After giving birth to her first child 11 years ago, Julia Indichova was trying desperately — and unsuccessfully — to have a second.
Doctors said she had no chance of conceiving another child, because of her age, 42, and a high hormone level.
Indichova was facing something known as "secondary infertility." The term refers to infertility in women who became pregnant at an earlier stage of their life but are now having difficulty conceiving. By some estimates, the problem accounts for one-third of all visits to fertility specialists. An estimated 3 million couples struggle with secondary infertility, almost double the number from 1995.
Indichova succeeded in finding her own path to becoming pregnant for a second time, which for her consisted of practicing both vegetarianism and yoga. She has written a book about her experience, Inconceivable: A Woman's Triumph over Despair and Statistics, and teaches classes to other mothers dealing with secondary infertility.
Late Start on Motherhood
Dr. Sami David, a fertility specialist from Mount Sinai Hospital in New York who has treated many women with secondary infertility, said the numbers are on the rise for a reason.
"It is often because women are waiting longer to start having children," David said. Most of his patients had their first child when they were about 35, then waited several years to have a second. But by ages 39 or 40, it becomes more difficult to conceive.
Often, doctors can pinpoint the problem by looking at the woman's medical history, along with the man's.
"Find out if anything has happened to either of their lives or their health in the interim," David said. "[Women] might have hormonal problems, or the quality of their eggs may have declined."
Doctors will typically ask whether a woman's menstrual cycle has changed, and measure her hormones with blood tests. Progesterone is the most important hormone involved in pregnancy, and a low progesterone level is the most common cause for secondary infertility. The low levels occur either because of a woman's age or from too much strenuous exercise, David said.
Process of Elimination
There is usually more than one factor to blame, so you have to go through the possibilities and eliminate them one by one, David said. The man could be causing the problem.
"If the man has a varicose vein, a vein around the testes, the sperm may be adequate on their first achievement of a pregnancy," David said. "Then subsequently, three or four years later that same vein is now creating semen that is not quite as good quality. So you have to turn towards the male in the partnership as well and see if he is still as good as he was, say, three years, four years, earlier."
The cause could also be the husband having a genetic disorder which results in chromosomal damage, or a thyroid problem that can make a man's testosterone level drop. It could also be environmental: Jacuzzi baths can affect a man's sperm.
"Then you look into other possibilities, infections," David said. "Even the minor infections may cause difficulty."
Occasionally, David said, the difficulty in conceiving a second time is related to the first pregnancy. "That doesn't happen very often, but in the history-taking from your doctor, you should bring up whether or not you delivered the baby by vaginal delivery or Caesarian section." Women undergoing a C-section, a surgical procedure, have a 10 percent chance of developing scar tissue following the operation, which can make it harder to conceive again, David said. He also said that having a dilation and curettage procedure following a miscarriage can cause scarring on the uterus that might make it harder to conceive again.
Understanding the Pain
Secondary infertility can be very emotional for women experiencing it. Indichova knows first-hand the pain experienced by women having difficulty conceiving again.
"I was feeling all this incredible guilt," she said. "I often felt like I was getting in line for seconds before everybody else got their turn, because I saw there were all these childless couples out there, and here I had this wonderful healthy child, and yet there was this terrible, terrible ache, and longing inside me, that I couldn't change."
Other women in a discussion group she started on secondary infertility said they too felt a longing for a second child.
"I just felt that I could not go on in my life without a second child," said one participant, Eileen. "It was a mission that I was going to work hard and I was going to create a miracle and I found ways of doing it — different ways. I started out really discouraged. The statistics were very, very bleak."
Trying to conceive for the second time is often more stressful than it was the first time around, David said. "Wanting a child is very important, whether you have one child or two at home," he said. "And I think the best person to speak to about the stresses of primary versus secondary infertility are the couples that have been through both."
Back to Life
Indichova said she was initially looking for a fast solution. "I wanted somebody to find that last good egg and to somehow use whatever technique they could do to turn that egg into a baby." But doctors said her hormone levels meant she had no chance of conceiving.
"When I didn't find answers in mainstream medicine, I turned to alternative medicine, and I started searching for answers there," said Indichova. She said that changing her diet helped in the disappearance of chronic symptoms she had suffered for many years, such as rheumatism and sinus headaches.
"First, I eliminated anything that could be possibly harmful, such as caffeine, alcohol, toxins in fruits and vegetables, processed sugar and dairy products," she told ABCNEWS.com. "I was on a modified vegetarian diet, but it's important to mention that everyone's biology is different and a vegetarian diet may not work for everyone."
She found that the answers were just as much about herself as a child. "I had this incredible longing to bring another child into our family, but this longing was also about something else, and I didn't know it then," Indichova said. "This longing was also about bringing myself back to life, parts of me back to life that I have left behind. I think to me, that's the incredible gift of this, is that not only did I get a child, I got me."