05/11/2015 06:13 GMT | Updated 03/11/2016 05:12 GMT

Secondary Infertility: The Silent Sadness

Sitting across from Jane, her sense of loss fills the room. As a fertility expert this isn't an uncommon experience, only Jane's need isn't for a much loved first baby. It's for a third.

Jane contacted me after trying for 18 months, having fallen pregnant easily with her first two children. Fast approaching 40 and her GP having told her there were no investigative options available to her, a friend suggested exploring alternative routes.

Secondary infertility accounts for 60 percent of infertility cases. During this National Fertility Week 2015, I want to raise awareness of this very real condition that is rarely discussed.

Feelings of frustration and anxiety are enhanced when you are not falling pregnant, and you know you are not infertile. Friends and family will glibly ask when the next one is coming along and first children will grow old enough to ask why they don't have a sibling. Many parents in this situation will suffer in silence, focusing attention on their precious only child, while harboring grief at the loss of another, sometimes for the rest of their lives.

Secondary infertility is diagnosed when a couple has already had a baby without medical support, has been trying to conceive again for one year when the woman is under 35, or 6 months when the woman is over 35. Causes of secondary infertility vary, but there are a number of factors that may be at play. As a woman ages, her egg quantity and quality will decrease, which will also increase the chance of miscarriage. Endometriosis or prior abdominal surgery, such as a previous caesarean-section may cause pelvic adhesions which can may make it difficult for the egg to be picked up by the fallopian tube.

Weight can also have an impact on the ability to conceive. Excessive weight gain can cause the ovaries to dysfunction and over-produce testosterone. In men, excessive weight gain can have the converse effect, by increasing estrogen levels which will negatively impact sperm production.

Age will also have an effect on a man's sperm quality and quantity. A semen analysis is one of the initial procedures in any infertility evaluation.

Finally, smoking cigarettes can significantly impair the ability to conceive for both the man and the woman.

Couples, especially women will find many ways to blame themselves when things don't go as planned. Whatever the underlying causes, talking with a specialist is the best way to untangle the web of information and emotion - including the helpful "advice" from friends and family.

Some might think that Jane was 'greedy' to want three children, but this precious third was the family she had always dreamed of. In Jane's case, I suspected a cocktail of high stress, pelvic adhesions from two previous caesarean sections and anxiety was getting in the way of conception. For four months I carried out de-stressing acupuncture treatments and on the fifth month she fell pregnant.

The solution is not always this easy, but what this story does tell us, is how important it is to not suffer in silence and to seek help from a fertility professional as soon as you feel that you might be experiencing a problem. There are solutions and once you have connected, you can work together to evaluate any issues and be set on a path toward creating the family you have always dreamed of.