When planning for baby number two, women with a history of fertility issues may question how getting pregnant for a second time will be different than the first. The decision to expand the family is an exciting one. However, for couples who have experienced infertility in the past, preparing for a second baby can cause fear, anxiety and uncertainty.

Thankfully, second-time parents have experienced pregnancy before, which can help relieve the stress of the unknown. Taking the time to consider the factors that can affect a second pregnancy can give couples an idea of what to expect this time around.

What is the minimum time to wait before getting pregnant again?

It may be important to some couples that their children be close in age, motivating them to expand their families more quickly than others. While the decision is ultimately a personal one, not waiting long enough between pregnancies can be risky for both the mother and baby, especially if the previous pregnancy was strenuous.

Research suggests that ideally, women should wait 18 months between pregnancies. The interpregnancy period for women who have a history of infertility issues is not any longer or shorter than for women without.

Pregnancies less than 12 months apart can put infants at risk of congenital disorders such as preeclampsia and in some cases developmental disorders such as autism. Studies found that short interpregnancy intervals carry a 3% increased risk of preeclampsia and two to three-fold increased autism risk. Babies conceived within six months of a previous birth have an 8.5% risk of being born prematurely and the risk of miscarriage in these pregnancies increases by 230%.

Having a baby is no easy task and while it may be natural for new moms to shift focus from caring for themselves to caring for their new baby, it is important that women dedicate enough time after giving birth to recovering both physically and mentally.

Research shows that mothers need at least 12 months post-birth to fully recover in the following ways:

• Regain nutrient levels. During pregnancy and breastfeeding, babies receive all of their nutrients from the mother’s body causing lower folic acid levels. Folate is a vitamin B, crucial to cell development. Low folate levels during pregnancy can lead to neural tube defects, preventing normal growth of a fetus’s brain and spine.
• Restoring iron levels in the blood. Maternal anemia, caused by low hemoglobin levels in the blood, affects 52% of pregnant women. Iron deficiency during pregnancy can lead to breathlessness and fatigue and premature birth. Iron levels need to neutralize post-birth, which happens naturally over time.
• Reproductive organs need time to reset. After giving birth, the uterus and birth canal may be irritated or inflamed, especially if there were any infections present post-birth. A study found that 1 in 10 mothers reported genital and pelvic pain for up to 12 months after giving birth. Getting pregnant again before the body heals can lead to lasting damage.

Waiting longer is not always better

While not waiting enough time between pregnancies is ill-advised, waiting too long to get pregnant carries its own set of risks. One study found that women waiting 72 months or longer between pregnancies were at a higher risk of stillbirth than women who waited less than 6 months. This can be traced back to physiological changes affecting pregnancy in older women.

Couples on their second pregnancy have naturally aged since the birth of their first baby, which automatically decreases fertility in both partners. Parents who experienced fertility issues with their first baby should also take into consideration the role of aging in infertility.

• Women over the age of 35 are at a higher risk for fertility issues.
• Women will only have about 3% of their original egg count left by the age of 40.
• Most women are unable to have a successful pregnancy by their mid-40s (before menopause).
• Men in their 60s also experience reduced testosterone levels, leading to a decrease in sperm count and semen quality.

Using assisted reproductive technology for a second time

Women who used ART, such as IVF, for their first baby may be worried about how this might affect their chances of having a second child. While there are no guarantees, a recent study published very positive results for IVF baby number two, reporting 43% of women had another baby after just one frozen embryo transfer. After six cycles of frozen embryo transfer between 61% and 88% of women had a baby.

It is important to note that these results differ when using fresh embryos, with successful birth rates standing at 31% after one IVF cycle. Frozen embryos are advantageous especially for women who are older at the time of the cycle than they were upon freezing the embryos.

IVF technology has advanced immensely, giving women with fertility issues a much greater chance at having children than ever before. That being said, science cannot prevent the aging process altogether and women who know they want to have a second baby should not wait too long before starting the process again. The study showed that success rates decreased with age, with women aged 40 at a 20% chance of getting pregnant with fresh embryos.

Reproductive changes after birth

Women who experienced fertility issues with their first baby are likely familiar with the potential causes of primary infertility and how these factors might affect a second pregnancy. After giving birth, however, women can sometimes sustain damage to their reproductive organs caused by complications during pregnancy or surgery, posing a different set of infertility risks.

Some of the leading causes of reproductive organ damage are:

• Cesarean delivery can sometimes lead to adhesions on the uterus, leading to potential infection and scar tissue build-up, hindering future conception and pregnancy.
• Polycystic ovary syndrome is a condition that can affect a woman’s hormone and egg production, especially later in life.
• Endometriosis can cause inflammation and scar tissue on the ovaries and fallopian tubes, making conception more difficult.
• Uterine fibroids can also cause blockage in the uterus and fallopian tubes. Fibroids can become worse as a woman ages, making them a potential factor in secondary infertility.

Managing anxiety and emotional health

For parents that experienced difficulty with conception or pregnancy in the past, the thought of going through a similar process again may bring up more feelings of anxiety than excitement. Fertility problems can be traumatic and isolating, leading some to self-blame.

It may be hard to remember, but millions of couples face fertility issues each year. Some may find comfort in the fact that they are not alone in their struggles and can look to support groups or counselors. Building strong support networks either through therapy, friends, or family, can help cope with feelings of fear and loneliness surrounding the topic.

Some may prefer to keep their fertility treatments private. In this case, strong communication between partners is important to maintaining emotional health in the relationship. Setting realistic expectations before trying for a second child can help prepare for emotions that may arise, no matter the outcome.

Sometimes fertility can take center stage, making it easy to forget the importance of self-care. Mothers need to take care of themselves by exercising, eating right, and getting proper rest. Anxiety can negatively affect fertility, so while it may seem difficult, relaxing can actually make a difference.

Becoming as informed as possible can help empower couples by allowing them to make the right decisions depending on their situation. Consulting a fertility specialist is the best way to determine the best course of action.

Families that take time to do their research can regain a sense of control and calm. No matter the chosen path to becoming a second-time, we hope your experience is as smooth as possible.