Infertility Challenges Description
Drs. Williams, Guthrie, and Greene discuss infertility challenges people may face when trying to conceive.
Infertility Challenges Transcription
Dr. Mironda Williams:
Welcome to Take Good Care podcast, an endeavor that grew out of our love for obstetrics and gynecology. Our aim and mission is to serve as a source of vital information for women of all races, ages, and walks in life.
I am Dr. Mironda Williams.
Dr. Deanna Guthrie:
I am Dr. Deanna Guthrie.
Dr. Karen Greene:
And I am Dr. Karen Greene.
Dr. Mironda Williams:
Welcome to our show.
Welcome to this episode of Take Good Care podcast. I’m Dr. Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I’m Dr. Karen Greene.
Dr. Mironda Williams:
As those of you who followed us for the last three seasons know, we try to stay sensitive to and aware of different observances that occur throughout the year, and we are aware that Infertility Awareness Month occurs during June. So, on today’s show we wanted to present some basic information about fertility, or how sometimes it can be difficult for people trying to get pregnant, that that can sometimes be a challenge.
And again, as a gynecologist this is something that we run into frequently, and so we understand how emotional this topic can be for both partners. So this is not just a woman’s issue, or the man’s issue if they’re in a heterosexual relationship, it can be a challenge for the couple that’s attempting to conceive and to become pregnant. So, we often see couples who are trying to get pregnant, or who have been trying for long periods of time, have gotten very frustrated and discouraged because of the challenges with it. So we want to try to present information, but to do it in a way that is compassionate and shows a care and concern that we try to exhibit for our patients.
In fact, one of the reasons that we even started this platform of doing the podcast is that even though we no longer practice obstetrics, which is the delivering of babies, we did that for almost 30 years each, we now only take care of GYN patients, but we’re seeing patients who are still wanting to be pregnant and/or who achieve an early pregnancy. So part of the reason for this platform is so that we can continue to educate women, their partners, as well as others who may be challenged with various different things.
So I’m going to get us started today, and I’m going to give a very brief look at how some challenges can occur when you are attempting to become pregnant, and when may be a good time to see your physician, in particular your GYN doctor, to get started. Then my partner, Dr. Greene, is going to present some information about different infertility treatment options.
And, again, as we’ve seen with so many things, fertility concerns can present some very difficult issues and barriers for black women and other women of color, so Dr. Guthrie is going to continue our discussion by giving us a look at some of these barriers, some of the challenges that can occur with black women, in particular women of color, as we just open up this discussion for everyone’s input.
So again, to get us started, infertility, or fertility challenges as I call them, I think, as with most things, there’s so many negative connotations that can be attached to words and to titles, and so Dr. Greene in particular is very sensitive to making sure that we use words that don’t necessarily have a lot of negative baggage associated with them. And again, because of the emotional attachment that a lot of women have when it comes to becoming pregnant, or not getting pregnant, you’re deemed “infertile” and so that term “infertile” can have a lot of emotional baggage that can be attached to it.
Dr. Karen Greene:
And I think it’s interesting that, as physicians, we say it sometimes without really even thinking about it. I was talking to a patient yesterday and we were just chatting as I was doing a procedure and she said when she had to go through treatment, she went to the pharmacy, and was filling some medications, and she happened to know the pharmacist and he made a comment and she went into a car and cried just because he was not really trying to be mean at all. He really wasn’t, it just triggered the fact that here she was attempting to get pregnant, and was having a difficult time, and he knew, and “I was terrible, that I couldn’t have babies.” And she said, “I realized how silly it was at the time, but at the moment, the emotions, it was just real.” It was something wrong.
Dr. Mironda Williams:
There’s all this pressure put on women culturally just through society, that if you don’t become a mother the “natural way” then somehow that diminishes your femininity or your womanhood.
Dr. Deanna Guthrie:
And that’s what you’re going to hear from me later on in the podcast is how the stigma of difficulty getting pregnant can affect women.
And like you said, trying to be sensitive to our patients who are having that challenge.
Dr. Mironda Williams:
And to the audience at large, here, for those of you who’ve tuned in today. So again, you know, may hear me use the term “infertility,” but a lot of times I just try to say fertility challenges. It’s just like folks who have height challenges. It’s just a challenge. It’s just a challenge.
Dr. Karen Greene:
We can’t reach.
Dr. Mironda Williams:
We can’t reach things on the top shelf that other people can. So it’s just a challenge.
So just as an overview, in the United States, 10-15% of couples may find themselves in the difficult position of attempting to get pregnant and not having succeeded with that. And again, infertility, or fertility challenges, are defined as not being able to get pregnant despite having frequent unprotected sex for at least a year for most couples. And then these fertility challenges, or infertility, can result from either an issue with the woman, like I said, if you’re in a heterosexual relationship, or with the male partner. And there can be a lot of factors that can occur in terms of achieving pregnancy, because even though getting pregnant is a very natural process, there are a lot of little steps along the way that if there’s any problem in any of those steps, then there can be some challenge in getting pregnant.
So when is it time to come and see your physician? And for most women, they would come see their gynecologist. And again, the good news is most people get pregnant, given time and just normal biological functions, most people can get pregnant, but it can take a while. But if you’ve been actively trying to get pregnant for at least a year without using birth control, and have not been able to achieve that pregnancy, it’s a good idea to come in to be evaluated just to make sure that there’s not something going on that could perhaps may be treated in some of the ways that Dr. Greene is going to talk about.
Or, if you are an older woman, if you’re 35 years or older and you’ve been trying to get pregnant for as little as six months or so, because again, we want to make sure that we don’t delay the time of identifying something that could be treated, you may want to seek care a little sooner than waiting a year. If you’re over 40 at any time point and you haven’t been able to get pregnant, then it’s good to come in to be evaluated.
If you have irregular periods, or no periods at all, then that could be an issue that may be addressed. So you need to come in so that we can do the evaluations. If you’ve been diagnosed in the past with endometriosis, or with pelvic inflammatory disease, because of some of the scarring that can sometimes occur that could damage your tubes in particular, or even the ovaries, or sometimes your uterus, those things will need to be evaluated by your physician, specifically a gynecologist. And yes, there are specialists in the area of reproductive health, reproductive endocrinologists, who do more advanced types of studies and treatments related to fertility challenges. But most of the time you need to come see your gynecologist initially to get that basic evaluation, so there’s some things that we can rule out, or in, in terms of a cause that we would address that your specialist may not.
If you’ve had a history of multiple miscarriages or pregnancy losses, there could be some things going on there that need to be addressed. If you’ve ever undergone treatment for any type of cancers, again, there could be some residual impacts on your fertility that need to be addressed. So for women, typically you’re trying to make sure there’s not a structural issue, meaning the tubes are blocked, or something is going on that prevents the sperm from getting to the egg. You want to see if a woman is ovulating, or releasing an egg, on a regular basis because if not, that can be an issue with getting pregnant, and then if there are other health issues that could be going on, endometriosis being an example of that, then those may need to be treated and addressed as well.
Now men, or if you’re not in a heterosexual couple, if you’re undergoing some other type of assisted reproduction, then of course a sperm count is what’s important. So when we have couples coming in for evaluation of fertility challenges, we will often ask for the male partner to have a semen analysis because, again, if the sperm count is optimal, and everything else is functioning normally for the male partner, there’s a lot of other evaluation that needs to be done. But it can be that it’s just a sperm count issue, which can be treated, and so before we embark upon a lot of investigation, and studies, and perhaps even treatment, for the female partner, we want to make sure that everything is good with the man, and that usually is just a matter of getting a semen analysis so that we can do a sperm count. This is done by a lab.
So in terms of male partners, if there’s a low sperm count, or other problems with sperm, like there may be enough of them, but they may have an abnormal shape or function, they’re not functioning appropriately, then that needs to be addressed. If there’s any history of any testicular issues or prostate issues. Also, if the male partner has undergone any treatment for cancers, any changes with the anatomy, all of that would need to be evaluated. Now, for the male partners, we don’t of course do those evaluations. We would refer the male partner to a urologist, which is a specialist that deals with the male anatomy and conditions related to men, and/or reproductive endocrinologist, but we can at least facilitate those referrals to make sure that the male partner has been evaluated.
So again, when it comes to some causes of female infertility or challenges, was getting pregnant, again, we look for ovulation disorders, because again, if you’re not releasing an egg on a regular basis, then can’t get pregnant, because there’s nothing for the sperm to fertilize. This can be caused by a number of different hormonal issues, PCOS or Polycystic Ovarian Syndrome, prolactin levels being abnormal, thyroid levels being abnormal. So again, these can usually be evaluated by blood tests and/or combinations of an ultrasound, pelvic ultrasound, to see if the ovaries are functioning normally.
And then again, structurally if there are uterine or cervical abnormalities, again, something that may be blocking or causing difficulty for the sperm and the egg to meet so that fertilization can take place, then those things would need to be evaluated, typically by imaging studies, whether that’s an ultrasound, sometimes hysteroscopy, or doing other specialized x-rays or pictures, so that we can determine if your tubes are open or if the uterine cavity, the inside where the baby will be developing, if there’s any abnormality there.
Of course, we’ve talked about endometriosis or scar tissue. Sometimes if you can’t detect anything just with imaging studies, like an ultrasound, we actually have to take a look on the inside. We do something called a diagnostic laparoscopy, which is an outpatient surgical procedure, that allows us to actually look, actually look at your anatomy, look at your tubes, look at your ovaries, look at your uterus, look to see if there’s endometriosis, scar tissue. We can see if there’s something structurally going on that is causing a challenge with you getting pregnant.
And again, as we’ve talked about in so many episodes, a good healthy lifestyle is important just for everything, but especially when you’re wanting to get pregnant. So of course, if you’re a smoker, excessive alcohol use, if you have weight challenges, being overweight, even being underweight, all of those things can impact your normal hormonal function, which can then impact your ability to get pregnant. So of course, as with most things, we want you to optimize. And a lot of times we’ll see patients for what we call preconception counseling. For patients who, everything’s fine, but they just want to make sure that there’s not an issue with them getting pregnant before they even start to try to get pregnant. Or they even ask, “What do I do? We want to start thinking about getting pregnant. What is the first thing or what should we be doing?”
Dr. Karen Greene:
I love when patients come in beforehand.
Dr. Mironda Williams:
Beforehand, because then we can impact it. We can encourage you to continue your healthy lifestyle or give you suggestions of ways that you can be more healthy. Taking a prenatal vitamin, the folic acid that is in prenatal vitamins is very important to be taking even before you conceive, because it helps to prevent certain types of birth defects. So getting started on those things actually before you get pregnant is important. Of course, stopping smoking, if you’re smoking, avoiding alcohol, drugs, healthy diet, healthy movement, healthy exercise so that you avoid huge shifts in your weight, all of that can impact your hormone studies, and your hormone function, so we can make sure that everything is optimized.
So that’s just a very basic, again, we don’t want to just talk at you and lecture to you, we want to give you information terms so that you can be empowered when you talk to your healthcare provider and understand a little bit more about what’s going on with your own body so that if something is needs to be addressed and it can be addressed. Dr. Greene?
Dr. Karen Greene:
I think that when, hopefully, a couple comes in, we do try to make them understand that, “Okay, this is what you’re doing. This is what you could be doing.” And the basics are the woman has to make an egg, the man has to make a sperm, and somehow they got to get together.
And so we break it down that way, and if the partner is there with them, if they’re in that type of relationship, a heterosexual relationship, then the guy does understand, because I think we also have to be sensitive to the fact that most men assume that they can get pregnant, or they can get a woman pregnant.
Dr. Mironda Williams:
Get somebody pregnant.
Dr. Karen Greene:
Some men it’s like, “Oh, there’s nothing wrong with my sperm. My boys are fine. They’re just fine.”
Maybe. They may be.
Dr. Deanna Guthrie:
Most often they are.
Dr. Karen Greene:
Most often they are.
But if you are truly trying to optimize the situation, it’s nice to know. It’s nice to know. For me, personally, I was older when I finally decided that this was a thing I wanted to do. So, after years of trying to prevent pregnancy, my question to myself was, How do I know I can? How do I know? How do I know that…”
Dr. Mironda Williams:
Because you never tried before.
Dr. Karen Greene:
Because I never tried before.
Dr. Mironda Williams:
Or you were good about preventing it.
Dr. Karen Greene:
Exactly.
Dr. Mironda Williams:
Because you didn’t want to get pregnant yet.
Dr. Karen Greene:
And you think, especially as at the time we were delivering babies, all these people that had gotten pregnant on birth control pills, and I thought to myself, “Well, I took birth control pills and I didn’t get pregnant.” But is there a problem? So of course you get that little panic. And so I never discount couples coming in to check to see if everything’s okay.
Dr. Deanna Guthrie:
Or the question a lot of them have. They’ll come in and say, “I want to know if I can get pregnant.” And so I explain to them, there’s not just a “can you get pregnant” test that we do that says, “Yes, you can.”
But I try to reassure them, if you’re having regular periods, and if you’re having regular sex, and are healthy for the most part, then yes, you’re in what we consider as the normal category that we would expect you, yes, to get pregnant. And then I also try to explain to them that, unlike a lot of things, getting pregnant is a monthly thing.
So when you don’t get pregnant one particular month, it’s a whole nother month before you can know again. And that can be frustrating, because it’s not something that, “Oh, I did last night.” And, “Oh, I’m just going to try next week again.” So I try to tell them, “Just try to relax about it. If this is a happy decision that you’re making together with your partner to try to enjoy the process because the more stress you put on yourself that can also impact your fertility.” It’s just reassuring patients that for the most part, like Dr. Williams said in the beginning, the majority of people do get pregnant. Give it time.
Dr. Karen Greene:
But for me, that was in a hurry because I was old.
Dr. Mironda Williams:
You were not old.
Dr. Karen Greene:
But in my mind, I was old.
So the thought was, “The only thing I can check is to see if my tubes were open. That’s really the only thing I can check. I’m assuming everything else works.” And there is treatment for things that aren’t working properly. So if you’re not making an egg once a month, there’s a medication you can take. Some people may be familiar with the name Clomid, and it basically encourages the production of an egg. And so we give patients Clomid to make sure that they’re making an egg during that time if we’ve already determined that maybe they’re not making an egg every month.
Dr. Mironda Williams:
And well, we’re born with all the eggs we’re ever going to have.
Dr. Karen Greene:
Yes, that’s true.
Dr. Mironda Williams:
So, how many eggs is it, Dr. Guthrie?
Dr. Deanna Guthrie:
I don’t know, there’s millions.
Dr. Mironda Williams:
Millions and billions. So they’re already there.
Dr. Deanna Guthrie:
They’re already there.
Dr. Mironda Williams:
So we’re not making them new, but you’re releasing them.
Dr. Karen Greene:
That’s true. That is very true. And sadly, a lot of those eggs get released before we even start having cycles, so we’ve wasted a few before we even got to the point.
Dr. Mironda Williams:
Don’t say that!
Dr. Karen Greene:
That’s how I thought of it. I was like, “All those eggs wasted! All those eggs that I prevented coming out with birth control pills. Now I got to make sure that the ones I encourage to come out…”
Dr. Mironda Williams:
Girls we need you to get going!
Dr. Karen Greene:
There’s a reason for the design. There’s a reason. There is a reason for the design. And so there are medications, familiar medications, Clomiphene is one. There are alternatives, medications that we’ve discovered, that actually will encourage an egg to be released like Tamoxifen. For people that have polycystic ovarian syndrome, putting them on a medication to control their insulin, called Metformin, will often cause a release of an egg. And then there are hormones like that are gonadotropins, so specialized hormones to encourage ovulation as well as gonadotropin-releasing hormones. So there are a lot of different hormones.
As gynecologists, we usually start with the basics, and then if the basics aren’t working, we may have to refer them to a specialist that would give those type of injectables. So, if it’s not the egg problem, maybe it’s the tube problem that the tubes, there’s something wrong with it. Sometimes we can make that diagnosis based on, as Dr. Williams said, a diagnostic procedure, taking a look at the tubes. But in terms of fixing of the tubes, or even if the tubes are blocked because you had a study called a hysterosalpingogram, which actually puts dye into the tubes, the fertility specialist is usually the one that would do that because the tubes are very small, they’re teeny tiny little areas, and if there’s something going on with the tube, fixing them requires teeny tiny pieces of suture. You use specialized glasses to sew that teeny tiny pieces of suture, and there are people that really enjoy doing that.
In the process of doing that, there are definitely risks when you’re repairing a tube because it may be that when you do achieve a pregnancy, the egg and the sperm, they get stuck, they get stuck in the tube, fertilization occurs in the tube, and then we have what’s called a tubal pregnancy. And so when we talk to patients, we try to explain to them that these are the things that could happen, you must understand what may be the risk of it if you do go through this procedure. In doing diagnostic type procedures, we do treat if we see evidence of things like endometriosis, or cyst, or minimal scar tissue that may affect their ability to get pregnant, because a lot of what we do know and don’t know isn’t as basic as I might have made it seem. The egg, the sperm, they get together and there’s the baby. Most of the time that happens. But sometimes we don’t really know why the person’s just not getting pregnant.
Is it something because of the endometriosis? Is it something because of a previous surgery? And if that is the case, then the fertility specialist usually will talk about assisted reproductive technologies. And there are lots of assisted reproductive technologies from as simple as putting the partner’s sperm into the patient’s uterus so that fertilization will occur that way, or as complicated as getting all the eggs, getting the sperm, putting them together, and putting them back in the uterus. Things that we don’t do.
Dr. Mironda Williams:
Putting together in a laboratory situation.
Dr. Karen Greene:
Things that we don’t do. But again, it’s just, it’s about the education, so patients do understand that we’re here to provide them with that. But, as Dr. Guthrie said, most of the time if you just relax, and go through with the natural process, and avoid some of the stress that can go along with trying to get pregnant, it will occur. It’ll occur naturally.
I think the frustrating part for a lot of people is that when we start talking about all these other things, these assisted technologies, there’s a cost, and sometimes your insurance doesn’t pay for that cost, or you don’t have the funds for that cost. And so for a lot of women, and African American women especially, or even women of color in general, it may be the reason they don’t mention the possibility of having to go through some sort of fertility treatment is the fear of the cost, that “Maybe I can’t afford.”
And anybody who’s thinking about trying to get pregnant, “Well, if I can’t do it the natural way, then I’m never going to be able to do it, because I’m not going to be able to afford it.” And sometimes even when it comes to adoption, it’s just as expensive so that they start thinking, “Well, there must be something wrong because I can’t do it the natural way. I’m going to have to go through all these processes, and so I’m just not going to mention it because that’s something that I know I can’t do.” But I think that knowledge is power, understanding what you can do, and then if we have to get to that point, if we have to get to that point, we can at least give you those options.
Dr. Deanna Guthrie:
Another thing I encourage couples to do when they first come in is to talk to each other, because the decision to have a baby sounds like a relatively simple one. Meaning, we love each other, we want to start a family, we’re going to try to get pregnant. Okay, let’s get pregnant. Well, if there are some difficulties, sometimes there’s a disconnect in how far each person is willing to go to get pregnant, and sometimes that can cause stress and strain on relationships, even ending some relationships because of it.
So, I usually encourage my couples to start talking to each other. As Dr. Greene said, more than likely, like I said, you’re going to get pregnant. Let’s worry about what we need to worry about when we get to that point, but at the same time, I’ve had situations where one person is willing to fly to another country to get special injections, and will do all this stuff, and then the other person was, “Well, I thought maybe I would do some blood work and maybe take a medicine, but much after that I’ll just leave it up to nature.” And unless you both know where each other is in that process, that can be a source of stress and concern.
So, like I said, one of the things I do is encourage couples to start talking to each other about what will you do. Some men don’t even want to get the basic semen analysis. Sometimes that’s…
Dr. Mironda Williams:
Difficult.
Dr. Deanna Guthrie:
Difficult to get them to do that.
And it’s not a pleasant thing to think about doing. They have the option of doing, again, depending on how close they are to the lab, it’s something that they could do at home, possibly, but you have to get the specimen to the lab in a certain amount of time, or a lot of times they have to go to a very public place. They’re not in public, but they have go somewhere where when they go into the room, everybody knows what they’re getting ready to do. So that may be a source of discomfort for some men, and that may be why they’re hesitant about doing it.
Dr. Mironda Williams:
And that’s the barrier part. And I know you’re going to get into this a little bit more, Dr. Guthrie, but I think that’s the issue. And one of the reasons why we wanted to bring this up and talk about it is, again, most of the time it’s a couple issue. So, as Dr. Guthrie has pointed out, you want to know what the possible scenarios could be so that as a couple, you all can decide how far you are wanting to go: distance, as well as cost, as well as the complex nature of some of the treatments and surgeries. How much do you all want to invest in this, from a time standpoint, a money standpoint, emotional standpoint with trying to achieve a pregnancy yourselves versus adoption or some other avenues that may be available?
Occasionally you’ll have some individuals who are wanting to become pregnant without having a partner. But again, those are the things you still want to have a conversation with trusted friends and your support group, because whether you have a partner with you who’s going to help support you during a pregnancy, and then the raising of this child, and/or children, you need your support group around you. So your support group needs to also understand all the ramifications. What are the options and how much are you going to be able to have support around you?
And then you have barriers of the equity of access, how many labs are close to you that you can get a semen analysis to in a timely fashion, in a way that’s comfortable, so that you don’t feel any stigma or any shame that could be attached with just that whole process, much less going to a reproductive endocrinologist. So there are a lot of issues that can present barriers on top of the challenges when you’re trying to get pregnant.
Dr. Deanna Guthrie:
So in that vein, infertility for the acronym is B-I-P-O-C, BIPOC Black, Indigenous…
Dr. Mironda Williams:
Say that again a little slowly.
Dr. Deanna Guthrie:
B-I-P-O-C. And I don’t know if they say BIPOC, but it’s Black…
Dr. Mironda Williams:
I read it, but I hadn’t said it.
Dr. Deanna Guthrie:
Black, Indigenous, People of Color.
So that encompasses a whole group that surprisingly we have more infertility issues than our white counterparts. Black women have a high rate of infertility, 7.2% versus 5.5% for their white counterparts. And another study showed that married Black and Latina women were also at higher risk for having infertility. And this goes against a stereotype that is out there about our BIPOC females that we have a stigma of being hypersexual, hyper fertile, and having more teen pregnancies. So there’s this misconception that we’re just out there just getting pregnant just all the time, all the time, anytime we want to.
Dr. Mironda Williams:
And data doesn’t support that.
Dr. Deanna Guthrie:
And data does not support that.
Also, with the history of slavery, we were bred, basically, so it wasn’t for the most part, family decision…
Dr. Mironda Williams:
Voluntary.
Dr. Deanna Guthrie:
Voluntary issue, and our offspring were property. So again, in a stereotypical mind, it’s “When we need to have babies from them, they will have babies for us.” Also, as Dr. Greene was saying, with the stigma of all the treatments that are out there, studies have shown that black and Latina women are less likely to seek fertility treatment. And it could be several factors.
It could be lack of knowledge, information. They don’t even know what could be done. They don’t know what’s available. They don’t even know if they should need infertility treatment. Of course, there’s always cost as a factor, and access, as Dr. Williams said. Reproductive endocrinology is a highly specialized field with advanced training, and a lot of these physicians want to be in areas where they have specialized hospitals, and equipment, and things like that. So you’re not going to see a reproductive endocrinologist in rural Georgia.
Dr. Mironda Williams:
Even like us, we work just outside of the metropolitan Atlanta area, but it’s a very highly populated…
Dr. Deanna Guthrie:
It’s an affluent area.
Dr. Mironda Williams:
Area of the counties that we serve, but we often are challenged when we have to refer patients to see a reproductive endocrinologist, ’cause no one has an office in this area within just a 20-mile radius even. They have to go 35, 40 miles into the city.
Dr. Deanna Guthrie:
So again, access is another issue.
Even in Chicago, the good news is that legislation is trying to catch up with this, and so there’s some legislation now that requires health insurances to cover infertility treatment. In the very beginning, infertility treatment was never covered, not the labs, not the medications, not the procedures that you needed to be done. Some changes were made with the Affordable Care Act, and then it has spilled over into, like I said, Chicago, or Illinois, is one of the states where it is mandated that infertility treatment is covered. But even in that area, the statistics, according to that, blacks in Chicago make up 35% of the population, but only 5% seek IVF treatment.
So again, even though they’ve made even some allowances for people in that situation, again, it’s knowledge access. So “Yes, I may have the coverage, but where am I going to go?”
Dr. Mironda Williams:
And do they even know that they have coverage?
Dr. Deanna Guthrie:
Exactly. But again, even with the disparities that we know exist, there is still differences then.
Studies also show that when black, BIPOC females, yes, I’m going to be my word for the day, which include Black, Latina, Asian, and Native American women, undergo in-vitro fertilization or assisted reproduction, they have lower live birth rates. And again, it’s that health disparity that we see often with most medical conditions, that we may even get the advanced technology, but for some reason the pregnancy outcomes are not as good. They’ve also found there’s a lack of cultural understanding for women who come in.
So like I said, for a lot of cultures there’s a stigma about not being able to get pregnant. So even though there’s an outside stereotype that’s being put on the community, but there’s also an internal stereotype, or stress, that we put on ourselves. Like you said, when you get married, you just have babies, and if you don’t then something’s wrong with you and you are not, it says something about you when it doesn’t.
And a lot of physicians may not have… Also, there’s a disparity in cross-sectional representation for infertility treatment. So it’s not one of the most popular specialties that people of color necessarily go into. Again, of course, everybody picks their field of interest, but again, we tend to be more primary care, and it doesn’t say that we can’t do other things. I saw an article on… There’s one practice of the top three transplant surgeons in this one area. They were all African-American. That’s wonderful. And we are now branching out into other areas, but again, we need more representation in all specialties across the board.
Dr. Karen Greene:
So that’s within anything, that representation matters to our patients. Our patients want to see someone who’s going to at least hopefully have that understanding. The cultural sensitivity is a big deal when you’re talking to a physician that may already have that thought process of, “Of course you can get pregnant.” They don’t take it as seriously as you might as a patient.
And so you want someone to take that concern when they come in, that question, “Can I get pregnant?” Are they going to take that seriously and do what they need to do and not say…
Dr. Mironda Williams:
Regardless of color.
Dr. Karen Greene:
“Of course you can get pregnant.”
Dr. Mironda Williams:
Exactly.
Dr. Karen Greene:
Because that’s their background. That’s what they think. And so a lot of women won’t mention it, because either they’re assuming they’re going to say it or they’ve heard that.
Dr. Mironda Williams:
And also to Dr. Guthrie’s point about representation of people of color in various medical fields, again, this is not an ability issue, it’s not an intelligence issue. Most of us, when we go to medical school, are in debt. And then when we come out of medical school, we’re more in debt.
Dr. Deanna Guthrie:
And we got to work.
Dr. Mironda Williams:
We got to work.
So these specialists, ’cause I know for Dr. Guthrie, at least for me, when I came out of residency, I had some interest in maternal fetal medicine. I even thought a little bit about repro-endo, reproductive endocrinology. But that’s more training…
Dr. Deanna Guthrie:
That’s more time not working.
Dr. Mironda Williams:
That’s more time not working, and potentially more time increasing a debt load. And so at that time, as a single woman, and I was like, “You know what? Even though I would love this, I can’t invest any more time in this.”
Dr. Karen Greene:
I’m already going to die with my debt.
Dr. Mironda Williams:
So I’ve got to go ahead and get to work. And so this is where equity, and I know everyone is hearing the term equity, equity, equity, but this is when the rubber meets the road, because these are the effects of equity and access issues that you don’t think about. It’s because we’re not all starting at the same point. There are people who say, “Well, you all start at the same point.”
No, no, no, no, no, I’m not starting where you’re starting, because I don’t have generational wealth.
Dr. Karen Greene:
My parents couldn’t pay off my schooling.
Dr. Mironda Williams:
Wonderful parents, and they did everything they could to help me, and I didn’t come out with as much debt as I could have come out with, but still.
And so this is when we say that there’s an equity issue and why representation matters, it’s not an equity issue because of an intelligence issue, or an ability issue. It’s because I need to make up for time. I cannot continue to invest more money into something because I got to work.
Dr. Deanna Guthrie:
Another point, too, is studies on our particular communities, are lacking also, of course. And it’s twofold, there’s always a distrust of the medical community about doing testing from the Tuskegee type studies that were done. And then we don’t have the information to know that maybe we do need to treat different racial communities differently, because we don’t have the information about. So that could also be a factor.
Also, mental illness. Depression is closely linked with infertility because of course there’s the stress and the sadness of not being able to get pregnant at the time. And so they found that 26% of women undergoing fertility treatment have major depression, and 9% of men have depression about infertility treatment. And you don’t really think about the men. It’s usually the woman who’s going, because she’s the one that has to take the drugs most of the time, and go through most of the tests, and do everything, but it truly is a couple situation.
Dr. Karen Greene:
Because if they’re giving them the drugs, and they’re seeing their wife upset, and they’re seeing their wife emotional and then they don’t achieve a pregnancy, they’re in it. They’re invested it it, too.
Dr. Mironda Williams:
‘Cause most men want to do something, and so they get depressed because they can’t fix it.
Dr. Karen Greene:
And they’re doing what they can, but it’s still not fixed.
Dr. Mironda Williams:
They’re doing everything they can, usually as often as they can, but they can’t fix it.
Dr. Deanna Guthrie:
So that’s basically the factors that affect infertility for people of color.
Good news is that there are organizations out there that empower black women with infertility. And this is not a total list, I’m sure there are many more out there, but these are the top four that I saw just in searching around.
One is Fertility for Colored Girls.
Dr. Mironda Williams:
Say it slowly.
Dr. Deanna Guthrie:
Fertility for Colored Girls, founded by Reverend Dr. Stacy L. Edwards. This group, they offer grants to help people cover the cost of infertility treatments. And she also has support groups, individual and couples counseling, and educational events. So a source of information and possibly resources for your infertility quest.
Another one is the Broken Brown Egg. I love that name.
Dr. Mironda Williams:
That is cute.
Dr. Deanna Guthrie:
And it was a blog group founded by Regina Townsend in Chicago. And her mission is to encourage black women to begin the important dialogue of reproductive health and infertility. And she has online support groups, she has resource guides, and she has a blog.
Here’s another one I’d like, too, Black Mamas Matter Alliance. In the theme of…
Dr. Mironda Williams:
Say that one again.
Dr. Deanna Guthrie:
Black Mamas Matter Alliance. And that was launched in 2016. They have an annual conference and they advocate for maternal health equity.
There was also the Resilient Sisterhood. That’s another one that’s out there that we’ve talked about before.
And then the last one is the Cade Foundation. And this was launched in 2005 by two doctors, Doctors Jason and Camille Hammond. They were a couple that they themselves had fertility issues and had to undergo fertility treatment.
Dr. Mironda Williams:
Spell Cade, is it C or K?
Dr. Deanna Guthrie:
C-A-D-E. Cade Foundation. And so this is a nonprofit organization that offers grants to help people cover the costs of becoming a parent. And they provide up to $10,000 per funded family to help with the cost of domestic adoption, so it’s not just infertility treatments, it’s also adoption, and medical fertility treatment.
Dr. Mironda Williams:
Awesome.
Dr. Deanna Guthrie:
So those are groups that are available.
Also in treatments, and Dr. Greene was talking about them, and there’s a wide variety. You can go anywhere from trying to have the baby yourself to adoption and there are costs with everything. But there’s a stigma also that they talked about certain types of fertility treatment. For instance, most people when they think about it’s, “What test of my going to undergo to get pregnant with my eggs?”
There are donor eggs, situations, and donor sperm. And when there’s a stigma with that, you’re taking somebody else’s eggs. I heard somebody say this and it was like, “Yeah, that is true.” And somebody said, “It’s like an adoption.” When you adopt a child, that child was not from your egg and you’re going to love that child just as much. It’s just that you are choosing the option where you want to carry that child and birth that child yourself. So donor egg, donor sperm, are to me in the same category as an adoption, you’re adopting that egg. Think about it that way. Adopting that egg or adopting that sperm.
Dr. Karen Greene:
But I think it’s also the whole idea of adoption and donor sperm for some people is, “Well, that’s not my child.” And they have to, again, having that conversation with the couple of how far they want to go. If they get to this point, are they okay with that? And they’re not, that’s fine. But if they are, then they got to be all in, because like you said, you’re making a choice. An adopted child, someone has made a choice to raise you and probably you’re going to be more like that people than you realize because they…
Dr. Mironda Williams:
Nature and nurture.
Dr. Karen Greene:
Nature and nurture. So that nurture makes a big difference. So even though you may not be related to your parents by genetics, you’re very much like them because they have raised you. And so I think having those conversations is something that as gynecologists, we do a lot just to get a feel for where the patients are and that they’re comfortable asking the questions.
Because oftentimes, as our teachers will always say, there’s no such thing as a bad question, no such thing as a dumb question. Just ask what you’re thinking and hopefully we can put point you in the right direction.
Dr. Mironda Williams:
And again, the information that we provide for you on our podcast, today’s show, as well as all the ones that we present to you, are never intended to substitute for your relationship with your healthcare provider, or to give you specific medical information or advice, we’re just presenting information and topics as a way to empower and to educate and to expose. A lot of it is just about exposure. As Dr. Guthrie said, some people don’t even know what they don’t know. And so knowing that there are some states, and in some areas that now fertility treatments can be covered by insurances, because for many decades they weren’t, so people just assume they’re not. Will your insurance company tell you that? Probably not.
So if it’s something that you’re really interested in, ask the question, call your insurance company, or communicate with them however you need to communicate with them to find out what are your options in terms of financial assistance to your insurance, to cover testing, as well as any treatments. So again, we’re just providing you information, not to substitute for you developing a relationship with your own healthcare provider so that that person can advise you on your specific issues based on their evaluation of your health, your history, and your physical examination.
And also the resources that Dr. Guthrie mentioned are just some of what you can find out there on your own. We’re not endorsing one per se to say that this is the best one or the only ones out there, but just to stand as an example, to let you know what is available out there, and to see what other resources you can find for your information, and for your empowerment, for yourself and your partner if you’re seeking to become pregnant.
So this is, again, just a way for us to provide you with this information for the discussion. Again, we want to try to remove some of the stereotype. We want to try to remove some of the stigma, and we want to do that by providing you with data, with science and research, but again, so much as it impacts people of color, is still yet to be determined because we’ve got to participate in research projects, and then those studies have to be done so that we can come up with some of the answers that may help to unpack why the BIPOC community has more challenges when it comes to fertility and getting pregnant.
And being a mama, is being a mama, is being a mama however you achieve that. I don’t have children that I have birthed. Dr. Guthrie does not have children that she has births, but we have “chirren.” We have children that we have helped to nurture and to mentor into their young adulthood. So never to even diminish anyone’s desire to be a mother. I had hoped I would have children, I always thought I would have children, but it didn’t happen for me. So this is not to diminish that desire, or that hope, or that need.
If you have that, pursue that. Get the information you need. Surround yourself with your support group. It’s a partner issue. It’s not an individual issue. It’s about the couple, or the person and their support group. You’re not in this by yourself, and your physicians and your healthcare providers should help you with that.
Dr. Deanna Guthrie:
So just like I said, there’s information and help out there for you. Don’t suffer in silence. ‘Cause Dr. Greene said, “Ask the question. Come in.”
Dr. Karen Greene:
Just ask. Even if it seems like a silly question, like for me, “Can I really get pregnant?”
And that’s okay, because we’ve heard it, and I think we do want to act as a guide. We’re not giving you anything that should take away from your own physicians, but we want you to have the ability to speak up.
Dr. Mironda Williams:
Speak up. That’s what it’s all about.
So thank you, everyone. We appreciate everyone’s hanging in here with us, especially in season four. We’re very excited about all the things we have going on. Remember to continue to share us with your friends and family in terms of where they can get the opportunity to watch our podcast, or listen to our podcast.
You can always check us out on our website at ptcobgyn.com. For other information you can see the previous episodes that we’ve posted, as well as articles and things that we are presenting to you. We have so much going on. We’re very excited about this season, so continue to share us with your friends and family and check us out on our website.
So until we get together again for the next episode of Take Good Care, I’m Dr. Mironda Williams.
Dr. Deanna Guthrie:
I’m Dr. Deanna Guthrie.
Dr. Karen Greene:
And I’m Dr. Karen Greene. Take good care.