Dear Black People

– a love letter to my community

Dear Black People, we need to break the stigma and misconceptions. We need to check the misinformation we have held onto for generations. We need to become more critical and progressive in our thinking because in doing this we will be able to see unconventional journeys towards fertility – or anything else – contextually, and not through the lens of our projections and societal conditioning.

Noni Martins

Had my story been different I would have never known just how misinformed we all are when it comes to fertility health. I am writing this letter from a place of love and compassion because I realise the tension between black/african couples trying to conceive and their families and wider community needs to be addressed. What couples tend to do when they find themselves at the trying to conceive stage and things are taking longer than they thought, is to keep quiet and smile on the outside as their loved ones say all kinds of inappropriate things, while fuming or even crying on the inside. First thing is first, and I say this with all due respect, my womb and its reproductive ability or lack thereof is my own business. My husband’s sperm and its reproductive ability or lack thereof is his business, and together as a couple trying to have a baby together, both those things – are OUR business. I know that a child belongs to the family and it takes a village to raise a child but the process of doing that is mine and my husband’s. The best way to think about it is if you are not there when the love making is happening or when sperm is being inseminated (IUI) or when an embryo is being transferred (IVF) – just conclude that it is NOT your business. For too long, couples trying to conceive have tolerated unsolicited advice/comments from people who “mean well” but really don’t have a clue about what is really going on, and worse still don’t have the courtesy to actually ask. As a community we project our own ideas and experiences of pregnancy onto others, but we have to realise that everything is contextual.

Take for example, our male factor infertility. My husband has low sperm concentration (count) and low sperm motility (movement) due to the fact that he has been on dialysis for over 10 years. Male factor infertility is a medical diagnosis – it is not a stab at his manhood. Our bodies are biological – male factor infertility has nothing to do with who he is a man or a husband, that’s a societal construct. And that is something that we as the society/community need to deconstruct. The same man who has a low sperm count and low movement is the same man who fertilised 19 of my 20 eggs that were retrieved at egg collection. The same male factor infertility is the same that gave us 10 good grade embryos. What happened between 19 eggs being fertilised to having 10 embryos is a matter of biology and science – and has absolutely nothing to do with my womanhood or my husband’s manhood. We need to deconstruct this – making babies is biological i.e. you don’t have much of a hand in this – raising them is societal and you have more influence over this. The two are different and the thing to remember is that even when trying to conceive naturally and much more easily, the same biological process has taken place. The only difference with infertility cases is the use of medical interventions that mimic what happens naturally and sometimes assist the process to improve the chances of a pregnancy. None of this takes away from anyone’s worth or validity as a man or woman.

So how about the female factor? The majority of what we know and believe about this as a community is WRONG. Do you know that research has shown that male factor infertility accounts for about 40-50% of all infertility cases? This means that if there were 10 couples dealing with infertility – i.e. struggling to have a child – 4 or 5 of these couples would be because of male factor infertility. The biggest myth of all in our community is that all infertility issues stem from the woman. This is largely in part due to the patriarchal societies we live in but is also due to the fact that we refuse to think critically and progressively – I mean honestly, in what real world would all infertility issues be caused by female biology. To what evolutionary gain? It actually doesn’t make any sense. Sometimes, question things you have always known to be true, we live in the age of information – seek it. In case you haven’t got my point – it is possible to have issues with conceiving when there is NOTHING wrong with the woman in the equation. If in doubt, think of me as a real example. Apart from an irregular cycle, which is insignificant by the time you’re having IVF, there is nothing biologically wrong with me that could affect my ability to have and carry a child (as far as all the investigations I’ve had show). The reason we are having IVF is due entirely to the male factor diagnosis. How’s that for some myth busting?!

Another key thing to mention is that infertility is a thing between 2 people. I can have contributing factors as an individual but until I am trying to conceive with someone, they are just factors. Using my husband again, what he has is a standalone medical diagnosis – so for example the reduced sperm concentration is called oligozoospermia and the reduced sperm motility is called asthenozoospermia. These are medical conditions that exist whether in the context of trying to conceive or not. Semen analysis is based on a standard of normal levels and so even if you are not trying to have a baby, you can still have tests and stand-alone diagnosis for how much you deviate from these ‘normal’ levels. It is only in the context of him trying to have a baby with me that it becomes male factor infertility. So, I never separate myself from that diagnosis, it is OURS, not just his. We are trying to conceive together; I am not doing this alone and neither is he. To put it simply, someone in my situation could potentially get pregnant easily, with a donor sperm for example – which is an option that has worked for so many couples! But again, everything is contextual – we are not there (yet) as we have 9 embryos frozen and have only used 1 of 3 of our NHS funded cycles. The point I am trying to make is that, just because we have male factor infertility, I don’t remove myself from the situation because infertility belongs to two people, what affects him – affects me – affects us. Other examples include women with PCOS, endometriosis or fibroids – many women know way before having babies is on the agenda but it becomes a different kind of problem at trying to conceive stage.

Which brings me onto my last point. It would appear that me talking male factor infertility has triggered a lot of people in my community. I’ve had quite a few messages from people asking me whether I have “permission” from my husband to blog about our story and others saying “you are very lucky that your husband let’s you do this”. This language is triggering for me! Permission let’s me… Look, I appreciate that I am fortunate to have the kind of husband that I have, that has never wanted me to be anything else but myself but we need to check our patriarchal complex here. It should not be a luck thing for a husband to “let” his wife do anything. And I also don’t believe in permission. The undertone of this kind of thinking feels very much like people would rather believe that I am a disrespectful wife who blogs about this stuff behind her husband’s back, than to believe that my husband is a progressive man who feels no shame about our male factor diagnosis! Again we need to deconstruct these patriarchal systems of the man as supreme and the wife subservient to him and his command. For the sake of speaking with love and compassion and fostering deep understanding, I’ll say this. Way before any of this began, I had multiple conversations with my husband – because it is not about permission, it is about discussion for us – and only when we were BOTH comfortable with the idea of sharing our story did I decide to do it. We both had to be comfortable, I am also in this process too and I had to think long and hard about opening myself up in this way. I am lucky in the sense that my husband is not ashamed at all, and he has never internalised the ‘male factor’ element of our fertility diagnosis.

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