Having just had a number of patients with fibroids as their major cause of infertility, it’s the perfect time to talk about this frustrating and widespread problem.

First, we really do not have an accepted theory as to why or how fibroids come about. We know that they are more common in certain races (for example, as many as 40 percent of African-American women have fibroids) and can run in families, so there is most surely a genetic component. But while the researchers try to figure all that out, we practitioners are stuck with what to do about them. The answer lies in what the person with fibroids is experiencing and what she desires regarding her fertility. 

Fibroids are often present with no obvious symptoms, or the symptoms can be so severe they feel as if they are ruining one's life. They can cause heavy menstrual flow and clots, and consequently severe anemia. They also can put pressure on surrounding organs like the bladder, causing a frequent urge to urinate. A fibroid can grow so big that it outgrows its own blood supply and cause severe pain as ischemia ( lack of oxygen) will do – similar to a heart attack. 

With regards to pregnancy, fibroids can prevent an embryo from attaching and implanting in the wall of the uterus and also be a cause of recurrent miscarriages. As fibroids may grow during pregnancy, they can put a pregnancy at risk in its later stages by causing premature labor or even incompetence of the uterus.

Fibroids are classified by where they are attached to the uterus. From the inside out, they can be: 

• Submucosal - under the endometrium or lining, often extending into the cavity (think of a boulder emerging from your lawn). Submucosal fibroids will cause increased bleeding, a failure to implant or even miscarriages. 

• Intramural - in the wall of the uterus. These fibroids often cause no symptoms but can cause bleeding if close to the cavity/lining and can cause increased menstrual cramping. They also can become quite large and cause pressure or abdominal swelling. I have seen intramural fibroids compress the fallopian tube as it travels through the wall out to the ovary, possibly blocking transport of sperm and embryos.

• Subserosal - these are on the outside of the uterus and are also often without symptoms, but they can cause pressure on the bladder and abdominal swelling. Also if positioned near the side (i.e. the tubes and ovaries), they could interfere with the transport of the egg to the tube by pushing them apart.

• Pedunculated - (I know what you're thinking...Pe-what?) this means the fibroid is hanging on a stalk – think of a  mushroom. These fibroids are different in that they are at risk for twisting around on their own stalk, cutting off the blood supply and possibly causing acute pain - what I call "a fibroid attack." These fibroids can get quite big and can also displace tubes and ovaries, causing infertility. 

When you are attempting conception, and pregnancy is not happening easily, why not always start by removing fibroids? Fibroid removal is called "myomectomy."  We think carefully before moving forward with myomectomy because the surgery can cause new problems, including scar tissue and new "plumbing issues," so we must be convinced the fibroids are an issue before moving forward to surgery.

So how should you manage fibroids? Part 2 of my blog post, coming Sept. 1, will outline what you and your doctor need to do to manage your fibroids and - if at all possible - preserve your fertility.

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Why would a fertility clinic talk about Black History Month? For Fertility Partnership, the question is “why wouldn’t we?”

From the beginning, we’ve been focused on increasing access to infertility care for everyone regardless of ethnicity, gender or socioeconomic status. We know that African-Americans are 1.5 times more likely to struggle with infertility, and we also know that they are less likely to reach out for medical care to help with infertility.

We’ve written before about the reasons for this disparity, and some of the suspected reasons directly relate to the historical experiences people of color have had with the health care system. Whatever the reason, the health care industry – and fertility care providers in particular – need to be doing everything possible to overcome the problems of the past and reach out to African-Americans in a quest for better health care for all. Fertility Partnership is focused on leading that charge and doing all we can to help raise awareness and spur action, care and healing.

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(Note: We welcome Fertility Partnership Executive Director Andria Simckes as a guest blogger.)

As Fertility Partnership grows its practice and continues to reach out to people of all ethnicities, we find ourselves battling some deeply held fears and beliefs about infertility in the African-American community. This is personally frustrating to me, because one of my key goals with helping my husband start Fertility Partnership was to lower the infertility rate among people of color. While overall, approximately one in seven couples experience infertility, the rate is 1.5 times higher in the African-American community, and that’s not acceptable to me.

Unfortunately, historical experience makes it hard for African-Americans to ask for help, or to even trust help that’s offered, for such a personal issue. According to psychologist Dr. Marva M. Robinson, utilization statistics clearly show that African-Americans often only seek medical help in the event of an emergency. This is probably due to a long-held distrust of the medical establishment after historical abuses such as the Tuskegee research project and the experience of Henrietta Lacks.

Additionally, we as a community don’t want to talk about infertility because we don’t want to “admit” that we as women are “broken” or that our men are “less of a man.” I understand the sentiment, but if we want to find real answers to the health problems that we face, we have to move past this. This secrecy is causing an immense amount of pain – both physical and emotional – and holding us back from finding real answers.

I’m focused on working to find solutions to these problems and helping African-Americans throw off the shame of infertility to get the help our community needs, but I need your input to help make real progress. I’d love to hear your thoughts and ideas about this issue, either in the comments section of this blog post or by emailing me directly at adsimckes@fertilitypartnership.com. Let’s work together to reduce the soaring infertility rate in the African-American community.

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(Note: We welcome Fertility Partnership Executive Director Andria Simckes in writing her first guest post for Dr. Simckes' blog.)

Misperceptions are sometimes hurtful, occasionally dangerous, and often get in the way of getting what we really want in our lives. The misperceptions about African-Americans and infertility are a perfect case in point.

For example, it’s a common perception that black women are incredibly fertile. They couldn’t possibly have problems with infertility, right? Wrong. In fact, according to RESOLVE, the infertility rate among African-Americans is nearly 1.5 times higher than other races. Unfortunately, that’s a statistic that very few people, especially black women, know. As a result, they suffer in silence when they can’t conceive, believing – even more so than other ethnic groups – that they’re all alone in their infertility.

And what about black men? That infertility rate statistic includes them, too, but that’s an even more taboo topic than black female infertility. Black men are supposed to be virile and sexually powerful – they couldn’t possibly have infertility problems, could they? Yes, they can. About one-third of the time when couples are struggling with infertility, the problem lies with the man, no matter the ethnicity. But again, how many black men haven’t even taken a simple, relatively inexpensive test to see if there is a problem, simply because of the misperception?

As African-Americans, we need to take the lead in doing everything we can to shake off these harmful misperceptions about our fertility. We need to demand more medical studies to fully understand why African-Americans suffer from infertility in such inflated numbers – current research is woefully inadequate and doesn’t give doctors enough information on which to base effective treatment protocols. We need to do all we can to spread the word about the sheer prevalence of infertility in our communities, and share the good news that – in many cases – help is out there.

Finally, we need to strip the stigma away from infertility. If you are black and battling infertility, you are not alone. You do not need to hide it. You do not need to just hope it will go away. Doctors like my husband and clinics like Fertility Partnership are out there ready to help with compassion and understanding.  Support is available through websites like The Broken Brown Egg. Let’s crush these misperceptions and turn the lights on a situation that’s been hiding in the dark for far too long.

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When I first began thinking about opening Fertility Partnership back in 2007, I knew I wanted to do things a little differently than many other fertility clinics in the U.S. I wanted to create a refuge for people stuck in the nightmare of infertility, and I wanted to make that refuge available to as many people as possible, regardless of their ethnic, cultural or economic backgrounds.

Why? Because I’d tried to comfort too many sobbing patients over the years who needed fertility treatments and couldn’t afford them. Because I’d seen too many patients mortgage their homes, take leave from their jobs, and leave the comfort of their extended families to travel abroad and get more affordable IVF in other countries. Because I knew in many cases fertility medicine had the tools to help, but not the cultural sensitivities or the compassion for the unique issues faced by minority patients.

It took a few years, but I’m grateful to everyone who helped transform Fertility Partnership from a thought into reality. Today, after nearly nine months in business (a meaningful amount of time for doctors like me!), Fertility Partnership is honored to care for women and men from all ethnic, cultural and economic backgrounds. Whether a celebrity or an “Average Joe” from the heartland, our compassion and our determination to provide the highest quality care at the most affordable price possible remains the same.

Along the way, we’ve run into our fair share of detractors and naysayers – people both in and out of the fertility care industry who said it couldn’t be done. Interestingly, I’ve found that the people who’ve protested the loudest are those who most strongly wish to keep the status quo in the fertility industry. I don’t, because I know we can do better for our patients – in terms of both quality and cost. Fertility Partnership is living proof of that, and I’m grateful to all the patients who have given us the opportunity to put our philosophy into highly successful action. I hope the entire fertility care industry will join us in continuing to work to increase access to fertility care for everyone, regardless of ethnicity, culture or economic status.

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