You’ve started your family, and now you’re impatient to expand or complete it. You assume creating your next child will be a similarly lovely and effortless affair as making the first. After all, everyone around you seems to be expecting number two, three or even four, so soon you will be too, won’t you? But why is that thin line on your pregnancy test stubbornly refusing to turn blue?

Age Matters
Doctors use the term secondary infertility to describe difficulty in conceiving after at least one successful pregnancy and delivery. With the average woman now increasingly likely to become a first- time mum in her early 30s, age appears to be the primary factor.

Midwife and fertility expert Zita West has seen an increase in cases in recent years at her clinics, and agrees that delaying the first child is a key cause. “Women are having their babies later in life – by the time they reach their late 30s, they’re in a panic to have number two.”

But when you’re older, it takes longer to get pregnant. Some women who delay having babies – but plan to have their children in quick succession – underestimate the impact of childbirth. “It takes about 18 months to get over childbirth and get your body back to normal. Breastfeeding and irregular cycles, exhaustion caused by looking after your baby, being too busy or tired for sex – all these factors come into play,” says Zita.

The problem could also lie with the man in around 30 per cent of couples experiencing difficulty conceiving again. While perennially popular media stories of older men becoming fathers naturally give the impression that men are fertile until death – just think of Paul McCartney fathering a child in his 60s – sperm quality declines gradually after 40.

Your First Pregnancy
Age factors aside, fallopian tube problems are a major cause of secondary infertility, says gynaecologist Dr David Walsh. “If a woman has had, for instance, a caesarean section for her first child, or if she needed an evacuation of retained placenta after delivery, these increase her risk of developing an ascending pelvic infection affecting and damaging the delicate fallopian tubes.”

Adds Dr Walsh, “She may have had a low-grade temperature a few weeks after birth, offensive discharge, pelvic pain, but may not realise the problem with so much else on her mind. She’ll recover, of course, either with or without antibiotics, but the tubes are so fragile that it doesn’t take much to damage them, and this can compromise future fertility.”

Gynaecological diseases such as fibroids or endometriosis could also compound the problem. A woman may succeed the first time, but then struggle a second time around when age-related endometriosis, for instance, combines with a diminished ovarian reserve of eggs to result in secondary infertility.

Replenish Your Reserves
Poor nutrition is likely to lower fertility. Harried women, especially new mums, tend to neglect their dietary needs. Dietician Margot Brennan points out that new mums, often so wrapped up in ensuring their child is looked after and well-fed, get complacent with their own eating habits and forget that postnatal recovery takes time.

“With healthy eating, it takes about three months for your nutritional stores to return to normal after you’ve had a baby. And if you’re breastfeeding too, it will take three months after you stop,” she says. “If a woman is juggling work, house and home, as well as a baby, she can neglect herself. Up to a third of women don’t meet their iron requirements and a third don’t meet their calcium needs either. It’s a huge problem.”

Margot also says that you should consume a little red meat – in the form of lean beef, for example, rather than fatty burgers – to restore reduced iron levels after pregnancy. Take folic acid supplements too, if you’re looking to conceive. Oily fish and a selection of fruit, vegetables and complex carbohydrates should be on the menu as well.

“New mums or mums with young children are often sleep- deprived and exhausted,” she adds. “Women in this situation have a tendency to snack and nibble on starchy or sugary carbohydrate foods – like white bread and biscuits – to keep them going and give them some quick energy. But if they do this, they could be compromising their protein intake and their levels of trace minerals such as zinc. And being overweight will also affect fertility.”

The Trouble With Stress
For some couples, the worry when trying to conceive can take a toll on their home lives and affect their parenting of the child they already have.

Zita sympathises with parents in this predicament. “I often ask women whether they’re enjoying the child they have, and most are, but they feel guilty and can’t explain why,” she says. “The desire for a second child is so strong that a mother may not feel her family is complete without producing a sibling for the child she has. Many women feel too silly and greedy to ask for help, and they’re unlikely to get sympathy from, for instance, childless couples who envy their position and feel they should be grateful for the infant they have.”

Other women get stressed because their family is not working out according to the ideal plan they’d always imagined. They fret over time gaps between children, and how this might affect schooling arrangements, or the closeness of the relationship between siblings. Zita urges these women to accept the innate unpredictability of life; having fixed ideas about wanting children at particular times can work against you and add to the stress.

The Fear Factor
A small percentage of women Zita sees have been traumatised because of difficulties or complications during their previous birth. They have become frightened of labour, and therefore – sometimes subliminally – frightened of becoming pregnant.

Whether or not these women subconsciously sabotage or put up psychological or physical barriers to conceiving is debatable, but Zita says talking about a previous difficult experience is essential.

“If they talk about it, they begin to rationalise it and accept that they were traumatised by what happened to them,” she says. “After a difficult delivery, you can develop postnatal depression which can stay with you. So much of the work I do with women is to do with their mindset: If you allay their fears, often pregnancy just happens. This also frequently works when couples stop trying extremely hard to conceive. I often tell them: ‘The baby will come when the baby will come’.”

The good news, says Dr Walsh, is that couples can and do normally succeed the second time around, although IVF may be the necessary option for older women. For others, regular (thrice-weekly) sex throughout the month is likely to result in a conception within two years. Either way, do not be afraid or shy of seeking help, advice or reassurance.

“Do go and speak with your doctor,” summarises Zita. “And don’t be afraid to rally support around you from friends and family. It will really help.”

This article was originally published in SImply Her April 2011.