Anna* delighted in motherhood and was eager to add a second child to her family. She expected conception and pregnancy to again be quick and easy but, after a year of negative pregnancy tests, Anna’s doctor used a term she had not heard before: secondary infertility.
For Anna, the anguish associated with secondary infertility – the inability to conceive or carry to term a second or subsequent child – was pervading all aspects of her life. Anna believed her family to be incomplete without a second child and was devastated at the thought of her child growing up without a sibling.
She came to dread kids’ birthday parties and other social interactions, fearful of inevitable questions about a sibling for her toddler. She became fixated on the idea of pregnancy, seeing pregnant women and families with multiple young children “everywhere”. While this could be explained by the psychological concept of attentional bias (paying attention to selective factors leads us to believe there is an increase in a specific event or occurrence), the distress and sorrow caused by these sightings was genuine.
Anna spoke of feeling like a failure, that her body had let her down and, worst of all, that she was a disappointment to her partner and child. She blamed herself for taking fertility for granted in her younger years, wondering aloud if her current age and previous long-term use of the contraceptive pill had contributed to current fertility issues.
Anna’s unrelenting desire for a second child also caused a strain on her relationship. While initially keen to expand their family, her partner was reluctant to pursue fertility treatment due to financial expense and likely side-effects. With her girlfriends announcing second and third pregnancies and her partner encouraging her to let go of their plans for a larger family, Anna felt increasingly isolated and misunderstood.
Therapy provided a space in which Anna’s concern were not minimised or disregarded. Unlike social conversations, Anna felt able to fully express her thoughts and feelings without tempering her views. She felt relieved to have a space in which others did not share their anecdotes about pregnancy or fertility.
Exploring Anna’s perceptions of family and the importance of siblinghood was central to our work together. Like all of us, Anna’s notion of family and thoughts about children were strongly informed by her own upbringing. Templates for our lives are based on our early experiences and shaped by cultural norms and observations of others. As Anna was experiencing, feelings of helplessness and hopelessness can arise from inconsistency or incongruence between expectation and reality.
Anna had enjoyed a close relationship with her older sibling throughout childhood. The pair relied on each other through difficult times within their own family unit and remained close into adulthood. Anna couldn’t imagine a childhood without her sibling; by extension, the idea of her own child not having a sibling felt alien. In this way, Anna was projecting her own experiences on to her child and her own family.
For Anna, coming to terms with secondary infertility meant recognising her fixed notion of family as being one that must include siblings. Sitting with uncertainty and acknowledging the worry of the unknown of being part of a single-child family – both for herself as a parent and for her own child – was key to adopting a more flexible view of family.
As months passed, Anna continued to adjust to the notion of finding fulfilment in the absence of a second child. Yet she continued to find others’ remarks about children and fertility upsetting. Stories from others about falling pregnant after “just relaxing” or not actively trying felt unfair and insensitive. Comments encouraging Anna to be grateful for having one happy and healthy child also fell flat – she was grateful but also felt deep suffering about not being able to have more than one child.
We devised a strategy to manage such queries and comments. Recognising secondary infertility as a little-known condition, Anna endeavoured to remind herself that most people were naive rather than ill-intentioned in asking about family plans and children. Developing several tailored responses to draw upon helped manage her anxiety about social situations and conversations.
As the mother of a toddler, it was impossible for Anna to completely avoid talk of pregnancy and babies. While she felt a pang of envy at the announcement of yet another pregnancy or birth, Anna was able to recognise that the composition of each family differs but no family is more or less authentic or valid than another. Others’ successes with pregnancy were not Anna’s failures.
*Anna is a fictitious amalgam to exemplify similar cases
• In Australia, support is available at Beyond Blue on 1300 22 4636 and Lifeline on 13 11 14. In the UK, the charity Mind is available on 0300 123 3393. Other international helplines can be found at befrienders.org
• Dr Bianca Denny is a clinical psychologist based in Melbourne. She is the author of Talk to Me: Lessons from Patients and Their Therapist
