How Race Impacts Your Fertility

The dialogue around infertility is filled with assumptions related to privilege. Media depictions of difficulty getting or staying pregnant prioritize upper middle-class WASPy couples, or the actual one percent. Whether we’re following real-life stories of celebrities like Courteney Cox or Brooke Shields, or fictionalized ones, like Kate Pearson on This is Us, we see the same type of would-be mom: white, wealthy — this is what it looks like to struggle to conceive. Even a google image search for the word “infertility” brings up almost exclusively white women, or white hetero couples, making sad faces at staged doctors’ appointments.

There are few spaces for marginalized individuals to discuss their fertility experiences, and this could be impacting their success getting pregnant.

A recent study presented earlier this month at the American Society for Reproductive Medicine conference in Denver found that Black women have lower IVF success rates than white women — and researchers aren’t sure why.

Researchers looked at 36,217 patients who had undergone IVF treatment at one D.C. area practice over the past 14 years, and who self-identified as Caucasian (29,547) or African American (6,670). According to their findings, the rate of clinical pregnancy was 9 percent lower, clinical pregnancy loss was 24 percent higher, and live birth was 14 percent lower for black women relative to comparable white women.

“African Americans had a lower pregnancy rate and were more likely to suffer from a pregnancy loss, says Kate Devine, M.D, a board-certified reproductive endocrinologist, and co-director of research at Shady Grove Fertility where the study was conducted. “Even more concerning was their higher rate of preterm delivery.”

Dr. Devine and the team were surprised to find black women responded well to ovarian stimulation medications, and had an equal if not greater number of eggs retrieved and embryos created, which, statistically speaking should’ve meant they were better set up for IVF success. But something was impacting their ability to carry babies to term. Previous research has shown this, too; the preterm birth rate of black women is 49% higher than other women in the United States. In the past, many assumed this was the result of lower access to quality prenatal care and medical resources.

“Some larger studies have demonstrated poor outcomes in African Americans, but these studies have used data from IVF clinics throughout the country. Therefore, you are grouping patients who used different embryology labs, each with their own success rates,” she explained. She and her team wanted to see if disparities persisted among women from a single fertility practice with identical lab techniques. And, they did.

“By determining whether and what type of disparities exist we can better counsel our patients for expectations and success when undergoing fertility treatment,” Dr. Devine says. “We can hypothesize and design future research studies to determine what might be the reason for the observed differences. Importantly, we can tailor our treatments to address causes for poorer outcomes among women of a particular race.”

Despite all of the patients in the study — both black and white — having access to adequate prenatal care, the preterm labor rates among black women remained elevated. Dr. Devine and her team saw that as an indicator that something deeper than “access issues” was at play.

Although the researchers are unsure what that thing is, a growing body of literature suggests it’s racism. Continuous exposure to racism dramatically impacts how black women experience the world and contributes to a wide range of racial health disparities. When paired with conditions like fibroids, endometriosis, and other uterine abnormalities, black women are left with much to struggle through while at their Ob/Gyn’s office.

The study's results confirmed just how important it is to explore the impact of race as an isolated factor.

Historical narratives and income gaps leave Black women particularly marginalized in the reproductive choice conversation. As a result, Black women are forced to deal with infertility in isolation.

According to Rev. Dr. Stacey Edwards-Dunn, Founder and President of Fertility for Colored Girls, cultural myths and media portrayals significantly shape Black women's experiences with infertility. “Breeding myths and cultural expectations have long perpetuated stereotypes and biases that have shaped many people’s beliefs that Black women (and men) are baby-making machines or hyper-fertile," Dr. Edwards-Dunn explains. Another is Black women being severely underrepresented in medical research.

“It is critical that more research considers the unique conditions of black women, such as cultural, physiological, sociological, race discrimination, gender and mistrust of medical institutions/doctors, and more,” she continued.

And Dr. Devine agrees, saying it’s vital that black women, especially those who struggle with infertility, are aware of the unique factors they face pre-, during, and post-pregnancy. Organizations like Fertility for Colored Girls play an essential role in disseminating this kind of information.

“Women need to be aware of these disparities and hopefully that leads them to seek infertility treatment and consultation earlier in their journey to a healthy baby, to maximize chances of success,” Dr. Devine says. She hopes her team will one day get to the root of the reproductive health disparity — and then all that's left to do is solve it.