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The Hidden Grief of Secondary Infertility

Photo-Illustration: by The Cut; Photo: Getty Images

Swellness” is a monthlong series exploring the health and wellness stuff no one talks about.

My 6-year-old son often asks out-of-the-blue questions on the way home from school. “Why do Minions like bananas so much?” “How far away is the moon?” “Why is duck poop white?”

I love how random and little-kid quirky his inquiries usually are. But sometimes, he tosses out one that catches me spectacularly off guard, like the other day when he wondered aloud on the bus: “Mama, why can’t you grow another baby in your belly?”

We were headed home from his international school in Amsterdam, where my American family moved last summer. I squirmed, wondering how much English the locals around us could understand.

But I tried to answer truthfully: It’s not easy for Papa and me to have children. It takes lots of doctors, medicine, money, and time. We’ve tried, over and over, and it’s just not likely to happen again. I tell him this makes me very sad, and that I know it might make him sad too, because when we really want something and we don’t get it, it hurts our heart.

Secondary infertility — the inability to have another child after having a first — affects about 11 percent of couples, and millions of people, in the United States. The contributing factors are the same as those affecting primary infertility, including advanced age and low sperm count. The complicated emotions that often accompany it are similar, too — sadness, anger, confusion, jealousy, and guilt, which I’m all too familiar with after a decade of reproductive challenges.

It took me a while to come around to the idea of having children, but when two pink stripes bloomed on a pregnancy test when I was 37, I was thrilled. That joy was short-lived, however. Genetic testing revealed fetal abnormalities, and my husband and I made the agonizing decision to terminate the pregnancy. The following years were a blur of staggering grief, natural losses, failed treatments, and infinite needle pricks before our son was born in 2016 via IVF.

We decided to try again. We had at least two early miscarriages from natural conception, then, in early 2020, decided to transfer another embryo. Timing wasn’t ideal, as we were headed to Berlin from San Francisco for my husband’s job. We sold our home and prepared for an international move — and, hopefully, kiddo number two. Despite the overwhelming stress and inevitable stumbling blocks (like a cyst on my ovary that required removal, a $5,000 procedure not covered by insurance), I remained hopeful and excited. I knocked out my to-do list while daydreaming about government-provided health care and child care. I even curated a box of my son’s outgrown baby clothes that my folks could bring when visiting us in Germany, just in case.

The procedure didn’t work. Crushed, we flew across the Atlantic with our little guy, then 3 and a half, without a clue about the impending pandemic that would soon upend every aspect of our lives, including how, or whether, we’d have any more children. About six months after arriving in Berlin, the word schwanger — pregnant, in German — appeared to my shock and delight on a digital test.

But like so many before it, that one didn’t stick, either. We considered IVF again. However, the prospect of navigating Germany’s infamous bureaucracy to import our embryos, or me traveling solo to California for the procedure — all during a deadly pandemic, no less — seemed like an insurmountable task I didn’t have the energy or emotional bandwidth for.

In the last few years, public discourse about pregnancy loss has broadened considerably. Meghan Markle’s New York Times essay about her miscarriage described the “almost unbearable grief, experienced by many but talked about by few.” Chrissy Teigen brought the public into the hospital during the in-utero loss of her son, Jack, at 20 weeks, documenting the trauma on her social-media accounts. I applaud this much-needed shift and increased awareness of the long-taboo topic. Yet, when it comes to the particular nuance I now face — being unable to grow my family — there’s no one talking about it. While I’d never wish these struggles on anyone, I do sometimes wish a highly visible public figure would step forward and say, Hey look, I want another baby, it’s not happening, I’m not sure how much longer I can keep trying, and it really sucks. Perhaps then, it might help pave the way for conversations that have been almost impossible with my loved ones. When I do express my desire for another child, I sense a subtle judgment that I’m greedy and ungrateful. That I’m not counting my blessings. It’s as if the presence of one child means I’m not even allowed to acknowledge a longing for another. Empathy feels almost nonexistent, making this a largely solo struggle.

In fact, I’ve pretty much stopped broaching the subject altogether, even with my closest friends and family. When I have opened up, I’ve almost always regretted it. “You have a beautiful son,” more than one friend has reminded me. “You’ll be fine” is my mom’s auto-reply. “How about you take one of my kids?” a family member once joked. There are also the standard suggestions of adoption or surrogacy, or sometimes a flippant “just try again!” — as if it has ever been that easy.

At this point, my husband and I are both old enough to be young grandparents, and my cycle is tapering off, so no matter how much sex we have, it’s nearly statistically impossible it would result in a healthy baby. And there’s nothing “just” about trying another round of IVF, especially with our embryos thousands of miles away in California, and our family now in Amsterdam following another move for my husband’s career.

Our $650 annual bill for embryo storage is due this month, a pricey reminder of what I’m trying to let go of. The “what ifs” have softened into “probably nots” — until I see a baby on the street like I did just yesterday, that sweet little head peeking out of a carrier sling, eyes squinting at the spring sunshine. Or when I watch my son with younger kids, and a tender, nurturing side of him appears as he holds their hands or tries to elicit a giggle. It simultaneously warms and breaks my heart as I imagine what an amazing older brother he would be, and I wonder, Maybe one more try?

Then reality creeps in. The stress and toll it would take on our family, to say nothing of the financial cost, just to attempt another IVF procedure. The real physical risks of a pregnancy on my aging body. Even with adoption or surrogacy, there would be bureaucracy, red tape, and an enormous price tag — all made more complex by living abroad. And the not-insignificant chance that none of these extraordinary efforts would even work. Yet again.

I know people aren’t mind readers. I don’t expect them to have an inkling of this carousel of emotions when they ask if our son has a sibling. But I do wish there was more compassion for the honest answer — that I really want another child, but it’s probably not in the cards. Instead, they assume that my longing somehow contradicts my gratitude for the child I do have. What I want is for people — especially those who have never had any trouble getting or staying pregnant — to just listen and try to digest the enormity of what I’m wading through.

Of course, they’re right about the importance of being grateful. My heart breaks for the countless people and couples out there who have tried over and over, unsuccessfully, to have even one kid.

My own fertility struggles have only deepened my appreciation for the blessing that is my son — my life’s biggest challenge and greatest joy, a curious, kind human with the energy of nuclear fusion. And therein lies a subtle message I constantly try to impart to him: Life is full of these co-existing dualities, and it’s okay to celebrate one thing (like being a mother to a wonderful 6-year-old) while grieving another (like the rapidly closing window for a sibling). The most important thing is, we try not to let the bad stuff define us, and do what we can to stay focused on the good.

I do my best to model this. I say a daily prayer of thanks to the powers of the universe (and science) for the miracle that is my boy, even as I still wish we could grow our family. I hope, as he watches me navigate this particular hurdle, I’m teaching him resilience, without sugarcoating the sometimes painful reality that the endless twists and turns in life don’t always lead us to where we thought we’d be.

And as I begin to make peace with our family’s future, I’m following the lead of one of us who seems to understand all of this innately.

“Mama,” my son blurted out one afternoon on the way home from school, “you guys are perfect for me.”

Taken aback, I released his hand and knelt next to him. “What do you mean, buddy?” I asked.

“I mean you and Papa. You guys are the perfect parents for me.”

Not even trying to hide my tears, I swept him up in a hug and told him that was exactly what I needed to hear — and that he was the perfect kid for us, too. Then he slipped his little hand back into mine and we walked the last few blocks home.

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The Hidden Grief of Secondary Infertility