Overcoming Infertility

If 40 is the new 30, then 30 should be the new 20. However, most women’s biological clocks are still ticking to the same beat they did in the 1950s. And fellas, before you flip this page, fertility isn’t a slam-dunk for you either. No matter who has the physical challenge, both share the emotional one. Thankfully, reproductive medicine has come a long way.

Many of us are claiming an extra decade to focus on ourselves before we consider marriage and starting a family. This isn’t necessarily a bad thing—often this time is used to knock out grad school, fast track it up the corporate ladder, or become financially solvent. For the first time, more babies are being born to women over the age of 35 than to teenagers, according to the Pew Research Center in Washington, D.C. However, says Dr. Thomas Vaughn, founder and director of the Texas Fertility Center in Austin, “Patients read about women becoming pregnant at an older age and assume that they, too, will have no problems conceiving. Couples do not realize that fertility begins to decline when a woman is in her early thirties.” Thankfully, couples do have options when their biological clock is thumping.

A couple is considered to have fertility problems when they have been sexually active for one year without using any contraception and has been trying unsuccessfully to get pregnant. (It is recommended that couples seek help after six months of trying if the woman is over 35.) According to the Center for Disease Control and Prevention, the total percentage of affected women, including those who are unable to carry a baby to term, is pretty consistent across racial and ethnic groups. But when it comes to using alternative methods of conception, the roads begin to part.

Health scientists are still piecing together the reasons why more fertility- challenged African-Americans are not undergoing in vitro fertilization (IVF) or considering surrogacy or egg donation. Contrary to popular belief, preliminary studies indicate that money is not always the top deterrent. Religious beliefs and other factors often play a significant role.

For those trying to make it happen by any means necessary, there are options— and an exhaustive amount of material and research to sift through. The Watleysbelieved in miracles—and IVF proved to be theirs.

IVF: She’s a Good Egg

After their dream wedding in 2006, Shawna Watley, 37, and Matthew Watley, 33, were eager to start their family. However, after a year of unsuccessfully trying to conceive, Shawna’s ob-gyn informed the couple that fibroids and a shortage of viable eggs were the probable cause of their problem. “[A fertility specialist] told us that there was zero chance,” says Shawna, a senior lobbyist for the law firm Holland & Knight in Washington, D.C. “It was our choice to keep trying. Given our trust in God, we were willing to step forward in faith.”

In an effort to increase the amount of viable eggs, Matthew, a pastor at Reid Temple North A.M.E. Church in Silver Spring, Md., administered daily shots of fertility medication into Shawna’s stomach for about a month. After the first three-week cycle, viable eggs were produced but there was no pregnancy. They continued with the shots and on the next round, underwent artificial insemination: Matthew’s sperm was injected into Shawna’s uterus with the intention of fertilizing her egg. This also proved unsuccessful.

The couple then consulted an IVF specialist at the Columbia Fertility Associates in Maryland, where African-Americans make up about 50 percent of the clientele. The doctors wanted to start right away, but Shawna delayed the process for about three months. “I totally shut down,” she says. “I didn’t want to deal with it. I didn’t have the strength to reengage. I was emotionally, mentally, and physically drained. I just thought, Well, maybe it wasn’t meant for us to have a child.”

Matthew urged his wife to go back to the specialist. Shawna says her husband carried her through the first step of the process by starting the daily shot regimen again.

“Once Shawna began the fertility shots, she had to go to the doctor’s office every other day for blood work,” says Matthew, in order to determine whether she was producing eggs. But Shawna’s test results were not favorable.

“They stopped me mid-cycle, after two weeks,” she says, tearing up at the memory. “The doctor decided that I wasn’t [producing enough eggs] and didn’t think it would be wise to continue this particular cycle. I was devastated.” The side effects of fertility shots, the couple’s desire to fully understand the medical process, and the financial component (IVF cost the couple $12,000 per cycle) taxed the couple considerably.

Nevertheless, two weeks later the doctor and Matthew persuaded Shawna to begin the IVF process a second time. This time it looked good. Shawna had produced five viable eggs to be harvested and combined with Matthew’s sperm in the lab. Once formed, three of the embryos were placed in Shawna’s uterus. This resulted in a single implantation. “My emotions didn’t really show until we were informed that we were pregnant,” says Matthew. “I was more even-keeled to provide support for Shawna, this process certainly brought us closer as we learned to face our trials and triumphs together.”

After three years of trying, Shawna, at 40, delivered a healthy baby via C-section in the summer of 2010. “I call Alexandra Elizabeth my fighter. You can see it in her personality. She fought to get here.”

According to Dr. Vaughn, there is a steep decline in fertility after age 35. The chance of conceiving for a fertile couple in which the woman is older than 35 years of age is 20 percent per month. That chance drops to 5 to 10 percent by the time she reaches 40.

ICSI: Swimming Upstream

Unlike the Watleys, the Browns had youth on their side. Judith and Jason were married in 2002 when she was 25 and he was 24. After a year they started trying to conceive. However, Jason had been diagnosed with severe male factor infertility when he was 21 years old. “I have an extremely low sperm count,” says Jason. “Where some men may produce millions of sperm per ejaculation, I only made 25 to 40. There is no issue with mobility or morphology, meaning they move fine and are not defective in any way; there just aren't nearly enough to make it to the egg and [fertilize it].”

“Jason never hid from me that he had been told he would be unable to have children,” says Judith. “It didn’t really register with me what this meant until we started this process. I guess I assumed we would have our ‘miracle’ child and prove the doctors wrong.”

In 2004, Judith’s ob-gyn first recommended that they consult a physician at the Texas Fertility Center. “We had been trying for about a year, using ovulation kits,” says Jason, a chemical synthesis specialist. “That was not fun. We had to ‘build up’ my sperm count by abstaining, and then try to reproduce only during the times Judith was ovulating. Nothing sexy about that.”

Their first fertility appointment wasn’t sexy either. “Our doctor reviewed my reports from the urologist and told us that IVF with intracytoplasmic sperm injection (ICSI) was our only option for a child who we would both parent,” says Jason. ICSI refers to a procedure of injecting sperm directly into each egg. It is used with in vitro fertilization in situations where the sperm is not adequate to penetrate the egg on its own in the petri dish.

“The reproductive endocrinologist suggested we try donor sperm,” says Jason. “This was something that had never crossed our minds. Maybe we would consider it later, but we hadn't even tried with my sperm yet. This meeting scared us off completely. The process seemed so complicated and involved taking so many drugs, it just didn’t seem natural. Of course, Judith would take the brunt of the treatment, but did I really want her to have to go through all of that?”

The fact that the couple knew absolutely nothing about IVF, ICSI, or any infertility treatments made the entire process a nightmare. “We had both heard about test tube babies, but it was such a random, sci-fi-type concept that neither of us grasped what was involved.” The Browns decided to keep trying on their own. They were just getting started in their careers, making decent money, traveling, and enjoying their freedom. They figured, Maybe we aren’t ready.

Their attempts to conceive led to more frustration. “It didn’t consume our lives, but it was always there, hanging over us,” says Jason. “Judith just got tired of getting excited every time her cycle was late, only to be disappointed in the end.” She adds: “We had pretty much accepted that we could possibly grow old together, just the two of us.”

After three more years, Judith, an engineer, extensively researched infertility procedures so that she could understand the risks. Then she pushed to undergo the IVF with ICSI procedure, which in the end would cost about $20,000.

Judith responded well to the fertility medications. The doctor retrieved about 20 eggs. In the Browns’ case, Jason provided sperm on several occasions leading up to the egg retrieval to make sure there would be enough. The “backup” sperm was frozen and stored for potential future use. Once Judith’s eggs were retrieved, a needle was used to manually inject Jason’s sperm into each mature egg.

“After the ICSI, we waited for the eggs to fertilize,” says Jason. “I started to get excited, thinking about the possibility of being a father, something I never thought would happen.” So after years of coming around to this optimistic thinking, it was traumatic when the first round did not work for the Browns.

“This was one of the most miserable times in both of our lives,” says Jason. “Words just can’t describe the pain that we felt after this [unsuccessful] cycle. We blamed ourselves. We blamed the [reproductive endocrinologist]. Then we just felt sorry for ourselves. We tried to be strong for each other, not wanting to cry and mope around because it would just bring the other down. The only thing I could think about was comforting my wife. I felt that the burden was always on me. She could have children. I was the problem. Privately, I wished that we had never done it. The process was way worse than I thought it would be. I had to give Judith daily shots several times a day and watch her be miserable, and also deal with her mood changes without adding to the problem. I couldn’t understand how people did this.”

“I don’t think I ever blamed Jason, but I wish I could say that I never got upset about it during our journey,” Judith admits. “I wondered if I should have married him at all knowing how important having a family was to me. At the same time, I couldn’t make him feel inadequate for something he had no control over. I could never see him as ‘less,’ but it was difficult getting him to see that I didn’t blame him. I was just hurting for us both.”

Six months later, the couple tried a second time via a frozen embryo transfer (FET) using embryos from their original ICSI procedure. This process was significantly less stressful than the cycle where “fresh” embryos are used. Judith did not have to take nearly as many drugs, and Jason didn’t have to do anything but offer support. This resulted in the birth of their daughter in 2008.

“Imagine holding something that you believed you would never have. How do you describe that feeling? Blessed. Amazed,” says Jason, who believes that thisjourney kept him and his wife together.

Last summer, the Browns unsuccessfully tried another fresh IVF cycle (and did not freeze any embryos). In November, the couple tried again with the last frozen embryo from their original fresh cycle from which they conceived their daughter. “I’m now pregnant with our second child, due in late August,” says Judith. “This experience forced us to confront some serious issues very early on in our marriage. Now we’re much more than best friends, we’re life partners.”

Surrogacy: A Gracious Host

When Carla Long married her husband Herb in 2004 at the age of 39, it was no secret that they wanted to get pregnant immediately. What the couple didn’t know was that the fibroid surgery Carla had nearly five years earlier would stand in their way. “The scarring in my uterus, and the multiple fibroids that had grown back, made the risk of me trying to carry a baby very high,” says Carla, vice president of affiliate distribution for Si TV in New York City.

But they soldiered on after the crushing news came from one expert after another that Carla could not carry a baby. “I could possibly bleed to death if a baby could even attach to my uterus, which was highly unlikely. If we wanted to have a baby of our own, the only way was to use a surrogate.”

“It was tough,” says Herb, CEO of Capstone Risk Management in New York and Washington, D.C. “A few friends and family members volunteered to be surrogates but then dropped out at different points in the process for medical reasons or because they had a change of heart.” The Longs’ informal surrogacy process dragged on unsuccessfully for nearly two years. Then they sought professional help.

Diane Hinson, founder of Creative Family Connections (CFC), matched the Longs with an ideal surrogate. Although 50 percent of the surrogates at the CFC are African-American, the couple and the surrogate can be from completely diverse ethnicities. “There might be a black woman carrying for a white couple or vice versa. We always ask if either side has a preference. People are going to have a year together so we want them to be comfortable with each other,” says Hinson, a legal expert in the area of assisted reproductive technology.

There are two types of surrogacy: “traditional,” when the surrogate uses her own egg and carries the baby to term, and “gestational,” meaning the surrogate is only the carrier, as was the case with the Longs. Their surrogate carried their daughter Makana, the product of Carla’s egg and Herb’s sperm.

The extensive vetting process used to select a surrogate includes a psychological evaluation, and an interview to learn whether the candidate is willing to carry twins or triplets, and whether she is willing to terminate the pregnancy if there are congenital defects. “We cover the parade of ‘horribles,’” says Hinson, who notes that the surrogate must also be a mother herself before carrying a baby for a couple.

The Longs started with the same steps as the Watleys, which included Carla receiving fertility shots. “Simultaneously, our surrogate (who lived in Atlanta) took fertility drugs to get her uterus ready for the transfer,” explains Carla, now 46. “Next, my doctor retrieved my eggs and fertilized them with my husband’s sperm. Once this was complete we had four viable embryos. Two of them were transferred into the surrogate. We prayed for implantation to take place, and it did.

“When the delivery started it was like everything had come full circle,” says Carla, who talked or exchanged texts with her surrogate every day during their pregnancy. “I lost it and started crying and thanking my surrogate with all my heart. I had the entire delivery room in tears.”

“You may get all excited when the agency matches you with a surrogate, but it doesn’t always happen on the first transfer or with the first surrogate,” says Carla. “It’s an emotional roller coaster. When you finally get the right surrogate, the transfer takes place and you pray that the embryos implant. Once they implant, you pray that she doesn’t miscarry. Because you’re not doing this the natural way, the risks are always much higher. We didn’t breathe easy until after the first trimester with Makana.”

“Being supportive of your spouse is very important, but you should also deal with your own feelings,” says Herb, now 44. “One friend forced me to talk about it, which helped me deal with the issue more effectively with Carla. This experience has definitely made our marriage stronger.”

The Longs wanted a sibling for their daughter, so after Makana was conceived, they froze the remaining embryos. When Makana was 2 years old, they tried a transfer with another surrogate but it didn’t work. After the fourth try with a surrogate was unsuccessful, the Longs are now considering adoption. “Between being emotionally and financially drained, we just couldn’t do it anymore,” says Carla. The Longs had spent over a quarter million dollars in medical, legal, and other costs not covered by insurance. “You experience the same highs and lows as if you are trying to get pregnant the natural way.”

Friends, family and children have questioned Carla about her surrogacy process. In response, but mostly as a gift to her daughter, she wrote and published a children’s book, Why I’m So Special (AuthorHouse, 2010). “I wanted to tell my baby how she got here. When I started looking for [children’s] books about surrogacy, there weren’t any. So I decided to tell my own story,” says Carla.

Donor Eggs: The Gift oF a Lifetime

Most African-Americans who have undergone assisted reproductive treatments are not so forthright. We canvassed fertility clinics to find an African-American couple who would share their story about having a baby through egg donation, in which case a relative, friend, or stranger donates an egg, which is then fertilized with the intended father’s sperm, and the resulting embryo is transferred into the intended mother’s uterus. Not one black couple would agree to go on record, not even anonymously.

“I’d be surprised if you find anyone who is willing to be associated with that level of public disclosure,” says Dr. Thomas Butler, of the Columbia Fertility Associates, who worked closely with the Nobel Peace Prize–winning team who produced the first IVF baby in the U.S. “People don’t even want to disclose to friends, colleagues, or even to doctors or the child that they [conceived] by IVF, much less with a donor egg,” adds Dr. Butler.

“Some men and women have concerns about bonding with a baby that is not genetically linked to the intended mother,” says Corey Whelan, program director at the American Fertility Association. “Those considering using an egg donor should ask themselves, ‘What can I pass down to my child if it is not my genetic heritage.’ Think about the things that make you uniquely you. Is it the color of your eyes? Your passion for sports? Think about the things that currently bond your family together. Is it your shared experiences, your shared genetic traits, or both things?”

“The chance of conceiving with the use of donor [eggs] is usually always higher than patients undergoing IVF because the eggs not only come from young donors, but the women donating are not patients struggling to become pregnant.” says Dr. Vaughn.

“There are many reasons why some couples transition from IVF to a donor egg IVF cycle,” says Whelan. “Funds may start to run out after going through three or more cycles of IVF without success.” Others may not have any viable eggs.

Regina Townsend, 28, is the executive director of The Broken Brown Egg, Inc., a Chicago-based nonprofit organization that raises awareness about infertility and reproductive health in African-American women. Her advocacy group first started as a blog about a year ago as a vehicle to address her feelings about being infertile. Townsend has hypothyroidism, in which her underactive thyroid doesn’t produce the requisite amount of hormones, and Polycystic Ovary Syndrome (enlarged ovaries with cysts), both of which cause her to be infertile. “My focus is on African-American women because I didn’t see any blogs or groups representing them. We weren’t talking about infertility,” says Townsend who has been married for five years and wants to start a family.

“The biggest hurdle in our community is that African-Americans tend to suffer in silence, not realizing that this makes our fight even harder,” she says. Weigh your options and discuss your family plans with your mate. Knowledge and conversation can go a long way.

Special thanks to everyone who participated in this article, Dr. Tanise Edwards in Great Falls, Va., and Dr. Elan Simckes of the Fertility Partnership in St. Louis, Mo.