Q I am a mother of a beautiful two-year-old daughter, who will be three in a month, and though I would dearly love another baby, I am having trouble conceiving. My husband and I always imagined having a family of three or more children and I particularly wanted to have my children close together. I am 37 and we have been married for five years.

Our first girl was conceived within two months of trying so I assumed number two would be just as easy, but nothing has happened yet and the clock is ticking.

We went for some tests last year and there were no physical problems identified, other than the doctor noting that I was getting older (which really hurt me). We were told to go away and relax and to try again, with the option of coming back and trying IVF.

I don’t know what to do as I know that going down the road of IVF is a hard one.

I feel guilty about it all as some women I know are having trouble having their first child. When I discussed it with a close friend she more or less suggested I should be happy with the great daughter I have. This made me feel terrible. I love my daughter to bits but I would just love a sister or brother for her. I find myself getting really down about it all. Every month I feel hope that this could be the one, and then I'm absolutely crushed when my period arrives.

My poor husband is trying his best to support me, but needless to say our relationship is under strain. Should I just keep trying, or start IVF?

A Your question highlights the common problem of secondary infertility and the particular stress and upset it can cause couples. While there is some public awareness of the upset for couples struggling to conceive for the first time, there is less awareness of the problems for couples struggling to conceive subsequent children.

Whereas nowadays people are more sensitive to couples who might be childless, realising that this might mask a private grief, there is less sensitivity to couples with one or two children and less realisation that they may want another child and be struggling to achieve this.

Although she was only trying to be helpful, unfortunately your friend’s attitude is quite typical. She probably does not realise how a suggestion that you should be happy with one child could upset you so much (and add to your guilt) when you are in the throes of trying for another child. The grief of not conceiving a second child can be just as strong as not conceiving a first.

Many couples I have spoken to who are trying for first or subsequent children talk about the experience of a private mini- bereavement each month when the hoped- for pregnancy does not happen.

Realise that you are not alone

In moving forward, the first step is to realise that you are not alone. Although some of your friends or people in your extended family may not fully appreciate what you are going through, your hopes and feelings are completely understandable and normal. Don’t add to your misery by feeling guilty about how you feel.

The fact that you wish for another child and a bigger family in no way invalidates your complete love for your daughter: your wish for more children is as much a dream for her as it is for you.

It is important to seek support and to talk to people who understand. If it is hard to find support in your immediate circle, there are some great forums online, where mothers (and some fathers) share the challenges of trying to conceive a second child and provide each other with great support and information.

Several of these forums and websites are Irish: search online for “ secondary in- fertility” or “trying to conceive a second child” and you will find lots of helpful links.

Make the best decision regarding treatment

I am not best placed to advise on treatment options for secondary infertility but I would advise you to seek the support of a team who you feel understand you and will support you in your journey. Take time to educate yourself about all the options and make the best decision for yourself and your husband.

It is important to take a holistic view of getting pregnant and many alternative treatments that focus on nutrition, a healthy lifestyle and a positive mental attitude can all help.

While of course stress is a factor in conceiving, it is very hard to relax when you feel under pressure, so engaging in structured health programmes that can help you have a positive self-care focus will benefit the process of trying to conceive.

Attend to your relationship with your husband

Concerns about infertility put great stress on couples’ relationships and you are right to notice and attend to this.

Remember that you are in this together and while such a big problem can drive you apart, it has also the potential to bring you closer together. Simple things can make a difference such as:

Taking time to share how you feel about the problem, recognising that you are likely to have very different feelings about what is happening. Try to understand your different perspectives without judg

ment.

Specifically ask for the support you need from your husband. Say what you need at the challenging times, such as when a period arrives; don’t assume that he knows. In addition, ask him what he needs from you and try to meet him half- way.

Set aside at least two times a week when you have a babysitter and you can spend special time together focusing on fun and without just talking about problems or issues

Set aside time for enjoyable family times with the three of you that nurture your family relationships.

Dr John Sharry is founder of the Parents Plus charity. He will present a workshop for parents of babies and toddlers on Saturday, November 22nd, in Dublin. New and expectant parents are especially welcome. See solutiontalk.ie