Michelle and Gabby Aren't Alone: What Black Women Need to Know About Infertility

Infertility is an unspoken shame for many Black women. Thankfully, more and more of us are chipping away at that stigma. Just this week, both Michelle Obama and Gabrielle Union went public with details about their journeys to have babies.

The former First Lady revealed that her teenage daughters, Malia and Sasha, were conceived via in-vitro fertilization.

Actress Gabrielle Union has been open about her attempts to carry a baby in the past, and she and her husband, Dwyane Wade, announced the birth of their daughter via surrogate a few days ago.

Visibility matters. So does access to good information and quality healthcare, things too many of us do not have. We talked to Dr. Lori Hollins, an infertility specialist, about things Black women who want to carry children need to know.

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Dr. Hollins, thank you so much for taking some time to talk to me. Before we really jump into this conversation, I'd love to know what you do.

I'm an OB/GYN and I did a subspecialty training in what we call reproductive endocrinology and infertility. I trained as an OB/GYN. Four years of training after medical school and then I did an additional two years of fellowship training and what we call endocrinology or hormones related to female reproduction and infertility.

Basically what I do on an everyday basis is what I call high tech fertility treatments. I see women who, for whatever reason, cannot get pregnant or have problems getting pregnant. The definition of infertility is one year of trying without using any type of birth control method or protection. I do things like we call in vitro fertilization where we basically give women fertility drugs and harvest their eggs. I do things like donor egg where women donate eggs to a woman because her egg reserve isn't very good. I do surgery for fibroids. I do the gamut of what we call reproductive medicine. But I did train as a general OB/GYN and actually did deliver babies for a fair amount of time before I actually did this fellowship training.

My maternal grandma had nine children. My paternal grandma had eight children. It's like they could sneeze and get pregnant. It seems that today women are having more difficulty having children. What has changed?

Well, I think the main thing that's changed is women are waiting longer to have children. My mother, her first pregnancy was age 18. Your grandmother probably had her first child at 16 or 17. Nowadays, people are waiting until they're in their mid-twenties, if not thirties, before they are attempting to conceive and it's because of going to school, lifestyle, finances, all those kinds of things.

I call it lifestyle infertility in the sense that as women we are made to have children when we're younger. The prime childbearing ages are between 21 to, maybe, 35. Actually, fertility starts to decline at about age 28. The main reason I see couples having problems is that they wait and don't start to have a family, or don't even start thinking about having a family, until they're in their late twenties, early thirties. That is probably the main reason that we're seeing such a rapid increase in problems with fertility.

Also, our society does not promote childbearing in the sense that we're trying to build our careers when we're in our twenties. I finished medical school at 26 and didn't finish residency until I was 30, so I didn't get married until I was 30 and didn't have my first child until I was 32. Thank God I didn't have a fertility problem, but I think that is the primary reason across all races and across all classes. People are waiting later to start a family.
Your fertility starts to diminish at 28?

Yeah. I'm not trying to scare anybody. It actually does start to decline slightly at about age 28. I give a talk to residents who are in training. Most people who are in training are in their late twenties/early thirties. And of course everybody's frightened, but there is a slight decline in your late twenties and then over the age of 35 there's a significant decline in fertility.

For example, if you're under the age of 30, your chances of getting pregnant on any given month are about 20 percent. Human reproduction is very inefficient. At the end of the year, approximately 80 to 85 percent of people will be pregnant. And in another six months, maybe another five percent, which leaves about 10 percent of people who are infertile. If you're 40, your chances of getting pregnant on any given month are only about 10 percent.

Which means that at the end of the year, only about 50 percent of people who are 40 and over are going to be pregnant. Also, as you get older, there's an increased risk of miscarriage because of genetic problems with the eggs. As eggs get older, there are more genetic errors. Anybody has about a 25 percent risk of having a miscarriage. When you're 40, the miscarriage rate is more like 40 percent. That's just normal. That is a normal process that happens throughout life. We know Black don't crack, but everyone's eggs get old. if you wait until you're 40 to really start thinking about having a family, you probably have about a 60 percent chance of not getting pregnant and not having a child.

That is a huge thing that most people don't understand. They see Janet Jackson had a baby at 50, but we in the fertility world know that she probably had egg donation. Somebody probably donated an egg to her. People say, "Oh yeah, I have plenty of time. I can't wait till I'm 50, etc." Which is really not the case.

I saw this thing about Gabrielle Union. I don't think she started fertility treatments until she was in her forties. It's unfortunate that she had all those miscarriages, but her chances of getting pregnant at 40 we're very much decreased even with the technology. Even though we have all this technology, we cannot change how old your eggs are. We can do fertility treatments. There's all kinds of information on this that people don't know.

For example, if you go to the CDC website that talks about fertility programs all across the country and you look at the age, you will see that under 30 people have about a 50 to 60 percent chance of getting pregnant if they have to use technology. But if they're over the age of 40, their chances of getting pregnant are less than 10 percent. Over the age of 42, they don't even keep statistics because the chance of getting pregnant is less than five percent. That is a huge thing that has been misrepresented in the media. I'm not trying to scare people. People do get pregnant. I'm not saying they don't, but if you have to use technology to get pregnant over the age of 40, the chances dramatically decrease, especially if you want to use your own eggs.

You're absolutely right. That's so much of the messaging we get around these innovations with fertility treatments. I just imagined that that means we have a longer window. You're saying the window has not expanded.

Well, we have a longer window if you're willing to use someone else's eggs.

The American Society of Reproductive Medicine does say that we can help people get pregnant up to the age of 55 in this country. But with a younger woman's eggs. A younger woman under the age of 35 will donate her eggs to the woman. Your uterus works. A 70-year-old woman's uterus can work, but the egg quality and the egg number dramatically decreases.

There is a decrease in male fertility as well. Not as dramatically, but there is a slightly increased risk of birth defects if the man is older as well.

Age is huge, and one of the things that really bothers me that I see with African American women is they do not get referred to me when I can really make a change and I can really help. I'm seeing African American women at much later ages, and I think it's just because you're not getting the information.

Even some of the general OB/GYNs are not referring people because they even don't really think about this as much. Then I see them. I get so angry sometimes because I'm seeing you at 42. African American women tend to have fibroids, which can make it somewhat difficult to carry a pregnancy. So I'm seeing you at 42. If you're over 35, we want to see you after six months of trying.

Then you come to me at 42, and I'm telling you you need to do egg donation and your head is spinning, It's really frustrating, and I really wanted to get the word out there that if having your own genetic child is extremely important to you, then that needs to be high on your priority list. Maybe even before your career. Do you understand what I'm saying?


Let's talk about egg freezing. We can freeze your eggs when you're younger, but, generally, the oldest we recommend freezing eggs is age 37. We don't recommend doing it before age 30.

Although our Reproductive Medicine Society doesn't, necessarily, recommend doing that for social reasons. Usually, we recommend doing that because someone maybe has cancer or some other thing like that, but more and more people are doing it for social reasons because they want to have that insurance policy.

I think our society needs to change in the sense that we need to make it possible for women to pursue a career and have children.

Let's say, hypothetically, that I'm a 31-year-old woman. I don't have a partner. I want to be married before I have children, and I know that I definitely want to have children. Should I look into freezing my eggs?

I would say give it a couple of years. I would say by 33 if you don't have a partner that's an option. The other thing is you can do donor sperm. I have a lot of single women and same-sex couples who decide to do donor sperm. The only thing about that, once again, is as you get older, even with donor sperm, your chances decrease.

I would say if you're not in a relationship, or it's not on the foreseeable horizon, I would say definitely consider freezing around age 33/34. And that's what the literature suggests as well because at least that gives you a chance. Whereas let's say you say you don't meet the person until you're 40. 40-year-old eggs don't work as well.

I would say definitely consider it if that genetic link is extremely important to you.
If I freeze my eggs now, I don't need to be worried that in 10 years there's going to be problems with implantation or with the quality of eggs. They're frozen and it doesn't change.

It doesn't change. Things can stay frozen indefinitely. That's how good the science is for that. Although, the chances of getting pregnant with a frozen egg are a little bit less than it was then with a fresh egg the egg quality does not change. If you decide not to use them until you're 40, the quality is going to be from when you froze them at 32.

You do have to do what we call in-vitro in the sense that you just can't put sperm around those eggs. You'd actually have to inject sperm into those eggs because the freezing process does change how the egg interacts with the sperm. They can stay frozen indefinitely, which is the beauty of it.

Wow. That's, that's a bright spot. But of course, I'm sure that a huge impediment to getting your eggs frozen is the cost. How expensive is this?

We're talking about around $10,000 to $15,000.

Oh my gosh.

It's not cheap by any stretch of the imagination. Then there's an annual fee to keep the eggs frozen, which actually really isn't that much. It's about $250 to $300.

Some of the costs are the fertility medicines that are used to stimulate the ovaries. The other costs are the laboratory stuff, the high tech stuff that we have to do in the lab to freeze the eggs. Also, the procedures that we use to get the eggs, so it's certainly not cheap. For a lot of women, that's a huge barrier. I'm not going to say it's not because it definitely is.

For the most part, if you're doing it for "social indications," it's out of pocket. I have heard people say that some of their employers may help pay for women getting their eggs frozen. But, generally, it's a drop in the bucket.

But once again, a part of it has to do with how we view society and is that a good thing to promote people to delay childbearing versus change some of our policies?

In some states, for example, in Massachusetts, New York, New Jersey, Connecticut, and, I think, Illinois, I a lot of fertility treatments are covered by insurance. But, generally, not egg freezing.

There is an organization called Fertility for Colored Girls. It's out of Illinois. That does provide grants for fertility. You have to apply for it. I think they provide up to $10,000, but those kinds of things are few and far between.

The other thing I would say though is if we see people earlier in their fertility course, sometimes they don't need to do high tech fertility treatment. Sometimes all they need is medication or maybe they need inseminations which are much, much, much, much cheaper option. Generally, when we get to the high tech stuff, people have tried everything else and they're older and that's what we have to do.

Let's talk about Black women and fertility. From everything I've read, Black women have higher rates of infertility than women of other races. Is that true?

Yeah, that is true. I think it's about one and a half times greater [than white women]. And there are many factors. You might've heard of a condition called polycystic ovarian syndrome. Black women have that just as much as any other ethnic group. We tend to have problems with our uterus more. We have fibroids. That is not necessarily a problem that affects fertility, but it can be a reason for miscarriage. We tend to have more obesity.

One of the major things I'm seeing nowadays with people not being able to get pregnant is what I call obesity-related infertility. Having extra weight on your body may cause you not to ovulate and also is associated with miscarriage as well as birth defects.

As you know, there's a huge obesity epidemic among Black women. I'm tending to see a lot more of what I call ovulatory dysfunction related to obesity as well. Obesity causes complications with pregnancy, too. I'm seeing a lot of that in some places.

I've seen people say that a part of the reason why we're experiencing such high rates of infertility is because of our diet. Is diet of a factor in infertility?

We tend to have more obesity, which is related to our diet, and when you're obese, you have what we call insulin resistance, which can interfere with you ovulating properly. So yes, I think diet is a factor because what we eat contributes to obesity.

I'd say about 60 to 70 percent of my patients are obese. I talk until I'm blue in my face about losing weight because we do know that fertility treatments don't work as well if you are overweight or obese. So if you're doing high tech fertility treatment, we're giving you injections with a tiny needle underneath the skin. If you've got a huge layer of fat, you're not going to absorb your medications properly.

So it's not the hormones or anything. It's not the chemicals in processed food? It's the actual weight on your body.

I think it's a combination of all of those things. You can't really tease it all out.

I think it is processed food. I think it is the chemicals. We do know that what we call endocrine disruptors that interfere with your normal hormonal milieu in your body. So I think is a combination of all of that.

Absolutely. That makes perfect sense. Another genre of comments that we get a lot when we post stories about women battling infertility is people blaming it on birth control or IUDs. They're saying that disrupts your body's natural processes.

I'm saying no. Certainly being on a birth control pill is going to change your hormones while you're on it, but once you stop it, you should be able to get pregnant. I was on birth control for most of my life until I decided I wanted to have children, so that's, generally, not the case. With the IUD, as soon as you take this out, you can get pregnant.

I'd say 90 to 95 percent of people who stopped their birth control method are able to get pregnant once they stop it, so I don't agree with that. I know there are all kinds of conspiracy theories.

"We're trying to control Black woman's reproduction, whatever, whatever." But in general, most people are able to get pregnant after they stopped those birth control methods relatively quickly. And once again, I've done general OB/GYN and you know, there is a subset of people who have a fertility issue that is not related to being on a birth control method. So I don't ascribe to those kinds of conspiracy theories that it is going to destroy Black women's ability to conceive because that really hasn't been borne out because most people are not infertile.

We're talking about 10 to 15 percent of women have a fertility problem. With Black women, it's probably more about 15 percent but 85 percent don't. I don't think you can say that a birth control method is the cause of this increase in infertility.
You mentioned that people have to be referred to you as a specialist. If I have questions, and I'm just going to go see my regular OB/GYN for a pap smear, I need to say to them, "I want to have a baby or I'm concerned." And then they have to then say, "Okay, well you need to see so and so."

Not necessarily. A lot of my patients are actually self-referral. I have a lot of patients that just do their own research, go on the website, look up infertility specialists and self-refer, so you don't have to be referred through an OB/GYN. A lot of patients are, but you don't have to.

In my particular practice, because women want to go to women, I have a lot of patients that have just done their research on the web and have found me that way. You can go directly to an infertility specialist especially if you think that you might have a problem. The problem is that people don't know that they can do that.

Are you accepting new patients?

Yes, I am. I'm in Jacksonville, Florida and I work for. I'm a practice called Brown Fertility.

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