Danielle Wade became well-known on Instagram for her posts about fashion and beauty products, but in the past four years, her feed has evolved after experiencing infertility.

“I found it to be very helpful and very therapeutic, actually, just talking about it because hiding that part of my life and just posting these beautiful photos in beautiful clothes and perfect makeup just didn't seem as genuine when I was struggling going through this process of trying to conceive,” Wade said.

Now, the lifestyle blogger and content creator says she's known as a woman who helps other women thrive during infertility.

“I've learned more people in my personal life have gone through infertility because I started talking about it,” Wade said.

Wade says she quickly realized there weren’t many other women who look like her being open about infertility. She wanted other Black women trying to conceive to know they’re not alone.

“Black women tend to report infertility issues at a higher rate than white women or non-Hispanic women," Wade said. "However, they're also the least likely to be able to access the care and treatment that they require to support and assist them in that process of going from having infertility to actually being able to successfully get pregnant.”

Dr. Yashica Robinson is an OBGYN and the owner of Alabama Women’s Wellness Center. She says there are many reasons disparities exist for Black women facing infertility.

“People of color are experiencing fertility at two-times the rate of their white counterparts,” Dr. Robinson said.

“The environmental stressors we know that plays a significant role in how our bodies function and our ability to carry our pregnancies to term," Dr. Robinson said. "Other contributing factors would be pre-existing medical conditions, obesity, hypertension, diabetes and our ability to access health care and optimize these health conditions prior to pregnancy.”

Infertility treatments are also very expensive, making them difficult to access.

“For those of us who don't have private insurance and we obtain our insurance through the government, then it doesn't cover those treatments at all,” Dr. Robinson said.

Dr. Robinson says physicians won’t even offer treatment as an option if they don’t feel it’s accessible to the patient. She says that assumption is sometimes made just through racial biases.

Lilly Marcelin is the founder and executive director of Resilient Sisterhood Project. It's an education and advocacy nonprofit that aims to empower women of African descent regarding common, but rarely discussed, diseases of the reproductive system that disproportionately affect them.

“So if you go on our website you’ll find a lot of well-researched information about complications with fibroids, endometriosis, polycystic ovarian syndrome, breast cancer, cervical cancer,” Marcelin said.

She says she felt inspired to create the nonprofit after talking with many Black women about their experience with reproductive health issues and attempts to seek care.

“Some of them revealed to me that as soon as they stepped in, just the way that they were received or looked at, they felt that somehow there was an assumption about can they afford to pay,” Marcelin said.

That reason is why Wade searched for a Black physician.

“I actually was specifically trying to find a Black fertility doctor, male or female, just kind of wanted to see if I could get connected with someone who looked like me, maybe better understood my health history and what specific experiences I was having in this process, dealing with health care, dealing with infertility," Wade said. "And I had no luck with that.”

Wade is currently in her first round of in-vitro fertilization. It’s the next step for her after four years of trying other methods. She plans to continue being transparent with her Instagram followers about her exhausting journey of trying to conceive.

“I want to be normal to talk about loss when it comes to infertility and miscarriages and stillbirths," Wade said. "I want it to be normal to talk about all the creative ways you have available to you to have babies. I want it to be normal for all insurances to cover all infertility treatment.”
 

Dr. Christina Yannetsos' patient was about her age, 38, and extremely sick with COVID-19.

"I remember having a conversation with her kids who were probably anywhere from 10 to teenagers, and them asking me if their mom was going to die," Yannetsos, an emergency medicine physician at the University of Colorado Hospital, recalled. "It was one of the most difficult things to have that conversation while I was also trying to build a family myself."

Yannetsos got married when she was 34 and tried to have a baby for a year but couldn't.

In March of last year, she was scheduled to do in vitro fertilization, but her procedure was canceled because of the pandemic.

COVID-19 got in the way again eight months later when she was scheduled to have an embryo transfer.

"We did our pre-transfer COVID test, which came back positive. The day before the transfer. So, I was heartbroken," she said. "It made me feeling sick a little bit more miserable, waiting to feel better and be able to be a candidate again for an embryo transfer and a chance at a family."

A tough situation worse

Since female physicians are training during their prime reproductive years, infertility is not an uncommon problem. In the U.S., infertility affects an estimated 1 in 8 women, but for female doctors, it's 1 in 4.

The pandemic has made a tough situation worse.

"Physicians who have taken on the physical and emotional burden on the front lines caring for patients throughout the pandemic, who are also struggling from infertility, are facing compounded challenges and stressors," Dr. Erica Kaye, a pediatric oncologist at St. Jude Children's Research Hospital in Memphis, said.

Last year, writing in the New England Journal of Medicine, Kaye shared her experience with repeated infertility treatments, and how she "grieved the loss of five desperately wanted pregnancies." When the pandemic started, she was hoping to do another round of egg retrieval, but no new workups were being done.

Dr. Soha Patel, a high-risk obstetrician at Vanderbilt University Medical Center, was planning to undergo a cycle of IVF treatment when COVID-19 patients started arriving at her hospital.

"We started wearing masks that were mandated while I was going to get ultrasounds and still doing the four-times-a-day injections," she recalled.

Patel was taking care of women with high-risk pregnancies, and there was a lot unknown about the coronavirus.

"It's terrifying from a professional level because you don't know how to counsel patients, and you're not sure how this will affect their babies," she said. "But at the same time, I was terrified for myself as well, to contract something that could potentially affect my infertility treatments."

Because of the virus, Patel had to attend procedures by herself, without her husband.

"He was not able to attend a lot of my ultrasound appointments. In fact, he wasn't able to attend any of them," Patel said. "He wasn't able to attend any of the retrieval procedures, as well. And so, while I was going through that process, he was actually in the garage, waiting in the car."

His absence made a lonely process even lonelier.

"I think what people don't understand is that this process can be very isolating. It can be very lonely for women," Patel said.

Patel has had a successful IVF cycle and is now moving on to the next stage in the embryo transfer process.

Yannetsos recovered from COVID-19 and finally got pregnant through IVF. Her twins are due in December. As someone still taking care of COVID-19 patients, she said the anxiety does not stop.

"Patients who are pregnant have an increased risk of getting severe COVID," she said. "I think that once they are born, I will feel much better about the situation."

Infertility in female doctors

It's not clear why infertility disproportionately impacts female physicians.

"There is a paucity of research literature," Kaye said. "We know that it is a significant problem and a problem that, until very recently, few people were talking about."

Medical training is incredibly intense and generally overlaps with prime fertility years in the mid-20s and early 30s. Many women training for various positions are working long and strenuous hours.

"There's an enormous amount of stress during that decade of medical training. There's a lot of sleeplessness and disruption of circadian rhythm," Kaye said.

Kaye went through a pediatrics residency and two sub-specialty fellowships for more than a decade. She would often be awake for 30 hours or more at a stretch taking care of critically ill patients.

"I suspect that that, at least for some women, plays a role in the struggles with fertility and pregnancy loss, but a lot more research needs to be done," she said.

The arduous training can also make it difficult for women to meet a partner they want to have children with until they are older.

"In residency I would spend rotations just five weeks of night calls," Patel said. "It's very difficult to sustain or even start a relationship. You go out with someone, and you can say, 'I'll see you in five weeks.' I mean, that's very difficult for others to appreciate what physicians go through in terms of training."

Dr. Ariela Marshall, a hematology physician at the Mayo Clinic, experienced and sought treatment for infertility. She says medicine doesn't make the atmosphere family friendly for people who may want to build their families during training rather than waiting until afterward.

"It's kind of damned-if-you-do, damned-if-you don't. If you try to build a family during training, the environment is not supportive," she said. "But then, if you wait until you're done with your training and more financially stable, then it may be too late."

The situation may even be driving some female doctors out of the profession.

"We have a shortage of surgeons, and we wonder why weren't not recruiting and retaining the best, talented candidates. And 50% of incoming medical students are women. And so, it's really not a surprise. If you take something that's the cornerstone of the lives of so many people, and you make it a very, very difficult journey, it makes the profession less appealing," Dr. Erika Rangel, a gastrointestinal surgeon at Brigham and Women's Hospital in Boston, said. "So, there's something in it for all of us to make this better."

Strategies for change

Last year, Marshall co-authored an essay in the journal Academic Medicine calling for change. She'd like to see insurance coverage provided to doctors struggling with infertility.

"Most plans will cover workup of infertility," she said. "But once you find the cause, if you want to do something about it, not all plans cover it."

Each cycle of IVF treatment can be costly. Patel had some coverage that was helpful, and it still cost about $10,000 to $15,000. She said her medications alone were $7,000 to $8,000. Yannetsos said she went through three rounds of IVF treatment, each one paid for out-of-pocket.

"Unfortunately, many, many hospital systems in our country do not offer fertility benefits," Kaye said. "We need to look to business and organizations in other sectors, for example, industry and tech, which have done a pretty good job of ensuing access to fertility coverage for their employees."

Patel doesn't want the message to young women to be: "Don't go into medicine." She says she'd tell young women going into medicine is probably one of the best decisions she made in her life.

"I do believe that women can be successful both professionally and personally, and I think it starts with starting the conversation at an early level," she said. "If we talk to medical students, pre-med students, early on, especially our female trainees, early on, to say, hey listen, this is something we should think about -- change the system so that trainees feel that they're supported through this process."

OMAHA, Neb. —

When Maria and Joseph Sawaged made the decision to grow their family, they never could have imagined what was in store.

"It took us almost five years to get to this point," Maria said.

During those five years and many rounds of fertility treatments, the Sawageds experienced their fair share of disappointment.

"We got a false positive," Joseph said, "I couldn't even go in because it was during COVID rules, so it was just one person at a time, and she came back. It was sad."

After that, the couple decided to try one more IUI. Following the procedure, Maria went in for an appointment, and she returned home with a recorded message from the doctor.

"She came over to me, she says like, 'Don't be scared or like don't be frightened of what you hear,'" Joseph said, "So I was like, 'oh this is gonna be bad news.' So she does the recording and the doctor saying, doctor said the same thing, 'Don't be worried. Don't be concerned. But you have four,' and I was like, what?!"

After years of trying, the Sawageds are expecting quadruplets this spring.

"It's exciting but nerve-wracking. Coming from having no babies at all, and now we're about to have four," Maria said.

Not only is the couple expecting the first quadruplets at Methodist Hospital in Omaha, Nebraska, since 2017, but they've also been navigating this pregnancy amid the pandemic.

"I was by myself the most of the time, and also like, we haven't been able to go to like the birth class or tour the hospitals or anything like that because they're not allowing it," Maria said.

The couple said COVID-19 has also changed the role their loved ones can have. From hosting their gender reveal on Zoom, to limited visitors allowed after delivery.

"You can't have your family around. You can't have your friends over just to talk about just what you're going through. I think that's the hardest part -- just not being able to have anybody around you," Maria said.

It's certainly all been unexpected, from experiencing pregnancy during a pandemic to finding out four babies are on the way.

For the Sawageds, these new additions are what they've been waiting for.

"We hit the jackpot, absolutely," Joseph said, "Now we can kind of say that we did everything that we could. And finally worked out. So now we got, we got a lot going on ahead of us."

The Sawageds are expecting three boys and one girl. As the couple transitions from no babies to four, if you'd like to send diapers to the new parents, you can do so here.