SART Fertility Experts - Fertility Myths and Realities for Black Women

Hello, I'm Dr. Danielle Kaplan, a clinical psychologist in New York City, and this is an episode of the SART Fertility Experts Podcast. I am so happy and so grateful to be talking today with Dr. Wiyatta Fahnbulleh, a psychologist and my colleague in ASRM's Mental Health Professionals Group. And today we're going to be talking about fertility myths and realities for black women.

Hello, Danielle. Hello, Dr. Wiyatta. Thank you for being here.

I should say Dr. Kaplan. No, you should say Danielle. Dr. Danielle.

Okay. So before we get started, can you just tell me a little bit about who you are and how you come to this work? Absolutely. So I'm Dr. Wiyatta, like she said, and I practice in Los Angeles, California or in California.

And I'm a psychologist trained in forensic psychology and reproductive medicine. And I came to this work a couple of years ago at 26, no, well, I met Dr. Landay, who was my REI in 2016 when I was going through treatment. And she said, you should speak to a reproductive psychologist.

I was like, what is that? They have people who do that. And when I started doing that, I just was like, if I'm a psychologist and I have a whole network of supportive individuals who love me and show me all this love, and I'm so anxious and my emotions are through the roof, I want to be a source for others who experience this so they have somewhere they can go and talk. So then in 2019, I actually took the big leap and went full force and started doing it.

Fantastic. And I will tell everybody who's listening out there that Dr. Wiyana is also a member of the Diversity, Inclusion and Anti-Racism Task Force for the Mental Health Professionals Group, which is one of the reasons we are so happy that you're talking with us today. Thank you.

All right. So before we get started, a question that I know we both know the answer to, but I want to make it very clear. Why aren't we just talking about fertility myths and realities for women? Why are we talking about black women? Because in our society, in our communities, first of all, just the talk of fertility and infertility, there's this narrative that black women are hyperfertile and hypersexual and we can just push our babies with no problems when the data really shows that we're two to three times more likely to struggle with infertility than our counterparts.

And we don't seek treatment because there's this idea like, oh, if I just think about it, if I just wait, it will happen because it just happens naturally. So we're less likely to seek treatment for fertility until it's kind of too late or, you know, we're older and there's probably going to be more challenges. Okay.

So can we go back for a second to this myth that black women are hypersexual, hyperfertile? Where does that come from? That started during the like slavery, you know, if you take it way back when, because I think we were seen as people who just were able to just like push our babies. So it started way back when, and that's just carried on through society through the years. And then even if you see things like if you take our music videos, if you look at the videos from like their nineties and the two thousands, the girls were always like hypersexual.

There was always this thing like social security and welfare. There's this myth like we're more than likely to have eight and nine babies. And so we're just known to just push out these babies, but never do we ever hear anyone talk about, oh, you know, there could be a struggle in the community for individuals.

So then it becomes really isolating for those of us who do struggle with fertility to even say, I struggle with fertility because people are like, well, why? You, it's a natural thing. Your body just pushed, should push out the baby. So it started way back when.

Yeah. And I want to go back in a minute and talk about that silence because I think it's really important to break it. But one of the things that I wanted to make sure that we highlight here is that these things that started in slavery are things that are still very commonly believed today.

There's a study, and I'm not going to get into data and authors and all of this talk, where they surveyed people from the general public and they surveyed medical students and they said, how much do you believe this and this and this and this? And people are buying into these myths that black women are hyperfertile, that black people's blood coagulates more quickly, that skin is thicker, don't feel pain as much. Right. And so all of this has trickled down from the very beginning, from 1619 to now, we're still dealing with it.

And this is why when people in health care, I mean, people anywhere, but when people in health care who are treating patients of different type of diverse groups say, I don't see color. That's the problem, because if you don't see color, these things that are coming down through the lens of black people are this, this, this. It may be in your subconscious and even if you're not aware of it.

But these are the things that you're probably treating the patients thinking, because we're seeing, if you think about in the maternal health care crisis, the black women are more likely to have cesarean or to die in childbirth than other women. So why are these things happening? Because the treatment is not equitable. The standardized treat is not standardized across the different ethnic groups.

That's right. That's absolutely correct. Okay.

So the misconception then is that black women are hyperfertile, that they can have babies easily, that they get pregnant very easily and so forth. What's the reality? The reality is we're two to three times as likely to struggle with infertility than other, the women of other races. And what's interesting is I know growing up, a lot of black women, if you talk to them, I mean, if you talk to a lot of women, we were taught like you keep your, you don't get pregnant, you keep your underclothes on, you don't, you know, you don't get in bed with anyone.

You wait like at least three months before you even like think about doing anything with a guy. And for some people, it's like you wait till you're married. So the reality is if you bring religion into it, a lot of us are taught early that you don't do this with a man, you don't do this with a man.

So the narrative that we're hypersexual was always like interesting to me because then when I talk like living in New York City, I would talk to my white girlfriends and they would talk about, yeah, I went on a date and after like one to two dates, we slept with the guy. And my black girlfriend's like, wait, you already slept with him? You're supposed to wait at least 90 days, you know, at least the minimum is 90 days. I mean, I'm sure things have changed.

But so when I hear like we're hypersexual, I'm like, wow, but the people that I know, not saying that there aren't people who are, but most of the women that I knew, we were like more on the other spectrum. Like, no, you got to wait. You can't just do this, you know, right? More on the conservative side.

Yeah, absolutely. When it came to sex. Absolutely.

Yeah. Okay. And we're both psychologists, so obviously we're not going to speak to the medical piece of this so much, but there are some very common conditions I know that are much more common in black women that impact fertility.

Yes. Like fibroids. Okay.

All together now. Yeah, definitely fibroids. Like I've had two fibroid surgeries and I think just about every friend of mine that I know who looks like me has had fibroid surgery and I think they're still trying to figure out why is it so prevalent in the black community? I mean, there's talks that it could be related to some of the hair, the hair perming products that we use, but I don't know that to be a fact, but there has been talk that that could be something cause you know, we were perming our hair back in the day, but we're very highly black women are very susceptible to fibroids and other endometriosis and PCOS.

Yeah. There's a graphic that I saw recently and you'd have to picture it. It's hard to talk about a graphic on a podcast, but you have to picture it like a pyramid where the bottom level of the pyramid is desire for children.

And that's the biggest part of the base and black women and white women and other women of color do not differ in that base. Right. And then you go up the pyramid and it gets narrower and narrower.

Right. And the next thing is having your infertility diagnosed. And the next thing is having a specialist who can treat you.

And the next thing is getting IVF and the next thing is having success in IVF and the top of it is feeling centered and cared for on the journey. And for black women and other women of color, that pyramid just gets narrower and narrower all the way to the top. And you know, that's, that's where cultural competence comes in for providers.

Like you have to be aware of how you talk to your patients. Like for instance, when I talked to a lot of in my practice and just women in general about egg donation or, you know, being, getting an egg donor or having their eggs saved, most black women don't have, are not giving that, given that information during treatment, like even from the twenties and thirties. And then I talked to my white girlfriends and like, oh yeah, my doctor talked to me about saving my eggs.

So even something as simple as that in fertility preservation, we're not educated on that. So it's not till later that we find out. But again, we already know later presents more challenges.

So cultural competence comes in. How do you talk to your patient? Talk to colleagues who look like your patients so they understand culturally. Speak to the person this way, because if you speak in a certain way, you might shut them down.

They might not be likely to want to have these tests or to even be diagnosed because the cultural stigma of being diagnosed with infertility is so, is so huge. Like how do you talk to them so they understand this isn't just isolated situation. This is something that is prevalent in the community.

Okay. And absolutely for any physicians who are listening out there, for any nurse educators, for any RNs who are listening out there, that is a huge part of the process is being able to get the word out there. But what about just person to person, community to community? What are some of the things that you wish that black women knew about their own fertility and fertility treatment? First of all, I wish they knew that there were fertility treatments out there.

Like I saw this documentary maybe a year ago, and it was talking about preservation. I wish people knew that there were the options of egg donors. I wish they knew that IVF wasn't so out of reach because we know it's expensive.

I wish they knew there were options. There are grants out there. The Cade Foundation.

The Cade Foundation, right. That can give grants, like they can go to... Resolve. Resolve.

Yeah. Resolve has a whole list of fertility grants that are applicable to different populations. Absolutely.

Exactly. And I wish providers, when they start talking to people about at an early age, like when we start to go to get our pap smears, that they talked to us from early on. Do you have a desire to have children? What's your timeline? These are some of the statistics.

These are ways that things can come up that you can invest in. You can think about when you want to start. You can think about if you have fibroids, having that surgery, and how that may impact fertility.

But give them all these different options so they know the statistics out there. But when you give them the statistics, give them something else so they have something that they know there's pros and cons that they can weigh. That makes tremendous sense.

I mean, always education, education, education and busting the stigma for all of this, right? Which is where I'm going to put in a plug for a couple of different websites and Facebook groups and pages. Okay. Do you have any favorites? Because I've got a couple of favorites.

No, you know, I just tell like for Facebook group. Well, we are Robin. I think it's black maternal health.

They're on Instagram. And it's the one with the egg donor. I forgot.

Oh, while you're checking that one out, I'm going to put in a mention of the broken brown egg. Yes. Okay.

All right. Regina Townsend, who is just a force in the world of educating about black fertility. Yes, that's her.

She's amazing. If you go on like Instagram and just put in black maternal health or something, so many pages will pop up. You know, now you go to Instagram, even TikTok, go to Facebook.

For Facebook, I just will put in like black women struggling with infertility or black birthing person, whatever, you know, I will put in those and those things and different groups will pop up. So Facebook groups are always like I always promote Facebook groups because then you get support. Yeah, absolutely.

Okay, so we're talking women, women, women and birthing people and so forth. What do we know about black men and infertility? Wow. So we know that that's if you think we're isolated and don't talk about it, that's like almost non-existent in our community.

But we also know that infertility and men in general and black men is on the rise. So just getting that information out there. I mean, we can barely get men to go to the doctor.

So when they do go and have their yearly and if they're, I think doctors should also bring those topics up. Are you interested? And maybe we should do some testing, you know, to test your sperm count. So they're not waiting until they're ready and realize, oh, there's a problem.

But normalize these things. I think we should maybe these things should be part of the yearly or maybe not yearly, but every couple of years. I mean, I'm not a medical provider.

So maybe but something that should be included. So it's not until the person is faced with the diagnosis that then they're starting to do all this testing because even that then now it's like added added element to the anxiety that's coming. So maybe make it something where you talk about it, you know, in your as you go talk to your patients, make it, you know, here's the info on fertility, talk to these men about it, because we can barely get them to go see the doctor.

So when we get them in there, let's educate them. Right. And one of the things we know is that women at least are told, okay, you start to menstruate, you go to a gynecologist.

Yeah, right. So there is a conduit if gynecologists are talking to women about their fertility. Yeah, there isn't something comparable for men.

And that's the thing. So because they're just going to their primary care doctors, not like they're like, I'm gonna go see the male doctor. No, they're not.

So who do they talk to? So as their primary care doctors, when they do go on their annual to bring these things up, because I don't think men are not really programmed to even think fertility impacts them, like infertility impact them at all is always looking at the female partner. So we have to bring a sense of awareness to this to that population. So they know this is something that could impact not just you, but both because what I said, one in six couples struggle.

So one in six, that means a lot of people that we're seeing. We're looking at the exhibit hall here. There's a lot of people walking around.

Yeah. So we know people, every one of us in our personal lives, whether or not people talk about it, know someone or a couple of few people who struggle with infertility. Okay.

So if the myths for black women are as prevalent and as long standing as they are, are there comparable myths about fertility for black men? You're nodding before I even. Oh, I mean, that's what I'm saying. Because for black men, they're not even, they don't even, fertility doesn't even impact them.

There's not even. So even in situations, like I've known of situations where they've been trying and trying and trying, and they would say like he would get the woman tested, but he's not going to get tested because it's obviously not him. But so when they find out it's him, the devastating, it's like he's emasculated.

It strips him of his manhood. So talking about it, I've had couples come to me where it was the male partner and how devastating it was and how broken he was. I mean, to the point like, you're sorry.

You know, almost like the female partner was like, I wish I was the one struggling with this because this is impacting you so much, you know? Yeah, absolutely. Absolutely. Okay.

So there are two more questions I want to ask you and then let's just open it up for anything you want to make sure that we talk about before you go. Okay. Okay.

So some couples and some individuals who are pursuing family building will require some third party help. They'll need an egg donor. They'll need a sperm donor.

They'll need a gestational carrier. What do we know about egg and sperm donation and gestational carriers in Black communities? There are few and is it far and few between. So again, because we're not, because we don't talk about these things like, I mean now, well now we're starting to talk about them, but because we don't talk about them, I think a lot of people don't even know like they have the option of being donors.

But also there's the stigma of what are you going to do with me? What are you going to use this for? Because we know from history if you think about the Tuskegee Airmen, if you think about Henrietta Lacks, when we think about those instances, there's this program that we're like, we're not sure that this is going to be used for any good. It might be used against us in some way. And so I think this is where using that diversity comes in, using providers, you know, of mental health conditions like myself, providers who can say this is the data.

This is what we need. We need donors of color because when a donor of color is out there looking, when a woman is looking for a donor of color, you're not really seeing them. You then have to go to a different race, you know? And so we need these out there.

So people are aware like this is something that is being used to further the community, to grow the community for the benefit of helping someone build a family. It's not going to be used against you in any way. And I think when we educate, we also have to educate them on what happens when the donor conceived child come, what, 18 years from now? I think that can be scary.

Like, wait, I wasn't trying to be a parent to this child. Right. Or more and more frequently now 10 years from now, right? With affirmative searching and with 23andMe, right? It's not just that magic 18 number anymore.

Right. And with the way things are going, like you said, that number is getting lower and lower. So we have to educate them on what that looks like, what we've seen when donor conceived individuals come in contact.

Because a lot of times we know they just want to understand who this person was, what my history is, what my medical history is. So I think just education is so important and using the voices of people like yourself, people like me to just get this word out there that this is something that we need to help with family building. Ah, fantastic.

Okay. So I'm going to ask you one more question. I want to talk to you about this all day, but our time is what it is.

So if you had a patient in your office, or if you had a friend, or if you were given a community workshop for coping with infertility for people of color. What would I? Yeah. What would you want to give them? What would you want to equip them with as they go through this journey? Here's one thing I always say.

I always say to patients, who were you before you found out you struggled with infertility? Oh, I like that. What did you do? What did you enjoy before you found out you were struggling with infertility? And then they, because we have amnesia before we found out about infertility. So then we go back and we dig and I'm like, what are you implementing any of those things that you used to do before into your life right now? And if you aren't, let's figure out a way we can start to implement.

We don't have to do everything, but let's figure out a way we can start to incorporate those things because that's a way to continue to live as this, as you're going through infertility. There's also talking about it. If you have a partner, I would say when you don't want to just bombard your partner, like all day fertility.

So carve out some time. He's like, we're going to designate 30 minutes, but every day, a couple of days a week, and we're going to talk all things fertility. And you can talk about how it's impacting me.

This is what's going on. This is what I feel. So that way you can look at, you have something to look forward to and they're not on edge.

Like every conversation is going to be, Oh my God, we're going to talk about fertility now. And of course, if you talk about intimacy, don't just plan intimacy around ovulation, plan it at different times, be creative, but do things together, do things with friends. Like you have to do those things that you loved doing.

So you're not just existing. And then also acknowledge those feelings when they come up for you. Do you feel jealous? Do you feel guilty? Acknowledge it, embrace it.

Cause that's how you're coping. And because if you try to ignore and avoid, you know, it's only going to come back stronger. So experience the feelings and then be kind to yourself.

Yeah, absolutely. Absolutely. This just about intimacy, although I know we're kind of going on a little garden path here.

One of the things that I will tell my patients all the time is sex is not just for baby making and intimacy is not just sex, right? Whatever it is that helps you feel connected. Yeah. Like cooking together, you know, cook together, you know, pick a recipe and make it together or go for a walk.

What do you enjoy? Do you like going to the beach? I live in LA. Do you like going to the beach? Do you like walking in the park? Whatever it is, find that thing to do. Go outside and play snowball.

I don't know, snowball fight. Right. Cause I live in New York.

We'll do that. We'll go out to Arrowhead. Okay.

So anything else that you want to make sure that you mention about black women, black men, people of color in general or infertility treatment as you see it? I think infertility treatment is not a taboo. It doesn't mean you're broken. I think we always have to say is nothing that you did that cost your infertility.

You didn't cause the miscarriage to happen. Um, be kind to yourself, seek all the education, seek support, talk to one or two people in your day to day life that you feel you can trust and you can come to when you feel, when you have these feelings that are distressing. So psychoeducation is a medical condition and be kind to yourself.

Wow. Well, Dr. Wiyatta, thank you for the best half hour of the conference. This was so much fun talking to you.

Thank you, Danielle. Thank you so much. It was great being here.

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates. These are provided as a source of general information and are not a substitute for consultation with a physician.