Q&A: The experiences of Black women seeking infertility treatment
May 22, 2025
To raise the U.S. birth rate, the Trump administration is considering policies to increase access to in vitro fertilization (IVF) and other reproductive treatments. Among the proposals being floated are requiring insurers to cover IVF and lowering the cost of fertility medications.
For women of color, a major barrier to receiving high-quality infertility treatment is the lack of diversity within the health care workforce and stereotypes around reproduction that are perpetuated by that lack of diversity. Yet, the administration is dismantling initiatives that would lead to a more diverse health workforce and greater understanding of health disparities.
Research has shown that Black women are more likely to experience delays in receiving a diagnosis of infertility and appropriate fertility counseling even though they are more likely to experience infertility than women of other races. When they do receive treatment, they are less likely to go on to a live birth.
Isabel Morgan, a postdoctoral fellow at Morehouse School of Medicine, researches maternal health and is the lead author of “Mapping fertility trajectories: An endarkened narrative inquiry of Black women’s fertility experiences and pathways through infertility treatment,” which was published recently in the journal Social Science & Medicine.
Morgan spoke with Woman Child Health about the findings of her study, in which 41 Black women were interviewed about their experiences with infertility. She also discussed how policy change and community initiatives can support Black women as they navigate the financial and emotional challenges that come with infertility. This interview has been edited and condensed.
Woman Child Health: Can you talk about how you became interested in studying infertility among Black women?
Morgan: I'd been doing research in Black maternal and reproductive health for several years, and it was focused on postpartum care initially and then maternal mortality. It wasn't until I was the director of the Birth Equity Research Scholars Program at the National Birth Equity Collaborative. My boss, Dr. Joia Crear-Perry, was invited to speak at the African Population Conference in Uganda that year, and they wanted her to talk about Black fertility.
I did not know about the inequities in infertility. And so that really is what piqued my interest. I didn't know that [Black women] were more likely to experience infertility. I didn't know that, when we leveraged the same treatment, less likely to have success. And so that really was intriguing to me, and disturbing.
I also, since 2017, have been a collaborator with Black Mamas Matter Alliance. I was in other reproductive justice spaces, and we weren't talking about infertility.
WCH: I know this next question is very heavy, but I felt like we needed it to frame the conversation. Can you talk about how our country's history of slavery and medical coercion is still shaping the experiences that Black women are having today with the health care system?
Morgan: Absolutely.
The history of Black women's bodies [is of] being commodified, being used for the labor market for this country. I think what it did for Black women and Black people — in everyone, really — is create this stereotype about our fertility and about our reproduction, and it also plays into stereotypes around promiscuity, hyper-sexuality, hyper-fertility. And so part of the challenge is that we still have these stereotypes that impact how we think about our fertility, so having a lack of knowledge and understanding around the fact that Black people do experience fertility challenges. In fact, the data show that we're more likely to experience fertility challenges.
There’s data that show that providers also have those stereotypes, and so we have these challenges where primary care providers are not referring Black patients as often to the reproductive medicine specialists, and that's, in part, because of the stereotypes that they think of white women as the prototype, or the folks who are experiencing infertility.
It delays us from accessing the care that we need, and then it prolongs the trauma and the isolation that people experience when they're trying to conceive or when they conceive but they're not carrying the pregnancies to term.
WCH: What are some of the main barriers for the women who are wanting to seek infertility treatment?
Isabel: The main barrier is cost, the out-of-pocket expenses, and so that was something that surprised me, because this was a fairly well-resourced group of women. Many had health insurance with at least some coverage of fertility. But as I'm sure you're aware, the health insurance is not covering all the costs. It's typically covering, yes, the procedure once you meet a certain threshold or certain criteria that you've demonstrated you have infertility, but it's not covering medication. It's not covering the donor gametes, if you're using donor eggs or sperm or embryos. It's not covering pre-implantation genetic screening. So there's ancillary costs that people in the study struggled with meeting and that prevented them from either initiating treatment or continuing in treatment after one cycle.
Some of the other challenges that the participants described is experiencing discrimination and racism, and that would show up, again, in the form of not being referred to a reproductive medicine specialist, or assumptions being made about them during the process or not receiving compassionate care.
WCH: How does the diversity of our workforce shape the experience that women will have? I feel like this is a major concern right now because we know that a lot of things are changing in terms of who's going to be entering the health workforce and how we're selecting people for the health workforce.
Morgan: We know from data that only 3 percent of reproductive endocrinologists are Black. How many are people of color? It's probably less than 10 percent, so that's a challenge when people don't see themselves in their providers, when they don't feel like they have that cultural connection to their providers, or they feel like they have to explain themselves, or they're walking on eggshells. That's a huge concern.
Thinking more broadly about the larger staff, who are the embryologists? Who are the clinic coordinators?
It's mostly white people, and so Black women describe not feeling welcomed within those spaces when it came to providers. It's also very isolating, as the patients describe, being the only Black person navigating through the clinic spaces, so that also doesn't make them feel welcomed — or seeing materials that don't reflect their family dynamics.
We did have a couple of participants who identified as queer or lesbian or bisexual, and they also described experiences that were uncomfortable, disrespectful, and assumptions being made about who their partners were, or assumptions being made that they had a partner.
People not having the training on how to provide care to folks who are queer, who have variations in their family dynamics, that was also a challenging experience for some of the participants.
WCH: From a policy perspective, how can we improve both the access for Black women to infertility treatment and the quality of care they’re receiving?
Morgan: In this climate, it's challenging, but we're still making strides in certain spaces. In terms of policy — state and federal level — we really need comprehensive fertility coverage.
We can't just cover the procedure. We really need to be covering the medication, the gametes, the screening, those ancillary costs. And we need to be doing that for not only private insurance, but for public insurance, so Medicaid. There are only two or three states that have Medicaid covering basic fertility evaluation and ovulation-enhancing medication.
Studies have shown, even in states that have mandated insurance coverage for fertility services, we still see inequities in utilization, and I think part of that is this ancillary cost. My own personal experience with seeking out fertility preservation services: I was like, ‘Okay, this is something that I can do. Let me look into it.’
The cost of the actual procedure was about $5,000. I said, ‘Okay, I can save for that. I can manage that.’ And then going into the clinic, doing my AMH [Anti-Mullerian hormone] test, doing my antral follicle count, getting the invoice quote, and it being $10,000 because the medication was $5,000. Then it's inaccessible for me.
When we know, too, that Black women are less likely to have success with these — IUI, IVF — then we are more likely to have to do multiple rounds. So that's even more expensive for us.
And then I also think about facility-level protocols. If someone experiences a pregnancy loss, how is that clinic supporting them? If someone is experiencing grief, which a lot of people do, what are the mental health practitioners that are in their network or that folks are referred to?
WCH: Within communities, how can we better support women experiencing infertility?
Morgan: I think support groups are phenomenal. People reference those in the study as places, certainly, of support, particularly when they were more diverse, where they felt like they could connect with other Black women that were in those groups.
I think we do need societal shifts, and we've already seen it around Mother's Day. I love how people are acknowledging it's not a happy day for everyone, whether you lost your mother and you're navigating that, whether you want to be a mother and you're grieving the experience of pregnancy loss.
I think in maternal health and reproductive justice spaces, acknowledging the experiences of people who are navigating fertility challenges, have family building needs, experience pregnancy loss, recognizing that many of these experiences are co-occurring. People who experience abortion earlier in life might be the same people who experience infertility; they might be the same people who experience a pregnancy loss.
I think in religious communities, the ministries that they have instituting campaigns or initiatives, conversations that are supportive for people that are navigating fertility challenges.
WCH: Are there any other points that we haven’t covered that you would like to talk about?
Morgan: This was a high-income sample of folks. They were people who basically had access to reproductive health care throughout their lives, and they used it, so it was very alarming that many of them described grief and anguish around delayed or misdiagnosis of reproductive health conditions. It is very alarming that when they were trying to get pregnant or when they experienced a pregnancy loss was when they were diagnosed with PCOS [polycystic ovarian syndrome], or when they found out they had fibroids, or when they were diagnosed with endometriosis. [Other research indicates] it has taken people 10 years to receive a diagnosis, on average.
It's also alarming to think about — and I see this conversation shifting — how people have symptoms early on in their reproductive lives and adolescence. A lot of us are put on birth control. A lot of us are put on hormonal contraception. And I think that, as someone who experienced that, it was great for managing my symptoms, to a degree, but it masked the underlying issues.
I think another challenge is the primary care providers that people are seeing, and their lack of training or understanding about reproductive medicine, which, it's understandable, but it's a challenge where someone is diagnosed with fibroids and they're told ‘That's fine. It's fine where it is.’ Then they get to the reproductive medicine specialist, who says, ‘Actually, no, that's most likely where your embryos will implant.’
You know, that is something that we need to be addressing. How are the family medicine doctors being trained to provide people with adequate information? If they don't offer basic fertility evaluation, how are they referring folks? We focus on preventing pregnancy in adolescence, but we also have to be asking questions about what people's fertility desires are earlier and help them manage expectations and take that control of their reproductive health.