According to a study published in Contraceptive and Reproductive Medicine, 15% of White women between ages 25 and 44 seek infertility treatment, whereas only 8% of Black women in the same age range seek treatment. While there are many reasons for these discrepancies, a report from the American Medical Association Journal of Ethics suggests that higher rates of health issues, such as obesity and fibroids, may contribute to infertility in Black women. Kecia Gaither, MD, who is double board-certified in obstetrics & gynecology and maternal-fetal medicine, says that “Black women can have a high incidence of uterine myomas, may delay being evaluated for infertility, and may have underlying comorbidities like diabetes, obesity, menstrual irregularities, or tubal factors accounting for the high incidence of infertility.” While there are lots of reasons why Black birthing people might face challenges when trying to conceive, they may also have less access to information, and are sometimes underprepared to use medical interventions to overcome challenges. Torie Comeaux Plowden, MD, who is double board-certified in obstetrics & gynecology and reproductive endocrinology and infertility (REI), explains that there is also a stigma associated with infertility in many Black communities. “It is important to speak up about fertility issues and how common they are in order to combat this stigma,” she adds. Each person’s infertility journey begins and ends differently, but Black birthing people can be disadvantaged along the way—both socially and biologically. Ahead, we’ll take a look at why—and what Black parents need to know when it comes to infertility and conception.
What Is Infertility?
The National Institute of Health (NIH) defines infertility as the inability to get pregnant before the age of 35, after at least one year of actively trying to conceive. NIH also states that people who cannot carry a pregnancy to term may be considered infertile. According to NIH, about 9% of men and 11% of women of reproductive age in the United States have experienced fertility problems. “[Infertility] cuts deep and there’s no other way to express it," says Natalie, a 38-year-old physician who recently was diagnosed with low ovarian reserves. As a Black Caribbean woman, Natalie shares that she struggled with the emotional impact of not being able to carry a child to term. “Knowing that I cannot create a little person who shares my biology is daunting. It’s overwhelming. You grieve. It’s a lot to process.” In Dr. Plowden’s experience, infertility is often thought of as “the woman’s fault,” although she says that statistically, in heterosexual relationships, about a third of the time infertility is related to females, a third related to males, and a third related to the combination of male and female factors.
What Causes Infertility?
There are many factors that affect fertility, including difficulties surrounding ovulation, which can prevent eggs from being fertilized. Hormonal imbalance, polycystic ovary syndrome (PCOS), or primary ovarian insufficiency (POI) could be root causes if a patient is not ovulating and struggling to conceive. Other common causes of infertility are blocked fallopian tubes due to pelvic inflammatory disease (PID), endometriosis, ectopic pregnancy, and/or uterine fibroids. Of course, fertility declines with age in all birthing people, while the risks of pregnancy complications arise over time. In Natalie’s case, she noticed that even after a year off of birth control, she and her partner hadn’t conceived. After several tests and irregular periods, Natalie was told she was undergoing early menopause. “I have what’s called low ovarian reserve,” she explains. “Essentially, women are born with a finite number of eggs. There just comes a point when that number runs out. It’s just biological.”
Stigma and Harmful Stereotypes
The American Psychological Association points to stigma that traces back to the myth that women of color are hyper-sexualized and hyper-fertile. This myth has its roots in racism and slavery, among other social ills, and can make it difficult for modern Black birthing people to admit that they are unable to conceive. However, according to the Centers for Disease Control and Prevention (CDC), Black women are actually twice as likely to suffer from infertility than their White counterparts. The stereotype of Black birthing people as being more fertile than others adds insult to injury. Nicha Cumberbatch, a Black doula, childbirth educator, and assistant director of population health at Spora Health, says that this stigma can make it more difficult to talk about infertility. “Unfortunately, these harmful stereotypes can delay or prevent women from seeking the care that they need,” Cumberbatch adds, reiterating that it’s important to understand that infertility is more common than they might think.
Racial Disparities in Care
According to Cumberbatch, some Black birthing people may not realize that they’re at higher risk for conditions that affect fertility, and sometimes have different responses to medical treatment. We are also more likely to have tubal factor infertility, or issues with conception caused by the fallopian tubes. Many Black people facing infertility say it is an uphill battle to get quality reproductive care. Challenges may include not having insurance that covers the cost of infertility services, a lack of Black sperm and egg donors, prejudice and bias from physicians, or feelings of shame and isolation. And those who do seek care can sometimes feel deeply uncomfortable in a medical space that is overwhelmingly White. In the 2015 landmark University of Michigan study titled Silent and Infertile, Rosario Ceballo, PhD (now Dean of Georgetown University), interviewed 50 Black women about their experiences with infertility. About 25% reported that physicians made them uncomfortable by making assumptions about their sexual promiscuity, ability to pay, or weight. Nearly all women reported feeling lonely, isolated, and like they had somehow failed. Natalie processed similar feelings during her journey, but for different reasons. As a physician herself, she felt silly for not realizing that this could happen to her. She knew a number of fellow Black friends who had shared their own infertility stories, and she had read studies that showed that female physicians had nearly double the rate of infertility as the general population. “It sounds stupid to say, but I never thought that biology mattered,” she reflects. After getting her diagnosis, she specifically sought out Black female OB/GYNs to help navigate her journey. “Infertility can be a very lonely experience,” she says. “I’ve tried to lean toward people who could identify with my experience in all aspects of my life.” Natalie emphasizes that Black women need safe spaces to feel vulnerable about their medical conditions and to explore their feelings about their motherhood journeys.
Accessibility to Infertility Treatment
“Just because a couple is experiencing infertility, it doesn’t mean that they will have to undergo In Vitro Fertilization (IVF),” says Dr. Plowden. “Depending on the diagnosis, they may be able to conceive with ovulation induction medications, with or without inseminations.” Many people may not know that their health insurance covers IVF and Intrauterine Insemination (IUI). In fact, 17 states in the U.S. mandate insurance coverage for infertility-related treatments, though the extent of coverage and reimbursements may vary. Numerous support groups and organizations, like Black Women and Infertility, Fertility for Colored Girls, Broken Brown Egg, and the Cade Foundation, can help families access infertility treatments by providing grants and other valuable information. A 2020 study published in Reproductive Biology and Endocrinology analyzed 122,721 embryo cycles from 2014 to 2016, including 13,717 cycles from Black women and 109,004 cycles from White women. Researchers found that Black women who undergo fertility treatment have markedly worse outcomes than their White counterparts. “We have a lower live birth rate for the initial cycle independent of factors such as age, ovarian reserve, past miscarriages, or the number of embryos transferred,” Dr. Plowden adds. This is why Black birthing people should reach out to their healthcare providers early to discuss their family plans, and to see if there are any underlying conditions or concerns that could be averted with preventative care, such as egg-freezing or other common treatment options. Jennifer Makarov, MD, OB/GYN, reproductive endocrinology & infertility specialist at New Hope Fertility adds, “What’s important to know about fertility is that the treatment gets less successful the longer you wait. So, if you’ve been trying to get pregnant for a year or longer, and you’re under the age of 35, you should go see a fertility specialist.” Dr. Plowden notes that if you are in your mid-30s and do not yet have a partner with whom you wish to conceive, speak with your OB/GYN, REI specialist, or healthcare provider about options for donor sperm, oocyte cryopreservation, or adoption.
A Word From Verywell
While the data may feel discouraging, there is increasingly more accountability for racial equity in all forms of health care. This means that more Black birthing people are getting the reproductive care that they need. Modern medicine can help parents expand pregnancy and fertility options, both with or without a partner. Healthcare without bias is always the aim, so Black birthing people should trust their gut if they feel like something’s wrong or that their provider isn’t fully listening to their concerns. Hopeful parents over age 35 and those who have been trying to get pregnant for over a year without success should speak with their healthcare provider. Together, you can find a supportive fertility specialist who can help you in your journey toward having a family.
