-My mother's a pharmacist
and my father's an ophthalmologist.
They met at Rochester Institute of Technology doing nerdy,
researchy things, and I was created.
-Mnh, not so nerdy. -Yeah, exactly.
-Not the nerdiest behavior. -Exactly.
-Yeah.
This is Joia Crear.
She's a gynecologist and women's health expert here in DC,
but I'm not here to talk to her about work.
We're actually chatting about her personal struggle
with infertility.
-Got married in December 2006, and I took the IUD out
right before the wedding thinking,
"Oh, I'll get pregnant on the honeymoon."
And now it's 2009, so three years later,
and I don't have a baby.
What am I supposed to do?
And my patients, I've sat across the table
from people all the time crying.
And I just was at a loss.
-In episode 5, we learned how to freeze eggs,
but what happens when you need to use them
to try and make a baby?
Egg freezing is the first half of in-vitro fertilization,
or IVF.
To make a baby, you have to do the second half,
and your eggs go through a lot of hurdles to get there.
They have to be thawed, inseminated with sperm,
grow into healthy embryos,
and transferred into your uterus.
During IVF, Joia and her husband
managed to get 13 healthy embryos.
But she still had trouble conceiving.
-And usually I would get pregnant, but it wouldn't last.
And we went down from say 13 to 10, and it still didn't work.
So then we go down from 10 to 6 or 7.
Still didn't work. When they did the ultrasound,
I had a fibroid which was really large.
But I also had my lining that would not grow.
-I did some research, and that's when I found
Dr. Feinberg.
She's an endocrinologist
whose research primarily focuses on women of color.
-It first dawned on me when I was a fellow
and I had all of these amazing
black women that I was taking care of.
They were soldiers. They were in military.
They were tough on the surface, but soft on the inside.
And I just wanted to see them get pregnant.
And so many of them did not get pregnant
on their first or second, sometimes their third try.
And it was heartbreaking.
It was heartbreaking to see some of my white patients come in,
one cycle, they're done.
It really led me to question whether or not
there was any racial disparity in IVF outcomes.
My hypothesis when I looked at the data
was that the lower success rates may have been
due to the higher prevalence of fibroids in black women.
-Fibroids are benign tumors that can grow in
and around your uterus.
They're fairly common, and women of every race can develop them.
But they tend to be more common in black women.
-About 36% of black women have fibroids.
White women tend to have a single dominant fibroid,
and black women tend to have multiple fibroids.
When we compare the women that had fibroids to those
that didn't have fibroids,
that's really where we saw lower pregnancy rates
and higher miscarriage rates.
If the fibroid is in the lining part of the uterus
or in that cavity where a baby can grow and develop,
sometimes taking it out can cause scar tissue
and can cause the walls in the uterus to stick together.
And so that embryo just simply can't grow and proliferate
in that environment.
-So, a part of the sort of premise of egg freezing
is that your uterus doesn't age.
-Right. -So, this complicates that.
-I don't think that you can say that egg freezing is the be-all,
end-all for every single woman regardless of race.
For somebody that has a fibroid uterus,
that impacts the likelihood of getting pregnant
as these women age
because the fibroids can worsen over time.
-Is the prevalence or likelihood of getting fibroids
something that is informed genetically?
Like, if my mom or my aunts have fibroids, is that a cue for me?
-Yes.
We think that there are multiple factors
that contribute to the development of fibroids,
but without question, they're familial.
-'Cause you know I gotta eat. -Mm-hmm.
-When Nicole was first born, she came out screaming so loud.
Aaaaaah! And shaking her hands.
He said, "Babies either cry or scream,
and you have a screamer." Yep.
-She's been screaming ever since.
-Oh, yeah. Still screaming.
-Ha-ha, ha-ha, aren't you funny?
I heard my mom and her sisters mention fibroids before,
but I didn't really know that much about our family history.
So I asked them to tell me about their experiences.
-It was the day before Thanksgiving,
and I was cooking with my parents.
And I had a sudden pain, very excruciating pain,
and I fell to my knees.
I had never heard of the word "fibroid"
until I went to the doctor.
-Right.
-So I didn't know anything the first time.
I was just like, "Okay.
Well, what do I need to do? Okay."
Very naive.
I was naive the first time. -How old were you?
-29, I think. -29.
-I was in the hospital at the same time giving birth to you.
And at that point, my OB-GYN physician shared with me
that I had a really small fibroid on my uterus
that wasn't really obvious until I was at full term with you.
-Were you regularly keeping an eye on that fibroid?
-No. No.
I was told I didn't really need to.
But I always, in the back of my mind,
wondered about the possibility of growing more
because I knew what my sister had been through.
I found out 30 years later that I have five fibroids
instead of just the one.
-When was that?
-A year ago.
-How big were they?
-Various sizes, but the largest one might have been the size
of a plum to a lemon maybe.
-You told me you had one
the size of a grapefruit. -Oh, no.
-Five lemons together equal one grapefruit.
[Laughter]
-How many did you have? -13.
Five of which were the size of a grapefruit.
-Yeah? -And I didn't even know
I had fibroids.
That's when I had my hysterectomy.
And, um, I was fine after that.
-Tracey, you had them, too. -You did?
-Yeah. Twice.
-We were trying to have a baby, trying to have a baby,
our first baby.
And found out I endometriosis and fibroids.
And then I had one miscarriage, and then Justice.
-I don't think that we've ever talked about any of this
while looking at each other simultaneously.
-Never. No.
-In our lives, like, there are things about
even my research of my family members that's like, "Oh, shit."
-Just know you have a support system at this table
that you can count on.
We'll stand by you, whatever your decision is,
and no matter what you go through,
we're here to go through it with you and hold you up.
And lean hard, girl.
We're here.
-The beauty of being kind of a popular OB-GYN
is that your patients think of you as a friend, right?
Like, get invited to baby showers,
and so I had 5,000 women who believed in me,
who trusted in me, who valued me.
-With only two embryos left,
Joia decided to ask a former patient to carry her baby.
-The surrogate. -Yep.
And these are her children.
So, we put two embryos in her uterus, and one survived.
And he's now 7 and bossy and all the things.
If I had not had the opportunity to have someone
who I know really well to be a surrogate,
I don't know what I would have done.
-Everything I learned from my family, Dr.
Feinberg, and from Joia was a lot to take in.
Luckily, Joia's story has a happy
ending with a beautiful family and an adorable son.
But her circumstances are unlike any of ours.
The odds of being a gynecologist,
having a patient who's willing to carry your child,
and having the money to afford it is just rare.
With all that said, I still have a really big decision to make.
In the next episode, I talk to a reproductive therapist
and get some really helpful insight
on how to make decisions like this.
Stay tuned for our finale
where I finally figure out what I'm gonna do.
Coming up in episode 8 --
-Let's say you go to use the eggs
and the eggs don't work.
Do you think you would have regretted having frozen them?
-I don't know.