Understanding Secondary Infertility and its Emotional Impact

Is it ever really okay to ask someone about their future fertility plans?

This is a question I reflect on time and again. As a qualified fertility nutritionist, my profession allows me to explore deeply personal topics – including reproductive goals, medical history, diet, and lifestyle – in a clinical setting. I am acutely aware that these discussions can feel intrusive, which is why they are always approached with sensitivity and framed around the client’s best interests. Once I explain that this information enables me to provide the best possible support, most clients feel reassured.

Before you engage in such conversations, ask yourself: Do I have the knowledge, let alone the permission to have this discussion?

The Emotional Weight of Fertility Conversations

While I consider myself a professional with a strong awareness surrounding my words and the pain they might inflict, I must confess I haven’t always been so cautious or even aware of the weight of my words. Before becoming a nutritionist and a mother, I mistakenly believed fertility challenges were primarily an issue for couples of a certain age. I blush when I think of my ignorance. 

I was also largely unaware of the struggles faced by those with subfertility – individuals with a reduced ability to conceive. Reflecting on my past misconceptions, I recognise how little this topic was openly discussed. Today, I am committed to deepening my understanding, choosing my words with care, and supporting my patients with empathy and professionalism.

Fertility – and infertility – has received increased media attention in recent years. Perhaps as a result, many couples find themselves fielding unsolicited questions about their reproductive plans from people who have no right to ask. These inquiries can come from a nosey neighbour, an outspoken relative, a well-meaning friend, or even a stranger. My patients frequently report that such questions persist, even after they have one child. This is at the heart of the issue.

It’s one thing to experience fertility challenges. Having to navigate medical treatments, manage the emotional rollercoaster and live with the constant uncertainty regarding future family planning possibilities. It’s another thing to undergo this challenge with the added burden of external scrutiny. Especially seeing most are doing everything within their power to conceive, often while masking their pain in daily interactions. They should not be expected to engage in awkward small talk or endure invasive questions simply to avoid making others uncomfortable.

Understanding Primary and Secondary Infertility

While primary infertility is widely discussed, sadly, secondary infertility is not as well known, understood or considered. As the name suggests, primary infertility is defined as a failure to achieve a clinical pregnancy after twelve months of regular unprotected sex. Secondary infertility, on the other hand, is the inability to conceive or carry to term a second or subsequent child after twelve months of trying.

To put it in simpler terms, primary infertility applies to couples that have never conceived, whereas secondary infertility applies to couples that have conceived previously. 

There are a lot of factors at play that can impact infertility. Infertility could be due to male factor, female factor or a combination of the two. The underlying reasons, diagnostic processes, and treatment options are complex and tailored to each couple’s circumstances. While addressing infertility as a global health concern is a significant challenge, the purpose of this discussion is to raise awareness of its emotional impact. 

For many, secondary infertility can come as a shock. After successfully having one child, it is natural to assume that expanding the family will be straightforward. Parents often envision a future with multiple children, and the excitement of adding a sibling feels inevitable. Some may delay trying for a second child due to the demands of early parenting, the pace of life, or economic reasons, only to face unexpected difficulties in conceiving. 

Secondary infertility again can be due to male factor, female factor or a combination of the two. It can be due to lifestyle factors, certain medications, and the elephant in the room of course is advanced age. Sadly, it is a biological fact that as men and women age, their fertility also declines. 

How to Offer Support with Sensitivity

While numerous factors can affect fertility, the key message to take away is the importance of not making assumptions about other people’s family planning or reproductive health circumstances. Questions surrounding why a couple is childless or why they only have one child might seem harmless, but they can be intrusive and deeply painful. Practise empathy, sensitivity and discretion always. 

So with this being said, how do you support a friend or family member going through fertility challenges? Firstly, if a couple or individual has shared their struggle, don’t take this lightly. It is not always easy to speak about deeply personal topics, so consider it a privilege to be entrusted into this space and welcomed into the inner circle. 

Be their confidant and don’t share information that isn’t yours to share. Listen without imparting advice and most importantly, just hold space for them. There is little you can do to fix their problem. They are not seeking your solutions, they are seeking your support and comfort. The best way you can provide this is to simply be there. Listen with an open heart, acknowledge their feelings, and where possibl,e contribute small acts of kindness. A calming herbal tea, a beautiful plant or an uplifting book are some ideas to get you started. It’s not about gifting extravagant items, but a small gesture to show you care – something to provide ease and comfort for when words feel hard. 

So, the next time you find yourself curious and about to ask what may seem to you to be an innocent question, pause and consider: Is this my question to ask? Consider the possibility of fertility challenges, and please remember compassion and respect should always take precedence over curiosity. It’s far kinder to let someone share their story with you on their terms, and if they do, understand the strength that it takes to have that conversation. Tread lightly and please be gentle with their heart. 

Angelica-Hazel Toutounji is a women’s health & fertility nutritionist with a Masters in Reproductive Medicine. Alongside her work as a health professional, Angelica-Hazel is a guest speaker and freelance writer specialising in health, travel and motherhood musings. She is also a wife, a mother, a breast cancer survivor and an eternal optimist. You can find her work here and follow her on Instagram.