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Infertility in South Asian American women ignored

By Natalie Benham

Many South Asian women are expected to jump into motherhood as soon as they are married. However, their reproductive health and challenges they may face throughout this process are not talked about and are underrepresented health topics in the community. 

From as early as a girl’s first menstrual cycle, the importance of women’s health is placed on the back burner. Talking about sex or periods is very uncommon and even discouraged. The stigma around discussing infertility in many South Asian communities is still very strong, even more so than discussing periods.

The idea is that what happens in the bedroom should stay in the bedroom, so seeking fertility advice or talking with family often comes with a lot of shame that they do not want to expose themselves to. A lot of times, the woman is to blame for infertility issues and can be rejected from the family and/or society.

There is a lot of pressure put on women to have children, and males at that, to keep the family respected and provide a chance for more wealth and honor. Unfortunately, without proper health education and communication, there are a lot of consequences with waiting to get help that can occur, especially as women get older. 

While South Asian women are not necessarily more infertile than other women, statistically speaking infertility affects around 10-15% of people, they are likely to face different complexities during their fertility journey. Common disease causes of infertility, such as endometriosis and polycystic ovarian syndrome (PCOS), have been shown to likely occur more often in South Asian women than in Caucasian women.

Studies have shown that South Asian women with PCOS have more undesirable outcomes compared with their Caucasian counterparts. These include higher insulin and testosterone levels as well as a higher tendency to get ovarian hyperstimulation syndrome (OHSS).

There is also evidence of lower success rates for IVF in South Asian women who use fresh embryo transfers, even when the embryos are of high quality, when compared to Caucasian women.

However, frozen embryo transfers have the same live birth rates in both South Asian and Caucasian women from the same study. Dr. Valerie Baker of Johns Hopkins School of Medicine has suggested that differences could be from the varying hormone balance from previous procedures leading up to the birth that are not present with frozen embryos. 

Along with personal stigma and shame, there is a certain amount of distrust in the healthcare system that ties into waiting to seek professional help from fertility specialists. South Asian women prefer high levels of confidentiality regarding the fertility treatment process and often do not feel comfortable seeking assistance from doctors.

About 15% of South Asian couples go as far as trying alternative therapies for infertility rather than the traditional methods, delaying even longer the start of fertility treatment. Consequently, as the data have shown, older women in general have a harder time getting pregnant or succeeding in IVF than younger women.

Moreover, South Asian women are also at higher risk for premature ovarian aging (POA) and early menopause compared to Caucasian women, making it even more important to seek help and start treatment as early as possible. 

If, after patience and lots of money, the woman can finally get pregnant and deliver the baby, everything should be all better right? Sadly, that is not the case. Some data show South Asian women can be more likely to develop postnatal depression or other psychiatric illnesses. Whether this is a genetic occurrence, stress from family, or the fertility process, it is not entirely clear. However, the cause is not necessarily as important as understanding what is happening and again, getting help as soon as possible. 

The health of Asian women often receives less coverage and research than Caucasian women’s health. Even more so, when studies are done, Asians are often grouped together when in reality, the sample consists of mostly Chinese, Japanese, or Korean women, which is not inclusive.

While it is great that these majority East Asian ethnicities are gaining attention, there is still a lack of women from South Asian countries which include India, Pakistan, Sri Lanka, the Maldives, Bangladesh, Bhutan, Nepal, and Afghanistan. For South Asian women specifically, their reproductive health and wellness receive even less attention than the average “Asian group”.

All of this goes to show that fertility and reproductive health need to be talked about. With more discussion and focus on these topics, the better outcomes South Asian women will have. A lot of categorizing has “Asian” as the focus group, but that is too broad and often not inclusive enough for accurate analysis. It’s time for all Asian women to be represented and offered the same care and support as other women. 

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