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I am a fertility specialist, and a woman who has struggled with infertility and yet I have no real authority to write this piece. I am white, and in that aspect, I cannot comprehend how infertility feels for a black woman. But I am writing this piece after days of soul-searching, reading, and learning; I am trying to open my eyes, starting to see that there is a whole perspective within fertility that I have not previously considered.
The statistics are disturbing. Here is a summary of just some of the issues I have been exploring this week:
Black women are twice as likely as white women to have issues with their fertility (Wellons MF et al 2008).
Studies show that 15% of white women aged between 25-44 will seek help to get pregnant, while only 8% of black women do so.
Research shows that black women are much less likely to discuss their fertility struggles with friends and family, let alone with their doctor or other medical professional.
Over half of black women will have fibroids through their childbearing years (Baird et al, 2013)
Vitamin D deficiency in the black population in the UK is much higher than in the white population, and Vitamin D deficiency is associated with an increased risk of fibroids, difficulty in conceiving and early pregnancy loss.
Several studies have shown that black women have a higher incidence of blocked or scarred fallopian tubes (Dayal et al, 2008).
Black women who do end up going through IVF have a lower chance of success, on average they produce fewer eggs, the rates of successful embryo and blastocyst development is lower and they are more likely to experience early loss (McQueen et al 2015)
Black women are almost twice as likely to experience pregnancy loss at between 10-20 weeks gestation (Mukherjee et al, 2013).
Black men seem more likely to have low sperm quality than white men (Redmond et al, 2013)
If you need an egg donor, it is much more difficult to find an ethnically appropriate egg if you are in the UK.
Why is there such disparity? Why is this not well known information? What is the cause, what is the solution? How do we get more awareness on this?
This Needs To Be Recognised, Talked About.
Fertility struggles are difficult for anyone who faces them, unexplained infertility can leave us feeling broken, defective and less worthy. I know and recognise those feelings as I myself felt them. But for black women there is an additional layer of pressure that comes in the form of the stereotypical image of a black woman who should fall pregnant easily and raise large families. This presumption that black women are more fertile makes the issue of infertility even more difficult to talk about, even more of a burden to carry for those who are struggling with fertility. This in turn may mean that people seek help less easily, which may mean that conditions such as fibroids and endometriosis are more advanced when they finally do reach out for help.
Research suggests that black women are less likely to talk to their family or friends about fertility concerns, a survey by OprahMag.com found that over a third of black women in the US have never spoken about their fertility. Infertility is a lonely space to be in, it makes you feel left out, left behind. I will never be able to fully appreciate how racial inequality makes this more difficult, but I do need to acknowledge that it does, draw attention to it and do my best to understand.
I know that speaking about my fertility issues when I was struggling was immensely helpful for me, it always surprised me to stumble across other women struggling with similar issues. I lost count of the number of times I would find myself discussing the ins and outs of PCOS and IVF with women I barely knew at friend's weddings and parties; the camaraderie and the shared knowledge were invaluable to me. I simply cannot imaging coping as well if I had had to do so alone.
Is the IVF Industry Inclusive?
A brief check through the websites of a dozen UK fertility clinics just now showed considerable difference in the image choices for the front pages of their websites and on their main marketing materials. While some clinics do attempt to suggest racial diversity in their choice of images, others do not and almost exclusively use images of the healthy, slim, well-heeled white couples.
Seeking help for infertility is a frightening process for everyone, the whole process is can trigger tidal waves of feelings of self-doubt and poor self-image. We need to be aware of the additional layer of stress that will be felt by a black couple taking a seat in an IVF clinic waiting room, surrounded by white clients and images of white couples. It is hard to know how to contribute to the much needed solution to this, but long before it can be corrected, as a society first we need to be aware of it.
What Could Explain The Increased Proportion of Black Women Struggling with Infertility?
Fibroids
Non-cancerous tumours that grown in the uterus.
Nearly 60% of black women will have fibroids by the time they are in their late 30's and over 70% by the time they are over 44 yrs old.
Fibroids can occur on the inner wall of the uterus, on the outer wall of the uterus or even in the middle of the muscular uterine wall.
They can be as small as a pea, as large as a grapefruit or even larger.
Fibroids may be suspected if the cycle is particularly heavy or particularly painful; while they do not usually bleed unless located on the inner wall of the uterus, they develop in an atmosphere of excess oestrogen which is a common cause of heavy periods. Early, and prolonged use of the oral contraceptive pill can increase the risk of fibroids as it can increase the oestrogen levels over a long time.
Acupuncture, diet, probiotics, castor seed oil packs and fertility massage are all things that can make a positive impact on fibroids and help to improve your overall fertility. Another important change to make is to reduce or eliminate your exposure to 'xenoestrogens' which are found in many plastics, tampons, makeup and cleaning products. Xenoestrogens interfere with our ability to control and manage our oestrogen levels.
Tubal Defects
Studies have shown that a significantly larger percentage of black women presenting for fertility investigations are found to have blocked or scarred fallopian tubes (Dayal et al, 2008).
Male Factor
Research suggests that the average sperm test result from black males is significantly more likely to show issues with poor values for volume, concentration, total sperm count and motility than that of men of either white or Asian ethnicity (Redmond et al, 2013). This is was one of the least discussed aspects of issues potentially affecting black infertility. It is important that this is recognised in order to prioritise male factor tests for black couples.
Vitamin D Deficiency
Vitamin D is a vital nutrient for the production of healthy eggs and sperm, important for the implantation process and to maintain a healthy pregnancy. We make most of our vitamin D in the skin in response to sunlight. When there is a high level of melatonin in the skin it can reduce vitamin D synthesis by up to 90%, so the risk of vitamin D deficiency is high.
Research suggests that there is a link between infertility and the high prevalence of vitamin D deficiency in people with darker skin (Bodnar LM et al, 2007). Conway et al (2019) suggest that vitamin D deficiency may also explain why there seems to be a seasonal pattern to conception in the black population living in the temperate regions.
It is easy to check your vitamin D level through a blood test, and easy to supplement this to bring it up if you are deficient. Vitamin D is a fat soluble vitamin, so it is more easily absorbed if delivered in an oil based compound such as the oil based oral sprays or in combination with a fish oil. If your vitamin D level is OK in the summer months, don't assume it will stay that way all year; it is a good idea to retest in the depths of winter as we tend to be at our most deficient in the late winter, early spring.
But Above All, Talk . . . I have been rightfully disturbed by the statistics around women of colour and fertility, and particularly disturbed by the thought that there are people out there suffering with infertility alone. The more people talk about this, the more awareness there will be which may also help to drive scientific interest and research.
My advice would also be to anyone struggling with infertility is to talk.
Talk to someone if your cycle is particularly heavy or particularly painful - these are both signs that a cycle is not as healthy as it could be, and could be warning signs that fibroids are starting to take hold. Talk to someone if you are starting to worry about your fertility, reach out to support groups, open up to your family - you don't have to do this alone.
I would like to have added a link here to a UK based fertility support group specifically for the black community, but I could not find one. If you know of one, please message me; if I find one I will add a link here.
I would also be happy to add links to other UK based resources - so if there is an organisation or a practitioner that should be listed here, please let me know and I will add them.
And if I have worded anything insensitively, or incorrectly from an antiracist perspective, please let me know and I will correct my language. I am committed to Learning & Unlearning.
American Resources:
Regina Townsend - thebrokenbrownegg.org
Chiquita Lockley - www.eggsovereasyfilm.com
https://www.bloodandmilk.com/
UK based resources:
Kezia Ashley Okafor @theinfertilitycounsellor (fertility counsellor)
Le'Nise Brothers @eatlovemove (nutritionist)
References
Baird DD, Hill MC, Schectman JM, Hollis BW. Vitamin d and the risk of uterine fibroids. Epidemiology. 2013;24(3):447‐453. doi:10.1097/EDE.0b013e31828acca0
Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007;137(2):447‐452. doi:10.1093/jn/137.2.447
Dayal MB, Gindoff P, Dubey A, et al. Does ethnicity influence in vitro fertilization (IVF) birth outcomes?. Fertil Steril. 2009;91(6):2414‐2418. doi:10.1016/j.fertnstert.2008.03.055
Conway KS, Trudeau J. Sunshine, fertility and racial disparities. Econ Hum Biol. 2019;32:18‐39. doi:10.1016/j.ehb.2018.10.002
McQueen DB, Schufreider A, Lee SM, Feinberg EC, Uhler ML. Racial disparities in in vitro fertilization outcomes.Fertil Steril. 2015;104(2):398‐402.e1. doi:10.1016/j.fertnstert.2015.05.012
Mukherjee S, Velez Edwards DR, Baird DD, Savitz DA, Hartmann KE. Risk of miscarriage among black women and white women in a U.S. Prospective Cohort Study. Am J Epidemiol. 2013;177(11):1271‐1278. doi:10.1093/aje/kws393
Redmon JB, Thomas W, Ma W, et al. Semen parameters in fertile US men: the Study for Future Families. Andrology. 2013;1(6):806‐814. doi:10.1111/j.2047-2927.2013.00125.x
Wellons MF, Lewis CE, Schwartz SM, et al. Racial differences in self-reported infertility and risk factors for infertility in a cohort of black and white women: the CARDIA Women's Study.Fertil Steril. 2008;90(5):1640‐1648. doi:10.1016/j.fertnstert.2007.09.056
ANTIRACISM LINKS
Books
White Fragility; Why It's So Hard For White People To Talk About Racism Robin DiAngelo (she also has talks on youtube)
Why I'm No Longer Talking To White People About Race Remi Eddo-Lodge
Podcasts
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