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November 13, 2018

'I'm not alone': How Michelle Obama's reflections on miscarriage and IVF could shatter stigma, according to providers

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    Former first lady Michelle Obama in her new memoir "Becoming" opens up about her experience with miscarriage and in vitro fertilization (IVF)—and providers say her experience could encourage others to seek treatment for a surprisingly common condition.

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    Michelle Obama's experience is more common than you think

    Miscarriage is the most common pregnancy complication, according to Vox, and each year millions of U.S. residents seek services from clinics to address fertility issues. According to the Pew Research Center survey, "33% of American adults report that they or someone they know has used some type of fertility treatment in order to try to have a baby."

    Since 1996, more than one million babies in the United States have been born using assisted reproductive technology (ART), which according to CDC includes IVF and other procedures involving fertilization outside of a woman's body. About 75,000 U.S. babies were born using ART in 2016.

    According to Vox, part of the reason why more people are using ART is because more people are attempting to conceive children later in life.

    However, people rarely discuss their experiences with miscarriages and fertility issues because of the stigma and the physical and emotional pain tied to the incidents. In recent years, more women, including Beyoncé, Sen. Tammy Duckworth (D-Ill.), Khloe Kardashian, Chrissy Teigen, and Gabrielle Union, have spoken about their struggles with fertility.

    Michelle Obama's experience

    In her memoir, Michelle Obama opens up about her and former President Barack Obama's attempts to conceive a child during her mid-thirties.

    She writes, "We were trying to get pregnant and it wasn't going well. We had one pregnancy test come back positive, which caused us both to forget every worry and swoon with joy, but a couple of weeks later I had a miscarriage, which left me physically uncomfortable and cratered any optimism we felt."

    The former first lady in an ABC interview said after her miscarriage she felt as if she'd "failed." She said, "I didn't know how common miscarriages were. ... We sit in our own pain, thinking that somehow we're broken." She continued, "That's one of the reasons why I think it’s important to talk to young mothers about the fact that miscarriages happen."

    Obama said it was during that period in her life, when she tried to conceive children, that she realized "the biological clock is real" and "egg production is limited," her memoir states. So, she decided to undergo reproductive treatment and began IVF treatments, which required Obama to inject herself with medications to stimulate her ovaries to produce eggs, Vox reports. According to Vox, the eggs are later removed from the ovaries and combined with sperm in a liquid lab for fertilization. The fertilized eggs are then reinserted in a woman's body to conceive a child. 

    With the help of IVF treatment, the couple conceived their two daughters—Malia, 20, and Sasha, 17.

    Providers react to Obama's revelation

    Fertility experts said Obama's memoir will help others realize the commonality of fertility challenges.

    Zev Williams, director of the Columbia University Fertility Center, said Obama's experience is "so universal, not just throughout the [United States] but around the world. There's a real sense of self-blame and guilt and a reluctance to discuss it with other people." Williams in 2015 co-authored a study on perceptions of miscarriage and found many people believed miscarriages occurred in 5% or less of pregnancies, when they occur in at least 20% of all pregnancies.

    Stacey Edwards-Dunn, who underwent seven cycles of IVF before conceiving a child and founded the advocacy organization Fertility for Colored Girls, said Obama's story could particularly help ease the stigma that affects women of color. "So many black women [and] couples live in silence and shame for so many reasons, including myths and misconceptions about black women being hyper-fertile," Edwards-Dunn said. But by sharing her story, Edwards-Dunn said, Obama "just gave so many women permission to exhale and say, 'I'm not alone, and I too can get support and help to become a parent!'"

    According to Edwards-Dunn, "Not only is this the first time that we hear of a first lady being so transparent about her personal fertility challenges, but her courageous truth-telling gives more women, particularly black women and couples, the courage to talk about their own challenges."

    Aaron Styer, a reproductive endocrinologist and founding partner of the fertility clinic CCRM Boston, said, "As one of the most respected and revered women of color, … Obama's openness to discuss her IVF treatments will open that dialogue and empower black women and all women, men, and couples facing infertility to seek these treatments to conceive" (Belluz, Vox, 11/9; Kellman, AP, 11/9; Almendrala, HuffPost, 11/9; Kindelan et al., ABC News, 11/9; Ravitz, CNN, 11/9).

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