Coping with secondary infertilityhen their daughter was 2, Gayla and JimCamoriano decided they were ready toexpand their family and began trying

to conceive their second child. "When we first gotmarried, we talked about how many kids we wouldhave. Going into that, I thought it would be easy.You could pick the number and dates," Jim recalls.But hope changed to disappointment month aftermonth as the Camorianos began a long battle withthe highs and lows of secondary infertility.

Like the Camorianos, more than 1.4 millioncouples each year experience secondary infertility,the inability to achieve a pregnancy despite havingexperienced one in the past. The causes of second-ary infertility can range from ovulatory disorders to

male reproduction problems to diseases such asendometriosis. For the Camonanos, the causesof their infertility lay somewhere in between.

After two pregnancies ended in earlymiscarriages, Gayla learned she had a luteal

phase defect. a condition in which thelining of the uterus

doesn't developproperly in thesecond half ofthe menstrualcycle. Her gy-

After riding theroller coaster ofsecondary infertilityfor more than threeyears, Jim and GaylaCamoriano and theirdaughter, Alycia, areeagerly awaiting thearrival of a newfamily member.

necologist prescribed a drug to help correct theproblem, but a year later the Camorianos still hadnot achieved a pregnancy.

The couple then was referred to Dr. JohnCassels, a reproductive endocrinologist and infertil-ity specialist at the University of Missouri HealthSciences Center. In addition to a hormonal problem.Dr. Cassels diagnosed a problem with Gayla's thyroid.

"It was a roller coaster ride of information,"says Gayla, who experienced many emotions com-mon in infertility patients. "At first. you think it'syour fault." she says. Jim felt the same way. "Mywhole life, I always had to have an answer for ev-erything. But when I ran up against this, there wereno answers," he says.

V' ingLike women dealing with primary infertility,

those experiencing secondary infertility feel emo-tional pain, but they also must deal with stressesthat are unique to their situation, says clinical nursespecialist Jennifer Baskett. "In many ways, second-ary infertility is more frustrating for these patientsthan if they had never been able to get pregnantbecause they know it can work and have achieved apregnancy before." For couples who already have achild, guilt also can become an issue, Jennifer adds."They may feel guilty because they feel they shouldbe appreciative of what they have."

Because of a lack of understanding from friendsand family members, couples facing secondary in-fertility don't always have the support they need tocope with their diagnosis. "When people say they'rehaving trouble getting pregnant, they get inappro-priate responses, such as, 'Take a vacation' or 'Takemine for a week, and you'll change your mind: "Jennifer says. "That's not what they want to hear."

The Camorianos chose to address questionsabout having another baby openly and hon-estly, eliminating further questions and insen-sitive remarks. This approach also helped them

cope with their own emotions. "People chooseto deal with it in their own way, but I can't imagine

having not talked about it." Gayla says.To provide a coping mechanism for people like

the Camorianos, Jennifer and medical socialworker Denise Pinkerton facilitate a support groupwhere couples are able to share some of their feel-ings about what they're going through. "We try tohelp patients in the support group learn techniquesfor coping with infertility," Jennifer says. "Makingthem feel their emotions are normal is important,

as is stopping them from feel-ing guilty about wanting sub-sequent children."

Gayla and Jim also soughtoutside support from a half-day conference held by thefertility clinic at UniversityPhysicians-Green Meadows."It was nice to see we weren'talone," Gayla says. "It's amaz-ing how many people gothrough this."

"Some of the most impor-tant reasons for couples toparticipate in a support groupare not only to realize they'renot the only people out therewith this problem and to getsome education but also to

develop relaxation techniques and ways for themto deal with each other, with the stresses andstrains that infertility has brought into their lives,"Dr. Cassels adds. "Being able to relax may make adifference in how hormonal events occur throughthe woman's cycle. That may be why some of thecouples who have been working with us and thenquit and go home end up pregnant in three or fourmonths."

If Ynci

want

.. • • ..• ••. . •••

seco I •••Ull IIlIvl LII"1 ••••••. . .. •••group' offered Ily ttie U II •••••••••

-of Missouri Health SciencesCenter, call 882-6565.

For more information aboutsecondary infertility, clinicalnurse specialist Jennifer Baskettrecommends the book WantingAnother Child: Coping withSecondary Infertility by therapistHarriet Fishman Simons.

Seeking medical helpDr. Cassels says fertility clinics and physicians

also can act as a source of support, education andtherapy for many women. In choosing a physician,"women concerned about their fertility should be

certain the person they are talking to has both aworking knowledge of fertility and reproductionand the interest and time to invest in providingcare," he says.

Clinics and doctors can't always provide theresult many women are looking for, but mostwomen with secondary infertility do become preg-nant. "On average, we statistically increase thechance of getting pregnant to about 12 to 14 per-cent each month," Dr. Cassels says. If you don't likethose odds, remember, "a failure to achieve a preg-nancy the first month doesn't mean what you'redoing can't be helpful." he adds. "If you look statis-tically at what happens if you repeatedly try some-thing with a 14 percent success rate for four to sixcycles, you probably increase the chances of successto around 40 to 60 percent, depending on the par-ticular problem. If you are starting with relativelynoninvasive and inexpensive forms of therapy forsix months to a year, you may eliminate the needto go on to the next step."

Gayla and Jim knew their last treatment stepwould come before fertility shots. After goingthrough six months of artificial insemination, Gaylasays they decided to quit trying.

In addition to facing additional emotional tur-moil had they decided to seek further treatment,they also had to consider the cost. Most womenwith secondary infertility do not seek treatment,and cost often is cited as a reason why. "I've heardpeople say, 'It's getting really expensive. I have tothink about whether I'm going to start saving formy current child's college education or try to givethe child a sibling.' I think there's probably no oneeasy answer to that," Jennifer says.

After riding the emotional roller coaster of sec-ondary infertility for nearly three years, theCamorianos got the happy ending they were look-ing for when Gayla became pregnant shortly afterthey decided to stop seeking medical treatment.Now the only uncertainty in their lives rests in onesmall detail- will it be a girl or a boy? (ffi