Fertility in black women is rarely discussed or acknowledged as a problem. Breeding myths from slavery perpetuate the stereotype that black women do not have problems conceiving. Studies have shown that when it came to infertility and IVF treatments, black married women had a harder time. Recently, I pondered the idea of whether I should have children. I never cared before. It came up as part of a relationship discussion. When a girlfriend was told that she could not have children I realized how I assumed that it would not be an issue. Sure, I was in my 40s but the women in my family were rather fertile and always had healthy babies. I'm probably the only one to wait so late in life to consider it.
Supermodel Tyra Banks admitted that she had trouble conceiving and used a surrogate. Janet Jackson's pregnancy announcement at age 49 had many scratching their heads at what wonder science was performed to achieve that feat. Morris Chestnut and Regina Hall's upcoming movie, When the Bough Breaks, addresses the issue of infertility and surrogacy, probably affirming our worst fears. With more professional black women getting married and having children later in life, I spoke with Dawne Collier MD, an OB-GYN who practices in Chicago, about fertility in black women.
Let's start from the beginning.
Women are born with around 1-2 million follicles (immature eggs). You don't make more. At puberty, it's down to about 400,000. Whereas, men constantly make more sperm as long as they have testicles, which explains 80 year old men fathering children.
Do we have a biological clock?
With each menstrual cycle up to 1000 follicles begin getting ready for ovulation. Only 1 becomes mature enough to do so. The other "999" or so are lost, so once you start your regular menstrual cycles, you begin to lose eggs on a monthly basis.
Do our eggs stop being fresh?
Because we are born with a limited quantity of eggs, there is a "shelf life." Your eggs in your 20s are "fresher" than in your 30s and 40s. The "older" the eggs, the higher the chance of chromosomal or genetic abnormalities.
At what age is conception problematic? I've heard tale that in maternity wards they refer to pregnant women over 35 as elderly.
The older you are during pregnancy, the higher the risk for gestational diabetes, high blood pressure and other factors. After 35, you have increased chances of miscarriage. Also, a younger uterus is better than an older uterus.
What questions should we be asking our OB-GYNs if we are over 30 and not sure if we want kids?
If you aren't sure if you want kids, start the dialogue with your OB-GYN in your early 30s. Some women are waiting until after their career has taken off. I've met women who have never considered kids then later meet someone and they want to have kids, but cannot. Delay works against you. Therefore, it is better to start the dialogue with your doctor. Take active movement to preserve your eggs. Think about saving/freezing your eggs. Some people worry about frozen eggs versus live eggs. Better to think about it this way. If your eggs are frozen in your 20s or 30s, they are younger "fresher" than live eggs in your 40s with less chance of chromosomal/genetic abnormalities.
If a woman is over 40 and wants to conceive what should she do?
If you have not taken steps to preserve your eggs, conceiving can be difficult even with IVF or surrogacy. Additionally, IVF is expensive and most insurance policies do not cover in its entirety. It costs upwards $9k to receive IVF hormone treatment (shots) to make more eggs more mature (superovulation). IVF maximizes what your body normally does during the ovulation process times twenty. If your eggs are mature enough, then you pay an additional $10k for the surgery to remove the eggs to become fertilized by the sperm then placed back in the uterus. Even if your eggs become mature and the surgery is successful, you are never out of the woods. A fertilized egg doesn't always result in a live birth due to miscarriage, chromosomal abnormalities, or other problems during pregnancy. Most women have to do IVF twice before it takes - around $30k for each treatment. Surrogacy is an option where you can have donated egg or sperm.
Any other advice for black women regarding their reproductive health?
The most important thing is not to wait. Start the dialogue with your OB-GYN in your early 30s, even if you're not sure you want children. If you later decide that you do and have not taking active measures to preserve your eggs, then the time delay works against you.