Perceived Causes of Fertility Challenges and Utilization of Infertility Treatment Modalities: Insights from U.S. Black Women

Introduction: To qualitatively explore what Black women themselves perceive as the causes of their fertility challenges and examine the treatment modalities utilized to address infertility. Methods: The study included 40 Black women aged 25–45 years, with a history of fertility challenges, residing in the United States, who completed the Fertility Equity Study between 2021 and 2023. Participants completed a survey and up to two semi-structured interviews to discuss their fertility journeys and perceived causes of fertility challenges. We examined and synthesized participant perceptions about the causes of their challenges in conceiving or maintaining a pregnancy. Frequencies and percentages were calculated for each common cause of fertility challenges and treatment modalities used. Results: Participants described five common perceived causes of their fertility challenges: (1) clinically diagnosed reproductive health conditions ( n = 26; e.g., fibroids, oligospermia); 2) age ( n = 7); (3) unknown causes ( n = 6); (4) structural issues ( n = 4; e.g., limited access to Black donor sperm); and (5) stress ( n = 4). Nearly half of participants ( n = 19) only used medically assisted reproduction (MAR), whereas one-third ( n = 13) had a history of using both MAR and holistic approaches (e.g., herbal teas). None of the participants who only used holistic fertility treatment modalities attributed their fertility challenges to reproductive health conditions. Conclusions: This study reflects the nuanced ways that Black women conceptualize their fertility and the antecedents to fertility challenges. These results reflect the need to integrate holistic and spiritual approaches into fertility care and MAR to appeal to the needs of Black women and families navigating infertility.