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Episode #2319
Fertility and the Black Woman
Brown: Imagine you dreamed for years of not much else than to have a baby. You’re married, or maybe not, but you’re unable to conceive. How would you feel? Where would you go? Who could you turn to? We’ll hear one woman’s personal struggle with infertility as well as other suggestions for support and advice, next on Black Issues Forum.
VO: Quality public television is made possible through the financial contributions of viewers like you who invite you to join them in supporting UNC-TV.
Brown: Good afternoon everyone, and welcome to Black Issues Forum. I’m Natalie Bullock Brown. Many women in America today are fighting to have it all; a fulfilling career, happy and exciting marriage, and healthy, well adjusted children. Unfortunately, the number of women who are discovering that they are unable to conceive and therefore produce life is on the rise. While the rate of fertility among women in all ethic groups is declining in the United States, African-American women, according to the National Center for Health statistics, now have a lower average fertility rate than their white counterparts. Today we’re going to explore some of the root causes of infertility and look at some fertility solutions as well as coping measures for those facing permanent infertility. We have an amazing panel of guests here to share their personal experiences and expertise with us. I’ll introduce them in just a moment. But first, reporter producer Rick Sullivan takes us to one medical facility in Raleigh that’s helping couples facing infertility.
Sullivan: The North Carolina Center for Reproductive Medicine calls itself the premier center for reproductive health on the east coast. A brief look at the facilities and the professionals employed here is impressive. The center’s most innovative and notable specialty is in vitro fertilization. It was the first private facility to perform IVF in North Carolina.
Mulvaney: Many things have been university based. And when you get it university based, you have a lot of restrictions. You have a lot of things that slow you down. But in a private facility, you’re able to do much more, do things much more quickly.
Toma: When we started, for example, Mena [ph] had very low sperm count. There was no way to do anything other than take the egg and put a drop of sperm on each egg. Now, we can pick the egg and inject the best quality sperm into each egg.
Sullivan: You are seeing one of the big moments of the in vitro process, a procedure called intracytoplasmic sperm injection. Using a microscope, a sperm is captured and then injected into an egg. In this session, Dr. Hugh Hensley, the laboratory director, successfully couples seven healthy sperm with seven healthy eggs. For five days, they will incubate, and then two will be selected to be implanted into a potential mother. But while in vitro fertilization is the showcase treatment here, it’s not the only one. Most women will never need, or choose, to go through the four to six week cycle of treatment that includes daily injections and frequent trips to the center.
Toma: Most people can get pregnant with making them ovulate because they’re not ovulating, improving their hormone status so that they can get pregnant.
Sullivan: Karen Middleton of Fayetteville tried those measures unsuccessfully. She came to NCCRM last august and began treatment with the drug Clomid, which induces regular ovulation. But that didn’t work, and now she’s traveling from Fayetteville to Cary every day for in vitro treatment.
Middleton: Something I want, something that my fiancé wants, it’s something his mother wants, I mean, we all want it.
Sullivan: Infertility rates among African-American women are higher than the average population. According to the Department of Health and Human Services, African-American women are two to three times more likely than the general population to have fibroids, a condition that adversely affects fertility.
Mulvaney: These are fibroids that are within the wall of the uterus. This is the uterus. This fibroid here is within the wall of the uterus, and then we also find fibroids inside the cavity of the uterus. A fibroid in the cavity acts like an IUD. So, even if you’re fertilizing and getting good embryos, they can’t implant in that uterus.
Sullivan: Dr. Mulvaney says the process to remove fibroids can also reduce fertility.
Mulvaney: To get these fibroids out usually require surgery, and thus cutting into the uterus to remove these fibroids. And the procedure is usually successful. If the fibroids are firm, they come out easily. There is bleeding in the wall, but not so much to cause injury to the patient. But with bleeding in the intradominal cavity, in the abdomen, that sets up an inflammatory process. With inflammation comes adhesion. And adhesions can cause damage to the ovaries.
Sullivan: For potential mothers like Karen who waited until her mid-thirties to find out she has a fertility problem, the North Carolina Center for Reproductive Medicine is giving hope that one day they will walk into the lobby at this center with a miracle baby of their own.
Sullivan: How would a baby change your life?
Middleton: It would make me happy. That would make me happy.
Brown: Karen echoes the sentiments of every woman, and couple for that matter. And so now we’re going to introduce our panel. We have Dr. Millie Behera, a practicing doctor, fertility specialist, and clinical director for Duke Center for Fibroid Biology and Therapy at Duke University Medical Center. Dr. Behera is also an assistant professor in the department of obstetrics and gynecology, and the reproductive endocrinology and fertility division at Duke University. We also have Dr. Grace Couchman, also a reproductive endocrine and infertility specialist, previously a faculty member at Duke and co-founder of Carolina Conceptions and Fertility Clinic in Raleigh. And we have Vanessa Richardson, a resident of Fayetteville who has authored a book title, The Certain Ones, in her effort to cope with infertility. Welcome, all of you, to Black Issues Forum.
All: Thank you.
Brown: Now, Vanessa, we’re going to start with you, and I’d like for you to share a bit of your story. I understand that you, after finding out that you had a collapsed lung, you also found out that you had some fertility issues. Why don’t you explain what happened from there.
Richardson: Yes, um, in 1999, I was diagnosed with first a spontaneous pneumothorax. And as the years progressed from 1999 to 2005, I kept going to the hospital. And during the time I was going to the hospital, they noted my blood count was low and my menses was on every time my lung collapsed. So then, I was diagnosed with catamenial pneumothorax. And this is very hard to diagnose sometimes, it’s so rare in America. So, having been diagnosed with that, the process was hormone suppressants. I was on Depo and Lupron, and that didn’t work. And the last result was my having a hysterectomy. Now, I was in so much pain and agony at the same time, I just wanted to go ahead and have a hysterectomy. I thought that I could deal with infertility later on. And once the smoke died, everything cleared. My issue was I can’t have a baby. You know, and I can understand with the young lady in the film, how she traveled from Fayetteville to come to Cary to have a child. She wants that child, and that’s what I did. I took the hormone suppressants for seven years in hope to my one day having a child. You heard of the baby boom, well now they have the baby bust, that’s where as in your piece said, young women are waiting for the year in life to have kids. And now they come up with these health issues, such is the case with me, catamenial pneumothorax and endometriosis.
Brown: Vanessa, I just want to, so that our viewers will understand what exactly we’re dealing with, I want to go to Dr. Behera. I know Vanessa’s case is probably unique or special; it’s not common that women, in African-American women in particular, end up infertile as a result of this particular condition. Can you just give us a little bit of explanation of the condition? But tell us, what really is the root cause for African-American women of infertility?
Behera: Well, you’re right. What Vanessa’s been through, and her actual diagnosis is quite rare. It’s an unfortunate story. I’m glad that she’s here to share that so more people know about it. However, endometriosis itself is fairly common, and when we see women that have infertility or undergoing investigations to figure out why they haven’t conceived over a year or two years, that’s often found as one of the causes. There’re multiple reasons for why women can have trouble conceiving. Sometimes it’s endometriosis, which can cause scarring within the abdomen, scarring of the tubes-
Brown: Can you explain what that is? What’s endometriosis?
Behera: It’s basically where tissue that often, when women menstruate every month, sometimes some of the tissue expels backwards through the tubes. And one of the theories is that, that tissue in most women gets cleared by the body and in some women it happens those areas and cause inflammation. And every month when, you know, within a woman’s cycle, and the hormones go up and down, those areas can become more inflamed and cause pain depending on where they are. They can be on the bowel, on the bladder, on the ovaries, on the tubes, and they can cause scar tissue and pain associated with that. Rarely, but this can happen, another theory is that these tissue implants can also spread via the blood, by the lymphatic system, and can be found in rare areas such as the lung or even the brain. So, that kind of situation has been described before and it just is a rare, rare occurrence.
Brown: And let me just add to this, since fibroids seem to be an issue for African-American women, how much of an impact do fibroids have on fertility?
Behera: That’s a great area of a lot of research nowadays. What we know, clearly, is that yes, African-American women do have a higher prevalence of fibroids. They usually have fibroids present earlier in life, they’re larger, they have more of them. And the way the fibroids work, it really depends on where in the uterus that they are growing. So they start within the wall of the uterus, but if they’re within the cavity, or if they’re pushing into the cavity, they usually have more effect on fertility, reproductive outcomes, and pregnancies. If they’re just within the wall, and they’re small, it’s still a controversial area. And if they’re on the outside of the uterus than they tend to cause more issues with pressure, pain, and bulk [ph] like symptoms.
Brown: Right. Well, Dr. Couchman, when a woman comes in presenting with fibroids or any other condition that is giving her problems with conceiving, what are some solutions that you are able to offer?
Couchman: Well, as with so many different people who come to us with fertility needs, there’s no one perfect solution, even just for fibroids, as Dr. Behera was saying. So much of it depends upon the location or what the symptoms are. For patients who have fibroids within the uterine cavity, that is the place where an embryo would like to implant, and those can usually be removed fairly easily through what we call a hysteroscopic procedure. It’s a simple procedure through the vagina, through the cervix, where we can take an instrument and essentially scrape out pieces of fibroid and have the uterine cavity become a more welcoming place for, you know, in implanting embryo. So those fibroids tend to be smaller and can be very easily accessible. As Dr. Behera was saying, they can be located anywhere within a uterus, so sometimes we will do abdominal procedures; make incisions in the abdomen, actually remove the fibroids from the uterus, which will often restore the uterine shape to a nice place again for an embryo to implant. Some of the newer techniques for removing fibroids: Uterine artery embolization and I know Dr. Behera is working on some other therapies at Duke. We are very hopeful that some of the therapies will be excellent in the future, but some of them are not approved for women who still want to conceive because they can affect blood supply and flow to the ovaries, which can reduce how many eggs are available for fertility. And, they can also damage the lining or affect the lining of the uterus. And, again, we rely on that so heavily for embryo implantation.
Brown: Dr. Behera, so how risky are these procedures? We heard Dr. Mulvaney I believe it was say that at least surgery is relatively safe, but all these different procedures that Dr. Couchman has mentioned?
Behera: Right. So, in general, these procedures are safe. However, you’re right. As we saw in the clip, depending on how we have to extract the fibroid, if it’s below and done hysteroscopically, it is a fairly low risk procedure. It’s day surgery. However, as we learnt from that segment, is that if we have to go through the abdominal wall and resect the fibroid from the uterine wall itself, there are some issues there. The fibroids themselves can be associated with some bleeding, the bleeding that’s left behind, or the inflammation from the surgery itself can cause scar tissue. And then, the area within the wall of the uterus that has been where the fibroid was resected from can sometimes be an area of weakness, so in future pregnancies, these women may be restricted to having cesarean sections for delivery and would not be allowed to labor. So, this is where there’re definitely, up until now, those were the traditional approaches and we really didn’t have many other options. So now, part of the exciting area of research now is offering these new less and basic procedures, and some of them really are based on early procedures where they were doing them on women who had completed childbearing and so we could learn how safe they were in these women and follow their long term progress and how it improved their symptoms. However, now we’re actually just starting to do some exciting research at Duke where we’re taking a non invasive procedure that could treat fibroids called MRI guided focused ultrasound. And it basically involves no incisions, no cutting, no stitching, a woman lies on the MRI table and ultrasound beams are focused into the fibroid to heat and destroy the fibroid only and leave the rest of the uterus alone. And, we’re about to do a study now to look at women who are younger and want to retain their fertility and see how that improves fertility, and compare that to the traditional way of myomectomy, which is cutting out the tissue surgically. So, there is some hope on the horizon, there are more choices for women that they really need to start asking more about and we’ll be learning more about in the future.
Brown: Well, Vanessa, I want to get back to you in just one moment. But, Dr. Couchman, I want to ask you a question since you have your own private practice. The types of women that come in typically and are able to afford the types of procedures that are available, and even what Dr. Behera is talking about, which sounds very exciting but also sounds expensive. Who can get these treatments?
Couchman: I think that’s an excellent question, because I think one of the barriers to seeking fertility care is people thinking it will be too expensive. And the reality of it is that a lot of fertility care, particularly care that has to do with something that might be wrong with the uterus such as fibroids, will almost always be covered under a typical insurance plan. It’s related to gynecology care and it can be causing symptoms, like we heard about pain and bleeding, and those are typically always covered by insurance, so we would welcome people to come in and find out, “Is this something that could be covered by my insurance policy?”, which it often is. So, again, that barrier that keeps a lot of women from seeking care, you know, the fear that it’s going to be just too expensive, often just is not true. And we see lots of people who are always surprised to find that so much of their treatment is covered by their insurance policy. So, they need to just ask those questions.
Brown: Well that’s good to know. Vanessa, when you were going through your process and all that you went through medically, did you feel like you were getting the types of answers and the information that you needed to make informed decisions about what you were going to do and how you were going to proceed?
Richardson: Let me just say this, I had two wonderful doctors. But as far as the answers, my condition is so rare, the answers were so far and few in between, really. That’s why I’m so excited about this show. There’s so much answers here today and the procedure, it’s progressing medically. But, no, for me I didn’t receive a lot of answers, basically because a lot of women, they’re silent in this issue. You know, they don’t come out and they don’t admit it. And like Dr. Behera said, they have invasive procedures now. I think sometimes they’re fighting over the process, you know, pain and of that nature. But, I didn’t have the answers. So what I did, I started to journal it. And when I journalled, I wrote down how I was feeling. I was angry and I was hurt, and especially I think, have a child. So what I did, it took a process of three years, I went back to the journal, and I opened the journal, and I didn’t look at it as a Vanessa, I looked at it as a young woman. What was she thinking? What’s her problem? And it was cathartic for me, and what evolved out of the journaling was the book called The Certain Ones. Sad to say, things like this happen to a certain one. And yes, I can’t have kids. And at the time, if you would have said, “Vanessa, you can have an adopted child.” I was not open to receive that at the time. But you know what, life is based upon decisions. If you want to be happy, you can be happy in your decision. And now, I’ve come to the decision that Vanessa, you can adopt. That was my process, my healing process. My child is out there waiting for me and I have wonderful mothering skills, you know. So I decided to be happy. And that’s a choice you make, I want to say that to the young ladies today. You may not be able to have a child, and you’ve done all you could probably. But you know what, it’s up to you to decide, “I want to be happy.” And you can have your quality of life, your child, once you heal. Once you heal, it’s out there waiting in adoption. You know, they’re out there. Be happy, it’s your decision. You are a certain one.
Brown: I’m sorry. I want to show Vanessa’s book which is called The Certain Ones and it was just published very recently.
Richardson: April. This year.
Brown: And, Dr. Behera, I mean it’s just so touching to hear Vanessa speak of her feelings, what she went through, and the fact that how she’s coping with infertility and the fact that that is, that’s that. You know, how do you I guess council women that come in and they’re faced with a similar reality?
Behera: I agree, I mean, what Vanessa’s been through is really inspiring for all of us. I’m so happy that she shared her thoughts in a book like that, and that even those of us who haven’t gone through an experience like that, or even, can find ways to relate to it and gain strength from something like that. I think, even in general, no matter what we deal with, any kind of health issue or concern where you feel that you’re out of control and there’s something with your body that might be wrong, or you just can’t achieve that goal, it’s difficult to deal with. And we all deal with stress differently, you know, some resort to, you know, it’s cathartic to write a journal. Some resort to hanging on to family and support groups, sometimes your faith is very important to help you through those difficult times. Any time a woman comes, or a couple comes to a clinic, and is going through these struggles, we always offer them our support obviously, and sometimes just getting those questions answered is helpful. Knowing your options is helpful and knowing that you can decide where your treatment is going to go and you’re not forced a certain way that you’re not comfortable with, that’s helpful as well. We also offer a clinical psychologist in the clinic because we know that every couple is going through this struggle and may need some support, help them learn some coping mechanisms, and that you know, not everybody needs to have a baby a certain way. There are different ways to get at that goal. Maybe coming to terms with adoption or other different forms of therapy, or even being without a child, you know, just coming to terms with those things may sometimes need outside help. And it’s just being able to accept that and to ask for, you know, that help and be willing to be open to that I think is most helpful. We’re also starting other stress reduction programs as well where a lot of couples are using acupuncture and other non-traditional modes of medicine to help with, you know, reducing some of the stress associated with fertility problems or other health related issues.
Brown: Dr. Couchman, I just wanted to ask, you know, at Carolina Conceptions when you are faced with couples or women in particular that are dealing with infertility, what sort of support resources are out there that you can refer them to?
Couchman: First of all, I would like to echo Dr. Behera’s comments and say to Vanessa, I think it is so wonderful that she is able to share her experiences because really it is, infertility is definitely one of the more stressful experiences I think that women experience. But, in terms of coping, I think one of the most important things is to find a physician and a clinic that you feel comfortable with because day to day, no solution for fertility will be the same for every woman or every couple, and I think having a physician who can hear what your needs are, what you would like your approach to be to achieving your goals is so important when you enter this journey, because again it has different endings for everyone. There’s no correct treatment and it can be something that each couple will pursue very differently.
Brown: And so is that the most important thing that a couple can come into your office with? Just that having thought through and come to a decision about, “This is what we want out of this.”?
Couchman: Well I think they, well, they need to be able to talk to someone about their options, so I think hearing all of their choices is important. But, some clinics or physicians may have more of a routine approach of, “You need to do this, this, and this.” And that may not be right for that couple. I see many women, African-American, white, everyone. Some of whom want to do very simple therapies and often they’ll get pregnant, other couples no matter who they are might say, “I want to go right to in vitro. So, those people have very different approaches to their personal relationship and to how they want to achieve their dream of having a baby.
Brown: I was going to ask you because I think you mentioned earlier that, you know, it’s not always, um, infertility is not always the end result. Sometimes there are very simple things that standing in the way of infertility.
Couchman: Right. Exactly.
Brown: Dr. Behera and Dr. Couchman, if you guys would just briefly, just talk about that a little bit. What are some of the things that are really easy and simple to solve, and clear the path for fertility to actually happen?
Behera: I guess, part of it even comes down to the very definition of what we call infertility. It’s just kind of a random definition but we’ve sort of divided it into, well you’ve been trying for 12 months, you know, that’s really actively trying. And sometimes, it’s just a matter of getting a couple together in the same room, and maybe just their work schedules aren’t working for the right time of the month, they’re just not in the same city or it’s something as simple as just happening with timing. And again, as we touch on, on the clips, sometimes it’s just getting an idea of white your cycles are like, and maybe ovulation is the issue. And that’s very simple to treat. Sometimes there are medications you can use that are not expensive, not as risky, you know, don’t require as much intensive therapy or as many visits and stress to go through, that could be a good option to start off with. And then you can go through the steps together. If we don’t get there that way, then we take the next step, and take the next step. And there are different ways to spice things up to improve your chances along the way. But the speed we go at, and where you start is really tapered to each couple.
Couchman: And Dr. Couchman, any last words?
Couchman: Well, I think we’ve covered a lot of important issues. Coping mechanisms for couples, the supportive staff at a clinic I think is very important because patients will interact not only with their physicians, but nurses and other lab staff as well. So, I think some of the simpler things, people overlook sometimes. And so we don’t want people to be afraid to come into a clinic thinking, “Oh my goodness, it will be such a big issue. I’ll have to miss a lot of work.” And again, it can be simple, simple things that we can help couples with.
Richardson: Mm-hmm. Education is the key.
Brown: Thank you so much for being here with us today. We really appreciate your presence. We are grateful for the time our esteemed guests spent with us today and if you’d like to get in touch with our guests or obtain a transcript of today’s show, visit us online at unctv.org/bif. And when you visit, be sure to give us your comments and program suggestions. You can also call us on the BIF line at (919) 549-7167. Be sure to meet us right back here, each Sunday afternoon at 4:30. For Black Issues Forum, I’m Natalie Bullock Brown reminding you to be encouraged. Excuse me, no matter what! Peace and blessings.
VO: Quality public television is made possible through the financial contributions of viewers like you who invite you to join them in supporting UNC-TV.
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