Secondary infertility can be as mystifying to the medical experts as to the couples involved.
"I think with our doctor he seemed to think because it had happened it was likely to happen again. I don't think he understands why it hasn't happened, something is different," says Sally, 40 a former social worker married to Paul, 43, a counsellor.
Kate was conceived with the help of IVF. "Our bio-chemistry is hostile," says Sally. They are continuing fertility treatment.
Going to the fertility clinic with Kate can be awkward, says Paul. "I see the looks in people's eyes and think, "Should we really be doing this, it's like rubbing their noses in it". "
For Sally the hardest thing is the foiled life plan. "Having children was my plan and to be a stay at home mother."
People also don't eat enough protein which can make an enormous difference.
Sally looks back on her early years with Paul and wonders if she wasted time just working on their relationship. "The first few years we built a platform, a foundation for our marriage."
She is still quite hopeful that she will become pregnant again and she has the full support from Paul although there is a limit to what they can afford.
But he was an only child and doesn't want that for Kate. "I found myself a little socially retarded at school," he says. Having a couple of siblings would help that, he says.
Sally finds that when she meets other couples experiencing secondary infertility, "it is like a silent bond. They know your story and we know their story. It's like a knowing, a secret handshake."
Paul says his message to other men is not to shut off but to be there for their partners. Sally thinks that Paul will lose hope before she does. "I am certain that Paul will reach that point before me," she says.
Adoption is an option for couples going through secondary infertility just as it is for those with primary infertility.
Susan and her husband Mark had Joshua naturally at 29 and then started trying for another at 31. They now have Sarah thanks to IVF, who is three. Joshua is now 10.
The couple looked at adoption as their second child failed to come along but it was awkward at times going to meetings.
“People would look at you as if to say, “You have a child why do you want another?”.
“I said: “Excuse me our family is not complete”,” says Susan.
Susan remembers how hard play group was when she was trying to get pregnant. One friend who was pregnant said : “Oh, I'm sick of being pregnant, if I could just get rid of this baby.”
Although she would have liked a third, Susan is not even going to try. “I don't want to go through all that heartbreak again.”
Fertility experts tread carefully with couples going through secondary fertility. Dr Guy Gudex, medical director of Repromed Auckland says “We have certainly seen some people very distressed by secondary infertility.”
According to his figures in New Zealand, about 10 per cent of couples who get pregnant easily, then experience difficulty the second time.
“For some people, not being able to have the second, it's huge.”
He tries to explain how secondary fertility happens. Sometimes it may be that a couple gets pregnant easily by chance, there is some underlying problem with the man's sperm and they've just “struck it lucky” first time round.
Then there is age – some people who might have waited three or four years between children and in that time the woman has gone from 33 to 37 or 38. For most it does not matter, but for 10 to 15 per cent of women, there will have been a drop off in the quality of their eggs. Also as couples age they tend to have intercourse less often and coital frequency is relevant.
Finances are very stressful second time round, he says. In New Zealand there is no IVF public funding for a second child unless you are in a new relationship, says Dr Gudex.
In Australia, Dr Richard Henshaw, medical director Repromed Australia, says of four people who come to Repromed clinics with infertility problems, three quarters have not had a baby and one quarter have.
He understands there are specific difficulties with coming to terms with secondary infertility.
“If you don't have a family at all, then it's: “Something is fundamentally wrong with me. If you have had a baby, you know it's possible,”” says Dr Henshaw.
The medical director recently saw a couple who already had three children, and wanted to have a fourth. “This is our wish, we are not under any pressure,” they told him. They were happy to be fatalistic about it.
People's ability to copy with failure has a much broader spectrum with secondary infertility than primary infertility, he says.
Alternative treatments from a number of areas like acupuncture and naturopathy are being as used as much by women going through secondary as primary infertility. Naturopath and medical herbalist, Sheren Marra, from Natural Fertility Women's Health clinic in Auckland, points out that there is often a lot of stress going on in the lives of couples as they try to conceive a second child.
“There's not enough time – couples don't have time for what is needed.” The recovery time you had during your fertility treatment first time round is simply not there. “They are incredibly tired, that's a huge part of it,” she says. Marra works with couples getting then to return to some basics of eating well and sleeping well.
The effect of stress on blood sugars is important, says Marra. People also don't eat enough protein which can make an enormous difference, she says.
The naturopath feels sympathy for the men who can be finding it hard being the sole breadwinner, if their partners are at home. Stress for men can lead to male infertility.
A traumatic birth with the first child can sometimes hold things back, adds Marra. “If there has been a traumatic birth there is a huge fear factor. A lot of women we see the second time, the first birth may have been so traumatic it blocks them. Once again it's about time.”
Read author Gill South's additional article on secondary infertility here.