One of the most beautiful things in life is having a child. Like many women, Annie Kuo wanted to be a mother. But after a miscarriage, she received a diagnosis of primary infertility. Her doctor recommended in vitro fertilization (IVF) but Annie got pregnant without intervention shortly after her diagnosis. Though her pregnancy proceeded typically and ended in a healthy delivery, she found herself unable to enjoy the experience.  “When you suffer from infertility,” says Kuo, “you can lose your innocence over it. You can lose your innocence over the fear of losing the baby because you’re always waiting for the other shoe to drop.” 

Kuo is not alone. Infertility is a problem that affects families all over the world regardless of race, ethnicity, or socioeconomic status, including Asians. But what exactly is infertility? The World Health Organization defines infertility as the failure to reach clinical pregnancy after 12 months of regular unprotected sexual intercourse. But for women aged 35 and older, most physicians would consider one infertile after 6 months. Most of the studies that looked at infertility have focused on outcomes in Caucasian women. Recent studies have shown infertility is an important but overlooked and understudied issue among Asians and other minority ethnic groups as well.¹ 

Dr. Victor Fujimoto, the director of the IVF program at the University of California, San Francisco and author of numerous Asian infertility studies, found that East Asian women and couples wait longer than (Caucasian) peers before they consult a doctor about infertility. They are also much less likely to seek early intervention when they’re having a problem getting pregnant. Dr. Fujimoto stated, “When looking at our population of Asian patients, 40 percent or more were delayed in speaking for at least two years after their problem began.”⁷ He noted that social and cultural factors may play a role in access to fertility care in the Asian population. Some social and cultural factors include attributing infertility problems primarily to women, disapproval or disappointment expressed by older generations for Asian women who are unable to conceive and continue the family line, and the idea of “saving face” which prevents Asian women from speaking about infertility without shame. He also found that Asian American women have 33% lower successful pregnancy rates after IVF treatment compared to Caucasian women⁵. Multiple studies have affirmed the need for further research to better understand why.

Studies have found lower pregnancy rates, both with and without fertility treatments, among Asian women compared to their Caucasian counterparts without clear causes²⁻⁶. These studies showed that women of Asian descent had lower average BMI, good embryo quality and number of embryos produced, normal hormone levels, and healthier diets which usually contribute to higher fertility. These factors, however, do not seem to have translated into better clinical outcomes. Another study observed that Asian patients demonstrate higher peak estradiol (E2) levels and E2 levels per oocyte compared with Caucasian patients². This finding may contribute to higher infertility but there is a need for more research.

Infertility is more than a medical issue for Asian American women. It can cause emotional distress or impact romantic and extended family relationships. Infertility affects one in eight individuals, but many have moved beyond the diagnosis to become parents through assisted reproductive technology, fostering or adoption. Ask about infertility if you are under 35 and have not conceived in one year. If you are over 35, ask after six months. Even if you are not actively trying to conceive, you can educate yourself about infertility and find support. 

References:

  1. Bloche M. Health care disparities—science, politics, and race. N Engl J Med. 2004;350:1568-70.

  2. Purcell, K., Schembri, M., Frazier, L.M., Rall, M.J., Shen, S., Croughan, M. et al. Asian ethnicity is associated with reduced pregnancy outcomes after assisted reproductive technology. Fertil Steril. 2007; 87: 297–302.

  3. Lamb, J.D., Huddleston, H.G., Purcell, K., Modan, A., Farsani, T., Dingeldein, M. et al. Asian ethnicity is associated with decreased pregnancy rates following intrauterine insemination. Reprod Biomed Online. 2009; 19: 252–256.

  4. Huddleston, H., Cedars, M., Sohn, S., Guudice, L., Fujimoto, V., Racial and ethnic disparities in reproductive endocrinology and infertility.

  5. Fujimoto et al.  Racial and ethnic disparities in assisted reproductive technology outcomes in the United States, American Society for Reproductive Medicine. 2010; 0015-0282.

  6. Huddleston, H., Rosen, M. Gibson, M., Cedars, M., and Fujimoto, V. Ethnic variation in estradiol metabolism in reproductive age Asian and white women treated with transdermal estradiol.

  7. Lamb, J.D. et al. Asian ethnicity is associated with longer duration of infertility and decreased pregnancy rates following intrauterine insemination (IUI) Fertility and Sterility, Volume 88, S260 – S261.

  8. Kuo, Annie. “She Didn’t Tell Her Family about Her Infertility Diagnosis. Now She’s Helping Those Struggling to Conceive.” NBCNews.com, NBCUniversal News Group, www.nbcnews.com/news/asian-america/she-didn-t-tell-her-family-about-her-infertility-diagnosis-n812846.

Tommy Na is a student at the University of Richmond with a strong interest in medicine interning at the Tinina Q. Cade Foundation, a nonprofit that helps families dealing with infertility. The original form of this article was written as an academic paper for the author’s internship.