Black Maternal Health Week: Equity on Path to Pregnancy

Irine Lagat-Fischer always knew she wanted a family. Originally from Kenya, she was one of 10 children and recalls her large, close-knit circle of relatives was the center of her world.

But when the former collegiate long-distance runner struggled to conceive, she didn't expect the journey to motherhood to become a grueling marathon.

"I was in my early 30s, and we'd been trying for about two years," said Lagat-Fischer, a nurse in Tucson, Arizona. "I started thinking that something was not right and that we needed help."

Rather than finding help, she said she endured two years of shuttling from one specialist to another, with visits to several OB-GYNs and fertility specialists who immediately wanted to start costly in vitro fertilization (IVF).

One physician erroneously told Lagat-Fischer that she had endometriosis. Another doctor told her that she had benign uterine fibroid tumors, a more common condition among Black women that often leads to higher rates of fertility issues. She later found out that her fibroids were small and not the cause of the couple's fertility challenges.

"It was frustrating and discouraging. My husband and I are both healthcare professionals, and we felt the care we received was all over the map. I didn't feel like our difficulty conceiving was being fully assessed, and there was never a deeper conversation about what might be causing it in my individual case," Lagat-Fischer said.

Her experience as a Black woman seeking fertility care is common, according to recent studies.

Difficulty conceiving among Black women and men has been understudied. But research published inFertility & Sterility found that Black women in the U.S. are significantly less likely to seek or receive a fertility evaluation or treatment compared with white women. Despite having a higher or equivalent prevalence of infertility, Black women appear to face barriers that result in delayed care and lower utilization of services.

Lagat-Fischer also noticed that when her husband, Keith, who is white, started accompanying her to every visit, whether he was having tests or not, there was more focused attention from the specialists. When her husband asked the questions, she felt the information they were given was clearer and more direct.

"I felt like I was being heard differently when he was there," she said. "That was very difficult for me to experience, and the emotional toll was significant. There were times I would be driving and just crying."

The emotional toll their fertility journey was taking on his wife was very difficult for Irine's husband.

"We struggled to conceive, which was stressful," said Keith Fischer, a physical therapist. "Then, when we sought help, we were met with incomplete answers, a lack of attention to our needs and poor guidance from the medical experts."

"It was hard to navigate a situation where you have a partner that is sad, frustrated and fearing she'll never have a family. It was gut-wrenching for me," Fischer said.

After two years of frustration and $20,000 of unsuccessful IVF attempts, a friend in Arizona suggested the couple go to Los Angeles to seek fertility care at Cedars-Sinai.

"Even though Irine had already been through IVF, I took a step back and tried to evaluate from the beginning, with a fresh perspective. Every couple deserves an individualized plan that is tailored to their specific health needs," said Jessica Chan, MD, a reproductive endocrinologist and clinic director of the Fertility and Reproductive Medicine Center at Cedars-Sinai.

Chan said that after reviewing all of their testing, she recommended they try a less invasive option before returning to IVF. After discussing the options, the Fischers and Chan agreed upon a treatment plan.

"When we came to Cedars-Sinai, it was a completely different experience. From the moment we walked into the clinic, I felt like someone was really listening and taking the time to understand the full picture," Lagat-Fischer said. "Two weeks after treatment, I found out I was pregnant. I honestly couldn't believe it after everything we had been through."

Does Chan believe racial bias can play a role in the kind of fertility evaluation and treatment a patient might receive?

"Communication and building trust between the doctor and the patient are critical in the fertility care process, as is a thorough understanding of a patient's medical and social history," Chan said. "But we know that implicit bias is also a significant factor that can lead to disparities in care and outcomes."

It was a very long journey, but the couple says that their now 3-year-old twins, Lily and Liam, were well worth the difficulties they had.

"I would go through that journey again to have my children. It was all worth it," Lagat-Fischer said. "My advice to other Black women is to advocate for yourself. Ask questions, seek thorough answers, and if you feel like you're not being heard, get care somewhere else."

Read more from Cedars-Sinai Stories and Insights: How Cedars-Sinai Is Working to Improve Black Maternal Health