Rise of the one and only child

This article, about the difficulty of getting pregnant with a second child, is running on Saturday in the Times Body & Soul section. Some doctors think the problem is increasing. Did you have a problem getting pregnant again or know someone who did?

Couples who have already had a baby are discovering increasingly that they have fertility problems. Lucy McDonald explains why

If your first baby was conceived with no more planning than a romantic dinner à deux, some saucy knickers and a drunken rumple under the bedsheets, it can be perplexing when getting pregnant again proves difficult, if not impossible. After all, your offspring is living testimony to your fertility, so what’s the problem?

Unfortunately, past fertility does not equal future success. Some doctors believe that secondary infertility – the medical term for being unable to conceive when you have given birth before – is increasing and affects as many as one couple in five. An American study last year suggested that it is more common than primary infertility, in part because the age at which women have their second child is rising. Official government statistics for 2006 show that the mean age for mothers having their first child was 27.6 and 30 for the second.

Dr Raj Mathur, a fertility consultant at Addenbrooke’s hospital in Cambridge, says: “Infertility generally is increasing and we see lots of cases of secondary infertility, particularly as women delay motherhood. Although they may conceive their first child quickly, by the time they get around to their second their fertility levels may have dropped dramatically.”

Sometimes the ease of a previous conception has masked an existing health problem, such as poor sperm count or polycystic ovaries. Problems may be caused by a difficult previous pregnancy or delivery (see panel for more information). Dr Mathur says: “There’s controversial research which suggests that women who have had Caesarean deliveries take longer to conceive, perhaps because of scarring.”

Fertility issues are often wrongly assumed to be a “woman’s problem”, but in a third of cases the difficulty lies with the man. And while famous senior dads such as Des O’Connor (who was 72 when he had his fifth child) and Sir Paul McCartney (a sprightly 62) give the impression that there is no barrier to male fertility, research suggests that sperm quality and quantity decline from 35 onwards.

Sperm counts can be affected through trauma, say from an ill-placed rugby tackle, but also by sexually transmitted diseases such as gonorrhoea or chlamydia. It is well-known that the latter infection – the UK’s most common STD – damages female fertility, but a Spanish study presented last month at an American Society for Reproductive Medicine conference, showed that it also affects sperm concentration, motility and shape.

Lifestyle is also important. Before trying for baby No 1 many parents may have consumed Popeye-like amounts of spinach, watched their weight and forsaken alcohol and cigarettes. Second-time around, complacency may have snuck in. Cases of secondary infertility are officially bracketed under general infertility, so there are no specific figures available. But the fertility expert Zita West is seeing more incidences at her London clinics.

She says: “It takes on average six months to conceive, but add to that the tiredness and stress of being a parent and it can take longer. Some women may have just stopped breast-feeding, so their cycles are all over the place, while others simply aren’t having enough sex.”

‘Couples feel they shouldn’t complain’

Any fertility problem is stressful – sufferers say it can take over everything – but with secondary infertility there is less support available. Family life has to go on and most help groups concentrate on the childless. Susan Seenan, of Infertility Network UK, says: “Couples may feel they don’t have the right to complain, but that doesn’t remove the feeling of incompleteness.”

Figures from the Government’s National Statistics agency show that the number of only-child families is increasing. While 15 per cent of women born in 1960 had only one child, this increased to 19 per cent for those born in 1970. The most common age gap between children is two to four years, but how do parents know if time is on their side? The short answer is that there are no rules when predicting fertility. Laurence Shaw, the deputy medical director of the Bridge Fertility Centre in London, says: “Two women of the same age and weight with similar lifestyles and medical histories could have completely different biological ages.”

But there are warning signs. If your periods are irregular and sexual intercourse painful, you may have an infection or ovulatory problem. A common condition such as polycystic ovaries, which hinders ovulation, can be triggered by excessive weight gain in pregnancy.

Diabetes and raised blood pressure can affect fertility, as can cancer treatments. And then there’s early menopause. If your mother had an early menopause, you might too. Shaw advises that this is not clear: “Nobody has discovered a gene for the timing of menopause yet.”

If you are over 35 and conception is taking more than six months, the official advice is to seek medical help quickly. Some problems are easily treated, but for others IVF is the only answer (although there is no public funding for those who already have children) and success rates plummet with age, from 28 per cent in the under35s to 10 per cent in women aged 40 to 42. The good news is that couples with secondary infertility are more likely to achieve a second pregnancy, even with fertility treatment.

Shaw says: “For the majority of people who have had one baby, conceiving the second won’t be a problem. But as time passes the unexpected occasionally happens – fibroids, declining fertility or endometriosis. John Lennon had it right when he said ‘life is what happens to you while you are busy making other plans’.”

CASE STORY: JODIE OLIVER: 'I COULDN’T HAVE MY SECOND CHILD BECAUSE OF POLYCYSTIC OVARIES'

Jodie Oliver (pictured above with her daughter), became pregnant with Evelyn, 2, when she was 31 after coming off the Pill just three months earlier. She presumed that her next child would be as easily conceived, but after 18 months of trying, Jodie and her husband, Paul, have been told that it will be difficult for them to have another child naturally.

Jodie, now aged 34, was told by doctors that she had polycystic ovary syndrome, possibly triggered by her weight gain in pregnancy. But even if she had been regularly ovulating, a test showed that Paul’s sperm were abnormally shaped and unable to penetrate eggs.

Armed with this new knowledge, the Olivers were surprised that they managed to conceive Evelyn at all, let alone with such ease.
Jodie, who works in a doctor’s surgery in Sussex, says: “It has been surreal. How can we be infertile when we’re parents? We feel utterly blessed with our daughter, but we can’t understand why we can’t do it again.

“Perhaps I don’t have the right to complain as I know the joy of someone shouting ‘Mummy’. But then the other part of me thinks this is harder than primary infertility because I know how fantastic being a mum is and I want to do it again.”

CAUSES OF INFERTILITY

How to test for problems The treatment of secondary infertility is similar to primary infertility. Couples should be tested to check the woman is ovulating properly and that the man’s sperm is normal. In older women, causes break down into difficulties in an earlier pregnancy or delivery, or an existing but previously undiagnosed health condition.

Pregnancy or delivery problems A womb infection, heavy bleeding after a Caesarean or the retention of part of the placenta in the womb after delivery can all cause scarring, making it harder for embryos to implant. About 1 per cent of pregnancies are ectopic, when the fertilised egg implants outside the womb, and about a third of women who have suffered will find it difficult to become pregnant again.

Underlying health problems Pelvic inflammatory disease – often associated with STDs – can cause infertility if left untreated. In extreme cases of endometriosis, a condition in which the cells that normally line the womb are found elsewhere in the body, scarring can make conception difficult. In mild to moderate cases, studies found that removing endometriotic spots improved the chances of conception for women under 40 by up to 75 per cent.

Ovulatory problems Up to a third of infertile couples are affected by an ovulatory disorder, typically polycystic ovaries. About one woman in five has polycystic ovary syndrome, but only a small proportion will develop fertility problems. If fibroids are too large or in a difficult position, they can prevent embryos from implanting.

For help, support and information: www.fertilityzone.co.uk | www.fertilityfriends.co.uk | www.infertilitynetworkuk.com

Comments

[sussex homeopath]

As a homeopath, I treat many couples for primary and secondary infertility, and have a 65 per cent success rate with satisfied clients all over the world. Most of them are well into their thirties by the time they come to see me. PCOS, endometriosis and low sperm count can all be successfully treated with homeopathy, too. It's not necessary to submit yourself to unpleasant hormone therapy when you can conceive naturally and improve your general health at the same time. Why not give it a try with a homeopath near you?

[Jane]

I agree with J - no sick leave when you are SAH! I can remember a mum with her second baby, when I only had one, and she only breastfed for a very short time. I said blithely, oh, I love b/feeding as it's my only quiet time to read etc. She just looked at me and said, 'My 2 year old doesn't see it that way'.

I wonder if there is more incidence of subsequent children being bottlefed for that (very good!) reason.

[Wonderbra]

My family is greatly diminished (I was an only child anyway) and so is ex husband's, which is why we tend to share all duties and, in a funny way, we're still each other's family! I am lucky he has always been a brilliantly involved father really pulling his weight in true New Man fashion. We even spend Christmas together, with fewer arguments than many other people I might add! His support has helped me re-launch my career and I couldn't have done it without him.
It meant a lot for me to have more than one child, although one seemed impossible at first, but, as an only child myself, I realise that I had much more of my parents' attention and went everywhere with them, which tends to be far more difficult when taking around several and was certainly unusual then.

[j]

one of the great luxuries of going back to work was getting sick leave... also, no maternity leave as a SAHM! I vividly remember my third pregnancy, really bad, all-day "morning" sickness with one in night nappies and one in all-day nappies, mopping up from a child tummy bug and being sick myself into the same bucket. I have done most of the flu childcare as I have no family nearby, and it was very hard work. Now if I am ill, cool, I go to bed.

Except I never am ill any more, 'cos the years suffering through at home have given me the immune system of a rhino. Not even caught the norovirus. How unfair is that??

[mumoftwo]

I actually agree Jane that you need a spare pair of hands, whether it be yours as a SAHM, or in my case, my mum within 30min/an hour drive. Only the other weekend I was suddenly ill (nothing serious, just not nice enough to look after the children), my husband was working, and after a quick emergency call at 8am, she looked after them for the rest of the day whilst I moaned and groaned (and watched the odd film! I'm so painfully aware how lucky I am to have this, most of my friends don't and they struggle all the more for it.

[Jane]

I agree - the trend towards small, widely dispersed families (my two 'halves' are at polar opposites in the UK geographically) does mean there is very limited 'back up' or 'margin' etc. Without wishing to revert (yet again!) to the old SAH debate, one advantage of SAH is that you do have more slack in the system, and simply more time, more flexibly at your disposal. For example, if you have a couple of pre-schoolers, it doesn't really matter if you whisk them off to Yorkshire fora week to look after Uncle Fred when he breaks a leg, etc. However, the rest of the family should not assume that beause you are SAH that means you are automatically at their disposal for their convenience because you've 'nothing better to do'... Ditto for 'unmarried spinsters' who are so often assumed to having nothing beter to do with their empty lives than make themselves useful to others... (shades of Jane Austen....)

[mumoftwo]

It's not just single children who have to content with the shrunken family, I also feel the same for my two, who, yes, will have each other, but absolutely no cousins and are unlikely to have second cousins of their own age. I grew up in a large extended family with a host of cousins around, as did my parents. I do wonder who they will turn to in moments of crisis, friends, of course, but I do feel an extra layer of security knowing I have that large family, any of whom I could rely on to help if I phoned them in the middle of the night and said 'something's happened'. Plus I've also found that friends around the same age are also struggling with the same issues as you, children, relationships, money, and have very little spare time even if they have the desire to help. I know one of my friends right now needs a helping hand in life, she's on bended knees with exhaustion and just needs someone to take her kids for a couple of days just to give her a break, but I live a long way away and have full-on commitments so am not in a position to help her out in the way I would like if I lived round the corner. So, the small family does have its disadvantages.

[Jane]

I agree - I'd have loved another child, but am grovellingly grateful we had one at all! It's quite interesting to see his reaction to chums who, most of them, have siblings. Although he'd 'like' a brother (not a sister, obviously - I mean, what is the POINT of a sister?), he also sees from his chums that they can be a real nuisance as well, and also sees that with twice as many children there would be half as much money to be spent per child! My main concern is that he should not get landed with having to cope with aged, depependent parents all on his own. And I'm emphasising hard the skills required to make friends in life, as that wil lbe increasingly important to him.

[gipsy]

I feel bad that essentially my son will grow up without a sibling close in age (he has a much older half sister and half brother). But that is just the way things work out sometimes. I'd love a second child but I accept now that it won't happen. It doesn't feel like the same all burning consuming anxiety that I went through when trying and (mostly) failing to concieve the first time around.

[Jane]

"Also very important to remember that not having a baby will not ruin your life, in fact you will be free to do other things that you probably wouldn't have got round to if you had a baby"

I would agree with you but only if the word 'another' is inserted in front of 'baby'. Primary fertility is not so easily compensated for, alas. One definite bonus of only having one kiddie - boy, is it cheaper!

[Delilah]

Those clever boffins at Harvard have just published a book reflecting the latest findings from the Nurse's Health Study on how to get preggers: "The Fertility Diet". Hot off the press at Amazon: http://www.amazon.com/Fertility-Diet-Jorge-Chavarro/dp/0071494790

[AmIreallyamummy?]

That's me KK. First one 3 years then finally IVF; second one "au natural" and 1 attempt (at the age of 40). Call them both my miracle babies. You can't second guess nature - for all the advice about planning. I would've had kids earlier if nature and circumstances had obliged, but then my two little ones would never had been born would they? And I wouldn't change that for anything.

[kk]

On a slightly different note, I have several friends who had difficulty conceiving baby number one (trying for 1-5 years etc.) but conceived baby number 2 and onwards very easily, within a matter of months of trying.

[mumoftwo]

A few of my friends have confessed that a distinct lack of bedroom action has been a barrier in helping them to get pregnant (sounds obvious, but people aren't aware exactly how much you do have to have sex to stand the best chance of getting pregnant). The problem seems to be that leaving child-rearing til the thirties means they have been in long-term relationships for quite a long time, and things have gone, well, downhill in that department. Then they want a baby and have to work out how to get that side of things back to reasonably regular levels to actually get pregnant. That's one advantage of marrying later and getting on with it straight away like I did- at least you are still in the honeymoon period so trying to make babies isn't so much of a chore, although obviously it depends how late is late and, let's face it, it's hardly like you can plan many of these things anyway ( I would have happily had children earlier if anyone would have asked).

I have/had PCO (it comes and goes in most women) and used Clomid successfully twice but then had a natural conception. Weight is definitely a factor, a lot of women gain weight after the first baby and it can play hell with hormones, as does lack of sleep and stress. Standard blood tests for hormones only measure "free" hormones circulating in the blood, not much use if your receptors are all out to lunch so the hormones aren't doing anything. Saliva tests are much better but rarely used. The good news is that diet and excercise can be dramatically effective. I recommend "Life Without Bread" by Allan & Lutz which explains very clearly how your weight and what you eat can have a direct effect on your endocrine system, especially as you get older.

My experience of fertility doctors is that they are moderately interested in finding the cause of your infertility but tend to move you quickly to IVF, it's easier for them to understand and control.

Also very important to remember that not having a baby will not ruin your life, in fact you will be free to do other things that you probably wouldn't have got round to if you had a baby.

[J]

theres just so much to think about in your 20s- housing definitely being one of them. I do wonder what my eldest will do about housing - sadly I dont think he will get a free house from his rich parents!

[Lazy Mummy]

Whereas I fit the profile of this article exactly. Having a sibling 13 yrs younger than me was, I think, one reason for not wanting children when I was younger - it put me off a bit.

But then, I got pregnant v. easily w/ my first at 34 but it's taken nearly a year the second time round.

I think this article makes some good points about parents being blase second time round - we were definitely more blase second time round - at least at first (as were our doctors), as well as the age issue, which is most important of all, probably. We need to tell our children to have their children earlier in life if they know they want to. But we also need to create a world where they can do that more easily. In my experience, some people put off settling down because their 20s are so much fun, but others put off starting a family because they feel they can't afford it. We need to create more flexible working arrangements AND figure out affordable housing for young people so they feel they can start a family if they want to.

One thing the article might have mentioned is the increasing role of alternative therapies, especially acupuncture, in supporting fertility. Some of these approaches have proven beneficial for many women, especially if stress is a factor.

[supermother]

It must be hard. We never tried for more than 1 - at the most 3 months but were lucky. My parents tried for year (they were married for 13 years hwen I arrived and a baby for adoption was just ready for them although they didn't take him in the end as my mother got pregnant after I think clomid and an operation to unblock her tubes... then my sister was born very soon after me. I think if anyone wants a large family like my (5+ etc) then you do need to start at a reasonably young age (I was 22 when I had the first just so you have time to pack them all in). Having children from the age of 12 was the one thing I was certain I wanted to do in my life and I wasn't going to leave it to the chances of plummeting fertility at 35+.

[Nicky]

I never got pregnant again a 2nd time... which was surprising, having not planned to get pregnant the first time! I thought that as I'd had one, I may as well have another quite soon and get the baby stage over and done with (I much prefer kids when they can speak, wipe their own bottoms and ideally do their own laundry). But it didn't happen.

I had put on a lot of weight after giving birth, which may have been a factor, but my hormone levels were tested and came back as 'normal'.

My husband was working in a very stressful first management post at the time, which may have been another factor. He never did get round to going to the little room with the girlie mags for the test...

When my son started nursery I gave up trying - I wasn't prepared to give up my little bit of 'me' time now that I finally had it. I'd hate to have another one now. But it would have been nice to have had 2.

[Jane]

I think a difficult situation is compounded by the fact that I'd say most people would prefer their children fairly close together in age, not more than four years apart, which gives a very tight window for conception.

Perhaps couples should 'think ahead' when planning their first child, and plan the next as well, eg, ensuring their health and stress levels stay good, etc etc.

And, of course, not leaving it too late.... It's annoying, but biology is NOT an equal opportunities employment fan...