One factor in whether a couple can conceive, and carry, is the lifestyle they lead and the impact it has on their bodies.
For the most part, African American women who go to a fertility clinic weigh more than other patients, and have a higher Body Mass Index, or BMI. Below is data from one study on these weight disparities, and most other studies reflect a similar pattern.
BMI is a formula to identify how much weight someone has on their body once we correct for their height. The method to calculate BMI is below. BMI doesn’t take into account bone density or ethnicity, but having a BMI on the high end of the range, say approaching 30 or 40, is clearly an issue.
For women trying to conceive naturally, a higher BMI correlates with a lower likelihood of success.
And this is true for men (unless they are severely underweight) as well as for women, as you can see below.
And if a woman, or couple, decide to do IVF, being too light or too heavy correlates with lower live birth rates for nearly all patients, as you can see here.
If you’re trying to get pregnant and your BMI is at the extremes, it’s important to talk to your doctor about realistic goals you can set to get pregnant quickly and safely.
For some women, delaying treatment to lose weight can be of real help (one example is women with Polycystic Ovarian Syndrome) but for others, especially for women approaching their 40’s, delaying treatment to lose weight can actually reduce their odds of success.
Furthermore, a woman’s weight will impact the safety of her pregnancy and the health of her children. One example of this would be pre-eclampsia, which can be dangerous or even fatal for the mother and fetus.
Here you can see the clear correlation between a woman’s rising BMI and her increased risk of developing pre-eclampsia.
On FertilityIQ, you’ll find a detailed course covering most major lifestyle factors and how they’re related to conceiving. For the moment we’ll just briefly touch on diet.
First, diets that incorporate more whole grains, vegetables & fish, like the Medittaranean diet, correlate with higher pregnancy rates for women trying to conceive naturally, as you can see below.
That’s also true for women who undergo IVF, with relative success rates nearly 40% higher for those who adhere to a Meditteranean-like diet.
On the other hand, consuming higher amounts of fast food and fried food often correlate with lower rates of success. That’s true for women trying to conceive naturally or in treatment.
Another issue that tends to disproportionately impact African American fertility patients is what’s known as a “tubal factor.” Below are three studies that compare the prevalence of tubal factor issues amongst fertility patients by race. While the definitions of “tubal factor” varied between the studies, in each one, African American women had meaningfully higher rates.
As you may remember from the first lesson on human reproduction (and can see in the diagram below), most women have two ovaries and each ovary has a fallopian tube connecting it to the uterus. If those fallopian tubes are scarred or blocked, it will make it difficult or impossible for the sperm and egg to meet, or for an embryo to reach the uterus.
Tubal factor issues can be caused by any number of issues, including sexually transmitted diseases like chlamydia or gonorrhea. When left untreated, each can cause damage within the uterus and fallopian tubes.
If both fallopian tubes are blocked, IUI is not a viable treatment option — conception still won’t be possible with anything other than IVF.
If only one fallopian tube is blocked, artificial insemination, or IUI, can work. That said, the odds of success really depend upon where the blockage occurs.
If the blockage is found closer to the uterus, what’s known as proximally, after three IUIs, 36% of women will get pregnant. If the blockage is seen closer to the ovary, or distally, after three IUIs, success rates are closer to 12%.
IVF has the benefit of bypassing the fallopian tubes because eggs are surgically removed directly from the ovary, fertilized outside of the body & then placed back into the uterus. In effect, IVF takes blocked fallopian tubes out of the equation.
Success rates for women with tubal factor issues are similar to most other IVF patients. As you can see below, for women under age 35, about 40 - 45% of IVF cycles lead to a birth. However, with every passing 2 year interval, the odds of success drop by about 10 percentage points so that by the time a tubal factor patient reaches her early 40’s per cycle success rates approach single digits.
If the fallopian tubes aren’t just blocked, but they’re also filled with liquid, your doctor may refer to this as a hydrosalpinx. As you can see here, when doctors remove the damaged tube, or tubes, IVF success rates can sky-rocket.
A uterine fibroid is a tissue growth in the uterus, and it can also be referred to as a “leiomyoma” or “myoma.” While the term “growth” can be off-putting, fibroids almost never become cancerous.
As you can see below, not only are African American women more likely to develop fibroids than Caucasian women, the majority of African American women have at least one fibroid by the time they reach their reproductive years.
As you can see in both studies below, African American fertility patients are more likely (than Caucasian women) to have their fertility challenges attributed to a fibroid.
For some women, fibroids can be painful or cause heavy bleeding. In this case, surgical treatment can dramatically reduce symptom severity, as you can see from the study below (conducted on over 300 women, half of whom were African American).
From a fertility standpoint, the data is hard to interpret on how treating a uterine fibroid improves a woman’s ability to conceive. The issue likely comes down to where the fibroid resides.
There is “fair” evidence that if a fibroid distorts the uterine cavity (often referred to as being “submucosal or intramural with a submucosal component”), removing it through hysteroscopic myomectomy improves pregnancy rates. Fibroids that distort the shape of the uterine cavity are an issue because they interfere with an embryo’s ability to attach to the uterine wall which, as you’ll recall from the lesson on human reproduction, is the fifth requirement for a woman to conceive.
However, if a fibroid doesn’t appear to distort the uterine cavity, the evidence is less convincing that it impairs fertility or that removing it improves the odds of success.
Removing a fibroid is a surgical procedure (though some approaches are more invasive than others), and any surgical procedure on the uterus has to be taken seriously. Removing a fibroid can cause scarring to the uterus and create further fertility challenges. It can also weaken the walls of the uterus, committing the woman to a C-section or early delivery, which in-and-of-itself has issues for the offspring.
In this lesson we cover high-level subjects (e.g. the basics of reproduction) and break down specific issues that pertain to African American patients namely, higher rates of infertility, inadequate referral patterns, variation in IVF success rates, tubal factor, fibroids, miscarriage, lifestyle factors and more