By Dr. Monica Best, Reproductive Endocrinologist at RBA Fertility in Atlanta, GA
You can book an appointment with Dr. Best here and follow her on Instagram @drbestivf
African-American women face unique challenges in their fertility journeys, from higher rates of infertility to barriers in accessing care. Stigma, healthcare disparities, and conditions like uterine fibroids often make the path to parenthood more complex. Addressing these issues with awareness, advocacy, and culturally competent care is essential in ensuring equitable access to fertility treatment. In this post, Dr. Monica Best, a reproductive endocrinologist at Reproductive Biology Associates in Georgia, draws from both her professional expertise and personal experience with infertility to explore these challenges and the steps needed to overcome them.
What unique challenges or barriers do women of color face when seeking fertility care, and how can these be addressed to ensure equitable access to treatment?
African-American women are twice as likely to experience infertility as Caucasian women, but seek treatment for infertility half as often. About 8% of black women seek medical help to become pregnant compared to 15% of white women.
Research indicates that 50% of African-American women feel uncomfortable talking to their doctor about infertility as compared to Caucasian women who are less likely to feel this way.
Are there specific health conditions or factors that disproportionately affect fertility in women of color, and how can these be managed to improve outcomes?
Approximately 70% of all women will develop uterine fibroids by the time they are 50 years old. Fibroids disproportionately impact African-American women. Black women are three times more likely than white women to have uterine fibroids which tend to develop at younger ages and result in a higher fibroid burden during the reproductive years. Fibroids can also distort the pelvic anatomy, lead to blocked fallopian tubes, and can lead to implantation failure when they grow inside the uterine cavity. Surgery to remove fibroids can leave behind scarring inside the uterus as well as scarring and obstruction of fallopian tubes.
Furthermore, African-American women may be more likely to have infertility journeys that are complicated by obesity and other medical problems such as diabetes and hypertension which can impact the risk of miscarriage and can increase overall risk in pregnancy.
It is imperative for African-American women to seek care with a reproductive endocrinologist to guide the evaluation and safe surgical management of uterine fibroids that may be impacting fertility.
What steps can women of color take to advocate for themselves in the fertility journey, and what role does cultural competency play in providing personalized care?
Knowing when to seek care and obtaining treatment for infertility early if you have known barriers is key. This is especially true since all infertility challenges are further compounded by advanced age. As women age, the number and quality of eggs we have remaining declines leading to lower pregnancy rates and higher miscarriage risk.
You should seek care immediately if you meet any one of these criteria: 1. If you are under 35 years old and have been attempting pregnancy for 1 year without success 2. If you are over 35 and have been attempting pregnancy for 6 months without conception. 3. If you have had 2 or more miscarriages, you should seek treatment for recurrent pregnancy loss.
Additionally, other known barriers to fertility such as endometriosis, uterine fibroids, and polycystic ovarian syndrome, should accelerate the evaluation and treatment of infertility earlier than 6 months if you are over 35 or earlier than 1 year if you are under 35. Further, if there will be a delay in childbearing for any reason, including for career or educational aspirations, discussing the merits of fertility preservation with your reproductive specialist may be warranted.
It is imperative that African-American women seek care with providers that they feel comfortable disclosing difficulty achieving pregnancy or if they have symptoms of gynecologic problems that can threaten fertility such as chronic pelvic pain, heavy or irregular bleeding, and irregular menstrual cycles. All physicians should be cognizant and sensitive to the cultural differences in how African-American women seek care within the infertility space.
It is important for African-American women to seek additional support from organizations such as Fertility for Colored Girls, which provides a safe supportive space for women of color with infertility. Organizations such as Fertility for Colored Girls help to remove the stigma of infertility or treatment of infertility within the black community.
As an African-American woman who has been in the dubious position of treating women with infertility and having experienced the pain of infertility myself, I want to see anyone who desires a family have the family of their dreams. It is up to all of us to remove the stigma and barriers that black women face in achieving their families.