Published Jul 25, 2026 | 11:33 AM ⚊ Updated Jul 25, 2026 | 11:33 AM
Secondary infertility exists in the uncomfortable space between gratitude and grief.
Synopsis: Secondary infertility carries a hidden psychological burden that is often dismissed with remarks like, “At least you already have one child.” Psychiatrists and fertility specialists explain how invalidated grief, guilt, anxiety and relationship stress affect couples, why counselling should be part of fertility care, and how emotional support can improve resilience.
For many couples, the first pregnancy comes without difficulty. They welcome a child, grow as parents and, years later, begin planning to expand their family. But the second pregnancy never arrives.
What follows is often not just a medical journey through fertility clinics and repeated tests, but an emotional one marked by a grief that few recognise.
Instead of empathy, many hear a familiar refrain: “At least you already have one child.”
The remark is usually well-intentioned. Yet mental health experts and fertility specialists say it often leaves couples feeling that they have no right to grieve, forcing them to carry their disappointment in silence.
This experience, known as secondary infertility, is defined as the inability to achieve another pregnancy after having conceived at least once previously, irrespective of whether that earlier pregnancy resulted in a live birth or ended in miscarriage.
While infertility is often portrayed as the struggle to have a first child, specialists say secondary infertility carries a distinct emotional burden because it exists in the uncomfortable space between gratitude and grief.
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“While both primary and secondary infertility can be deeply distressing, secondary infertility often carries a unique emotional burden,” Dr Girishchandra BG, Medical Director and Senior Consultant, Adult Psychiatry, Maarga Mind Care, Bengaluru, told South First.
“Couples are grieving the loss of the family they had envisioned while simultaneously parenting an existing child. Their emotions are frequently more conflicted because they feel they should be grateful for having one child, yet continue to experience extreme disappointment and loss. This internal conflict can make their grief more isolating and difficult to express.”
Unlike parents experiencing primary infertility, those with secondary infertility rarely receive the same level of emotional validation.
Dr Girishchandra termed it “invisible grief” — one that often goes unnoticed because the outside world assumes parenthood should erase any sense of loss.
“Families and friends can unintentionally minimise the couple’s experience with comments like, ‘At least you have one child already,’ assuming that parenthood should alleviate their distress,” he said.
“While these comments are often well-intentioned, they can leave couples feeling that their grief is illegitimate and that they have no right to grieve.”
For many, the struggle is not simply about wanting another baby. It is about mourning the family they imagined, the sibling relationship they hoped their child would have, and the future they had planned.
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The phrase — “At least you already have one child” — is intended as comfort, but psychologists opined that it often has the opposite effect.
“Although intended to be reassuring, such comments often leave couples feeling misunderstood, guilty or ashamed about grieving,” Dr Girishchandra said.
“They may start to repress their feelings, thinking that they have no ‘right’ to feel upset. Repeatedly invalidating someone’s feelings can ultimately lead to anxiety, depressive symptoms, social withdrawal, and reluctance to reach out for emotional support.”
Dr Rani Aiswarya, Consultant Fertility Specialist at 9M Fertility by Ankura Hospital, has seen this frequently.
“There are couples who are DINK couples, meaning dual income, no kids. They have decided that they don’t want children, and that is their choice,” she told South First.
“But secondary infertility is completely different. These couples want a second child for their own reasons, but they are unable to conceive. When somebody comes and says, ‘You already have one child,’ or starts advising them about finances, or why they don’t need another child, it hurts them more because they are already trying.”
“The couple has not decided that they don’t want a second child. They are trying for one, and somebody else is telling them not to. That makes them more irritated, more stressed, and emotionally it affects them even more.”
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One of the defining features of secondary infertility is guilt.
Many parents struggle with conflicting emotions. They love the child they already have, yet feel heartbroken about not being able to have another.
Dr Girishchandra said these feelings are not contradictory.
“Many parents feel guilty that they are grieving while already having a child, worrying that their sadness reflects a lack of appreciation for their family. They may also feel guilty if fertility treatments consume time, energy or financial resources that could otherwise be directed toward their first child.”
He stressed that gratitude and grief can coexist.
“Recognising that gratitude for one child and grief over infertility can coexist is an important step toward emotional healing.”
Yet many parents continue to compare themselves to families whose children have siblings, wondering whether their own child will grow up alone.
Dr Aiswarya said these concerns often emerge during consultations.
“Parents tell us, ‘I had siblings, so why should my child grow up alone?’ They compare themselves with other families where children have brothers or sisters to play with and grow up with. They worry about emotional companionship.”
“They also think ahead and wonder, ‘We are already older because we had our first child later. We don’t know how long we will be physically or mentally able to support our child. Who will be there for them after us?'”
Secondary infertility is not only emotionally exhausting because pregnancy does not happen. The treatment journey itself can become another source of stress.
“The most common psychological problems are chronic anxiety, depression, uncertainty, frustration, guilt, decreased self-esteem and ongoing stress,” Dr Girishchandra said.
“Many couples may suffer emotionally from repeated fertility evaluation or treatment, and the uncertainty of future outcomes may increase psychological distress. Coping styles, financial worries or the emotional toll of treatment can strain relationships.”
Dr Aiswarya said infertility frequently spills into relationships.
“It certainly affects the couple’s relationship, even their sexual relationship and intimacy. Sometimes it becomes a blame game.”
“One partner may blame the other for obesity, hormonal imbalance or postpartum complications. As age advances, these issues become more common, and if pregnancy is not happening, partners may start blaming each other. Instead, they should stand by each other because infertility is a couple’s problem.”
Despite the profound emotional impact of infertility, psychological support is rarely used.
Dr Girishchandra said counselling should become a routine part of fertility treatment rather than an afterthought.
“Psychological counselling should be an integral part of fertility care, not an optional service. It helps individuals and couples process grief, manage anxiety, develop healthy coping strategies, improve communication and make informed decisions throughout treatment.”
Dr Aiswarya agreed, but added that stigma continues to prevent couples from seeking help.
“Unfortunately, almost none of my patients agree to meet a psychologist, even when we suggest it. Infertility itself is not a psychiatric illness, but its consequences can be overwhelming. Still, many people are not ready to accept psychological support.”
She opined that counselling should involve both partners.
“If only the woman comes to my clinic, I always ask, ‘Where is your husband? I want to talk to him too.’ I prefer to counsel both partners together because infertility affects both of them.”
The problem, she added, often extends beyond the couple.
“Sometimes the mother-in-law or father-in-law accompanies them. They may ask us to examine only the woman and not even evaluate their son.”
“In fact, I sometimes feel the extended family needs psychological counselling more than the couple.”
Both experts said there is no quick solution to the emotional burden of infertility, but there are healthier ways to navigate it.
Dr Girishchandra advised couples to communicate openly, express their emotions without judgement, seek support from trusted family members or infertility support groups, maintain healthy routines and avoid constantly comparing themselves with others.
He recommended professional help if sadness, anxiety, hopelessness, sleep disturbances, relationship conflicts or emotional distress persist for several weeks or begin affecting everyday life.
Early psychological support, he said, can reduce the emotional burden and help couples navigate fertility treatment with greater resilience.
For couples living with secondary infertility, perhaps the first step is not another medical test, but something far simpler: having their grief recognised.
(Edited by Majnu Babu).
