Race, Reproductive Medicine, and Dream Redefined

People of color encounter significant racism across all fields of medicine at both the systemic and individual level. Reproductive medicine and genetic counseling are no different, and despite our best intentions, conversation in the fertility space is especially prone to being dominated by voices that are mostly white and heteronormative. This can be incredibly isolating for those that don’t see themselves and their unique struggles represented in the narratives of reproductive medicine. That is to say, the stigma associated with race only compounds the potential stigma of facing infertility struggles. So what can be done to truly achieve the goal of equity for all of those on fertility journeys?


Candace Trinchieri and Dream Redefined

This is where Candace Trinchieri and her memoir come in. Dream Redefined: The Struggle and Success Through Infertility as a Woman of Color focuses on Candace’s own story alongside short pieces written by other women of color about their lived experience with infertility. The authenticity with which Candace guides the reader through her journey provides a platform to lift up the voices of other women of color and re-center their stories in the conversation about infertility.

Two moments from Candace’s journey stuck out in particular. The first of these was the heart-wrenching account of her many miscarriages and procedures that concluded in a traumatic radical hysterectomy after her fibroids returned. She received only ibuprofen after this painful surgery. Here, Candace acutely describes the feeling of losing her sense of embodied self as a woman because of her infertility with such vulnerability. The sheer strength required to talk about her grief as loud as she can so that hopefully nobody has to experience what she went through alone really comes through in these parts of her journey.

The second story that stayed with me was one of the most shocking encounters with racism in the book. After the birth and adoption of her son, Candace writes “the undercurrent of racism that the doctors and nurses had toward a white woman placing her child up for adoption with a Black mom was palpable.” Candace and her husband weren’t allowed access to the nursery even though they were now officially the parents, and nurses even illegally attempted to convince the birth mother to change her mind about the adoption. They were forced to get their lawyer involved just to see their own son. Clearly, blatantly racist actions are still present in our medical system that, in combination with racism on a systemic level, forces people of color to always be thinking “Am I being treated this way because of race?”

By telling her story as overtly and truthfully as she can, Candace reminds those that aren’t represented in the fertility space that they don’t have to go through it alone; there is a community that is ready and willing to provide support. Most importantly, Candace’s vulnerability about her many surgeries, IVF cycles, and miscarriages that ultimately ended in the adoption of her son serves to highlight the power of being able to find peace in choosing where your journey resolves and to define its meaning for yourself.


Racial Folklore and the Facts of Race in Medicine

A common theme throughout the stories in Dream Redefined is one of isolation, not being taken seriously, and a lack of support. Unfortunately, this is the reality for patients of color across all medical specialties, and part of the problem stems from racial folklore. This folklore is made up of myths about race that are deeply ingrained into our society. Two of the notable myths about black people in particular are hyperfertility and increased pain tolerance. This folklore stems from racist ideas about certain races being more “primitive,” with the supposed lack of intelligence resulting in increased reproductive capacity and “tougher” nerves. The hyperfertility myth also has roots in American slavery in that after the transatlantic slave trade ended, the monetary value of enslaved individuals was tied directly to their reproductive capacity.

Racial folklore manifests in clinical consequences including lower referrals to infertility specialists, receiving less or weaker pain medication, or misdiagnosis of conditions like endometriosis and fibroids. In short, assumptions about the essential nature of someone’s biology as a result of race leads to the voices of patients of color being ignored even though they are the experts on their own bodies. The only way to break these stereotypes is through effective communication and representation to give people a mirror with which to see their struggles reflected in.

The harrowing legacy of race in American medicine has also understandably generated great mistrust among many patients of color. Again focusing on the black community, James Marion Sims, the so-called Father of Gynecology, conducted his experimental surgeries on non-consenting enslaved women without anesthesia. There is also the infamous Tuskegee Experiment, the story of Henrietta Lacks, the government mishandling of Sickle Cell testing in the 1970s, and the forced sterilization laws of the eugenics era, among many other abuses. The lack of trust from these injustices combined with the hyperfertility myths discussed previously has also created stigma around infertility and assisted reproductive technologies from within communities of color themselves. Regina Townsend, the founder of The Broken Brown Egg, describes the consequences of this best when she says that being black and experiencing infertility feels like being “a minority inside a minority.” All of this to say, there is a great deal of work to be done when it comes to rectifying the past and achieving equity in the present.


How Can We Do Better?

For genetic counselors, medical providers, and individuals, achieving equity has to start with unequivocally admitting that racism is ever-present in our society and that everyone has socially-cultivated biases that affect their interactions with certain groups of people. But this is not enough. You must also be willing to consistently re-evaluate your implicit bias without thinking things like “not me” or “not all white people.” Speaking candidly about racism does not put the blame and guilt on you. These phrases only center the conversation around your own discomfort and are a distraction from the real work that needs to be done. The only way to get past this is to accept that sometimes the wrong things are going to be said and to learn from those mistakes so that you can use your privilege for good. As Candace writes, “sit in the discomfort, lean into the conversation.” Only then can we all work together to recenter the narrative with true empathy and amplify voices that have been silenced for so long. That way, everybody can have the support and resources necessary to redefine their dream and find peace wherever their unique infertility journey leads them.


For more information on Candace Trinchieri’s story and Dream Redefined, visit her website: infertilitystory.com

For further reading on race in reproductive medicine, check out Butts & Dokras (2023). This short literature review does a great job summarizing some of the racial disparities in reproductive medicine, and the authors acknowledge that identifying disparity is only part of the solution; actual interventions to improve outcomes need to be researched as well.