Infertility And African Americans

Are you struggling to get pregnant or know someone who is?  About 10% of reproductive age couples have trouble conceiving, which translates into approximately 7 million women and their partners.   A common misconception is that infertility doesn’t exist in the Black community, where we are often stereotyped as super-fertile and more in need of birth control than infertility care.  This portrayal is both inaccurate and unfair.

You may be surprised to know that infertility rates have increased for Black women over the past several years, while they have decreased for White women at the same time.  Although Black women are more affected by infertility, we are less likely to ever receive infertility treatment.  In addition,  Black women seeking  infertility treatment usually wait longer before seeing a fertility specialist, have more tubal disease, more fibroids and are more likely to be overweight than women of other ethnicities.

Though many are affected by infertility, we now have options and answers for couples who need help. Before starting any fertility treatment, a general health screening and exam is in order. Specifically for women, testing for hormonal imbalances and irregularities in the menstrual cycle should be done.  Simple treatments like weight loss and managing pre-diabetes can improve reproductive function and overall health.  Men should complete a semen analysis early on to evaluate for problems with sperm production or function.  Men produce new sperm every few months, so even if they have fathered children before, they should have a current evaluation to make sure nothing has changed.

Causes

The initial female fertility evaluation should also include a check of the uterus and fallopian tubes.  Uterine fibroids are extremely common among black women and they can cause infertility or early miscarriages.  Damaged or blocked fallopian tubes caused by pelvic infections or surgery can also cause infertility.  An x-ray test called a hysterosalpingogram (HSG) is often used to determine if the fallopian tubes are normal.

Ovulation problems are another common cause of infertility.  Women who don’t ovulate regularly will have irregular periods, or no periods at all.  Some women who are overweight or underweight may ovulate irregularly and modest weight loss or weight gain, as appropriate, can improve cycles.

Common infertility treatments are ovulation induction (OI), intrauterine insemination (IUI) and in vitro fertilization (IVF).  With OI treatment, a woman takes an oral medication, like clomid or letrozole, to stimulate eggs to develop in the ovaries.  OI can be combined with intercourse timed around expected ovulation or coordinated with an IUI procedure.  These medications will usually stimulate 2-4 eggs to develop.  A good candidate for this treatment has at least one normal fallopian tube and normal partner or donor sperm.  The natural fertility rate for fertile couples is 20-25% per cycle, and rates for couples treated with medication and IUI can reach 15-20% per cycle.

Treatment with IVF is more involved than OI and IUI.  With IVF, a woman takes hormone injections for about 10-12 days to stimulate many eggs to develop at one time.  The developed eggs are removed from the ovary during a minor surgical procedure and fertilized with sperm in a laboratory.  The developing embryos are then placed directly in the woman’s uterus.  IVF treatments are more costly than other therapies, but every couple does not require IVF.   There are a few situations where IVF is absolutely necessary, such as absent or damaged fallopian tubes, low sperm counts or unsuccessful attempts with less invasive treatments.  If one of these indications does not exist, there are usually affordable and effective fertility treatments for you.

Where to start for help?

The first step is recognizing that there may be a problem.  Ladies, if you have been trying to get pregnant for over one year without success it’s time to see a fertility specialist.  Women over 35 should see a doctor after just six months of trying.  If you already have a history of infertility, low sperm count, tubal/uterine issues or ovulation problems, don’t delay in getting evaluated and on your way to treatment.