance of getting pregnant again compared with women who had given birth vaginally.
However, both Dr Waterstone and Dr Kennedy question these findings.
“Approximately one-third of babies born in Ireland are now delivered by C-section,” says Dr Waterstone.
“The uterus heals well afterwards and it’s very unlikely that scarring of the uterus would cause any fertility problems afterwards.”
Dr Kennedy adds: “When someone comes to see us and tells us they have previously had a C-section, we will routinely check their womb to make sure there’s no fluid in the scar.
“There rarely is, so I don’t see that having a previous C-section is something prospective mothers should worry about.”
Like the causes, the treatment for secondary fertility is also similar to that for primary infertility.
“If you’ve been trying for a baby for six to 12 months without success, it’s time to seek help,” says Dr Waterstone.
“Fertility specialists can perform a variety of tests such as hormone evaluations, ultrasound scans, and semen analyses to explore what the issue might be.”
Specialists can also help women to track their cycles.
“This is crucial as you may not be ovulating as consistently or predictably as you did before your last pregnancy, so you may be missing opportunities to become pregnant,” says Dr Waterstone.
“We all know that parents lack sleep and time alone. They may still be up nights with young children or even have kids in bed with them at night, so there might not be a lot of sex happening. It’s easy for them to miss that vital fertile window.”
If tests and tracking reveal that fertility treatments are necessary, there is a range available, and specialists will recommend which best suits an individual woman or a particular couple’s needs.
Ovulation induction involves using medication to stimulate ovulation when a woman isn’t ovulating predictably. Prices start from €240.
Intrauterine insemination (IUI), a treatment that costs upwards of €950, stimulates ovulation and then places sperm directly into the uterus precisely as the woman ovulates.
In vitro fertilisation (IVF) starts by stimulating a woman’s ovaries to produce eggs. Those eggs are fertilised outside her body, and the resulting embryo or embryos are implanted into her uterus.
The price of this treatment starts at €4,495. Egg and sperm donation services are also available, and surrogacy is another option.
Dr Waterstone has noticed that women in their late 30s and early 40s who receive treatment in his clinic are more likely to opt for IVF treatment over ovulation induction or IUI: “This is because IVF generates multiple eggs and provides an opportunity for freezing embryos, which protests against the passage of further time.”
He welcomes that Budget 2025 contained an announcement that the HSE would extend its public funding for IVF to couples experiencing secondary infertility: “There hasn’t been much public acknowledgement of secondary infertility until now so it’s remained a silent issue. It’s wonderful to see the Government recognise the valid challenges that couples like this are facing so that they aren’t left behind.”
For now, both Ellis and Ronayne are determined to continue trying to grow their families.
“We’re doing fertility testing at the moment, but it’s hard to keep going,” says Ellis. “But it’s harder to stop wanting it, so we’ll keep trying.”
Ronayne has two goals in mind: “One is to spread awareness of the restrictions surrounding Irish abortion law. Women are still being forced to travel to terminate much-wanted pregnancies, and I won’t stop until that changes. The other is that we have been referred for fertility treatment and are awaiting our first appointment. One day, I hope we’ll have our rainbow baby.”
One in six Irish couples experiences fertility issues. Statistics vary, but according to Dr Waterstone, some 35% to 40% of these experience secondary infertility.
- Fertility issues are defined as failing to become pregnant after having regular unprotected sex for six months to a year.
- Primary infertility is diagnosed when someone who has never had children is unable to get pregnant after a year of having regular unprotected sex.
- Secondary infertility is diagnosed when someone has already had one or more successful pregnancies and then struggles to have another baby.
Fertility specialists recommend that those who are failing to conceive or who are getting pregnant but miscarrying seek help sooner rather than later.
A woman’s age and the quantity and quality of her eggs are decisive factors in any couple’s ability to conceive.
- Women under 35 are advised to talk to their doctor after a year of trying and failing to get pregnant.
- Women over 35 should seek treatment if they have been trying for more than six months.
- Women over 40 are advised to wait no longer than three months.
A wide range of treatment options are available, including ovulation induction, intrauterine insemination, in vitro fertilisation, egg donation, sperm donation and surrogacy.
Help is also available to deal with the psychological impact. “Secondary infertility can be emotionally draining,” says Dr Waterstone.
“On top of societal or personal pressure to have another child, people may feel guilt that they cannot conceive a sibling for their child. They may also feel that they don’t have the ‘right’ to such feelings since they already have a child.
“Support is out there through groups like NISIG and fertility clinics. There are others in the same situation. People shouldn’t have to suffer alone.”
