Jemimah Hayes would love to have a second child.
"Mum is my favourite title of all," the 39-year-old from Melbourne/Naarm says. "Being a mum is everything I wanted."
It's why her experience with secondary infertility, after giving birth to her daughter Billie 13 years ago, has been so painful.
Secondary infertility is when you're unable to get pregnant or carry a pregnancy to term after previously giving birth without help from fertility treatment.
"Secondary infertility is often very, very unexpected, because they may have no problems at all conceiving the first time around," explains Narelle Dickinson, a fertility reproductive counsellor in Brisbane/Meanjin.
Jemimah experienced an ectopic pregnancy a few years after Billie was born and hasn't been able to get pregnant since.
"Everything went so swimmingly with Billie. When you realise it's not always that simple, your heart starts to break, but you feel like you can't talk about the longing or infertility, because people will be like — you have a child, how are you infertile?"
An 'invisible' grief
Jemimah says she and her husband grieve the family they imagined for themselves, and processing that has been difficult.
"You feel like you're not entitled to talk about your longing because you've already got one [child], and there are people who are … not able to have any."
Ms Dickinson says the physical, emotional, and financial impacts of infertility can be painful regardless of whether someone has no children, one, or several.
"We all have an idea in our mind of our imagined family, whether it's no children, one and done, or a football team.
"Struggling to have the family that we want, or to have that completed family, is still a really emotionally distressing and challenging situation."
She says often people experiencing secondary infertility are "poorly supported".
"People have a lot of sympathy for people who are wanting to start a family and struggling with that.
"But there is a bit of invisibility if you've had a baby and are trying to expand your family and that's not working for you."
Ms Dickinson says there is the extra challenge for people trying to parent while going through infertility.
"Even pragmatically, just getting to medical appointments and finding time while juggling having a child."
How common is secondary infertility?
Manuela Toledo is a board member with the Fertility Society of Australian and New Zealand, medical director at TasIVF and a fertility specialist at Melbourne IVF.
She says about half of the patients she sees have primary infertility (meaning they have never been pregnant), and the other half are experiencing secondary infertility.
"Almost one in five people experience infertility, and of those, at least a third to almost half will be secondary infertility."
Dr Toledo says the medical causes behind secondary infertility can be the same as those experiencing primary infertility, but commonly are related to maternal age.
"If you're starting to have babies in your early 30s, by the time you are ready to have another you might be mid to late 30s, and that's when medical age-related infertility starts kicking in for women."
She says unexplained infertility is also common in these cases.
"Up to 30 to 40 per cent of patients we see in the IVF world present with unexplained infertility, be that primary or secondary."
Dr Toledo says she treats patients with secondary infertility just as seriously as those trying to have their first baby.
"I see couples with three children trying to have their fourth, and they are just as devastated as the couples trying for their first."
When 'one and done' doesn't resonate
Patti Lupari gave birth to her daughter five years ago. She and her husband started trying for another child two years ago.
Her doctor recently suggested they try IVF, which they are considering.
"It does make me feel less of a woman [that] I can't conceive on my own.
"I did it once, why can't I do it again?"
Patti says she is worried about the financial stress of having to undergo fertility treatment, but feels motivated by giving her daughter a sibling.
"Our little girl has just stated prep and she's really wanting to be a big sister. That has an emotional push on myself.
"I feel sad I'm not giving her a sibling and her growing up without one, especially coming from a really large Islander family of six."
Patti says while she recognises there are positives to having one child, "one and done" doesn't resonate with her.
"I knew that I wouldn't have six children like my mother, but that I would have two at least to grow up together and have a companion, and not feel alone in the world."
'Throwing all our love into one child'
Jemimah says she and her husband have tried to cope by putting all their energy into daughter Billie.
"You end up throwing all your love into the child or children that you've got.
"It makes you parent in a different way … it changes the decisions you make for an only child.
"But it never takes away the ache that you wanted another one."
Jemimah sought professional counselling to help with her grief, something Ms Dickinson recommends to anyone struggling.
"It's a significant loss, and requires a lot of processing.
"It deserves gentleness from ourselves, and also from the people around us."
