Ep 84: The Black Fertility Myth with Dr. Tia Jackson-Bey
Fertility Forward Episode 84:
The dialogue around infertility is filled with cultural myths and enduring stereotypes that significantly shape the experiences of Black women. As a result, there are few spaces for marginalized individuals to discuss their fertility struggles and, as today’s guest explains, this could actually be impacting their access to care. For this thought-provoking discussion about Black fertility, we welcome recurring guest, Dr. Tia Jackson-Bey, a dedicated Reproductive Endocrinologist and Infertility Specialist at RMA of New York. Dr. Jackson-Bey recently gave a talk at the Icahn School of Medicine at Mount Sinai on ‘The Black Fertility Myth’ as part of their Diversity Rounds and, in today’s episode, she shares some of her research with us, from what the Black fertility myth is to who it affects, how it has evolved, and how it impacts fertility and reproductive health. We also touch on why infertility or the decision to go child-free can be more isolating for some cultural groups than others, the connections that modern gynecology has with the enduring legacy of slavery, and the importance of bias training in continuing education for medical professionals. Dr. Jackson-Bey also shares some resources for those who wish to learn more. Make sure not to miss this important conversation that encourages us to embrace discomfort and address our biases with Dr. Tia Jackson-Bey!
Rena: Hi everyone. We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Rena: We are so excited to welcome to Fertility Forward today, a recurring guest, Dr. Tia Jackson-Bey, who is a reproductive endocrinologist at RMA of New York. We are so, so excited to have you here to talk about what is going to be a really open and real discussion about the black fertility myth.
Tia: Yeah, I, I'm glad to be here again as always. Thank you so much for having me.
Rena: We were talking a little bit before this show, you know, we had come up with this episode. Tia had shared with us a presentation called the Black Fertility Myth that she did for a grand round presentation at Mount Sinai. And so both Dara and I watched it and, you know, it brought up a lot of, and, you know, I said, I'm gonna be really honest, I had never thought about a lot of this. And you know, some of it kind of made me a little bit uncomfortable because why hadn't I thought about it? And then I thought it was also really important to address the fact that now discussing it on the podcast Dara and I are to white women interviewing Dr. Jackson-Bey who is a black woman. And I did clarify that with her before we recorded to say, what, what do you prefer to be, you know, called for your background? You know, because everyone obviously is, is so different. And, you know, we kind of had that discussion before, you know, obviously this topic can be really sensitive and, and bring up a lot of things to people. But I, I think this is a really important and thought provoking conversation. So we're really excited to delve in.
Dara: I didn't even realize there was something called the black fertility myth. What exactly is it? And is this something that you created or something that has been formally named?
Tia: So that's a great question. Honestly, Dara, as far as I can tell, it's something that I've always used. I don't think that it's actually been coined, but we may need to look into that. But it, it, for me, it encompasses this idea that is not, you know, to just black women, but you know, this idea of this kinda very supernatural, magical hyper-state of fertility for certain groups of women and unfortunately in our world where we see a lot of persons with fertility challenges and dealing with infertility, that idea at the cultural level, societal level and even at individual levels can act as a barrier to care. And so, you know, just knowing that that has always been in the background and I’ve done a lot of work with disparities, how to address them, what are they, how can we finally overcome them, as well as how to help providers at all levels - nurses, physicians, other professionals - to recognize our own inherent and unconscious biases. Then you have to kind delve into these topics of where these ideas come from, how did they originate and then how do they inform what's going on today?
Rena: So I guess, can you explain a little more, you know, what, how would you define the black fertility myth and then how is it a barrier to fertility care?
Tia: Yeah, so I, you know, the way I discuss the black fertility myth is this idea that black women do not have infertility. And it's not just the absence of infertility. It's actually an idea that their fertility is so abundant that it may even need to be controlled. And so, you know, if we look over the of American history, we see at different points where the fertility of black women was particularly valued and then where it actually became a liability and then where, you know, there was actually forced sterilization of black women in this country in order to control this aspect of fertility that they thought was so different or unnatural or unwanted. And so, you know, the black fertility myth really just relates to that in that, you know, not just that these women are don't experience infertility, because maybe you don't see them in fertility clinics or you don't see them represented in our typical kind of fertility population, but also that their fertility is so abundant that it's a cause for concern.
Rena: So do you think that's a broad stereotype that there's a sort of societal generalization that black women are super fertile? And so therefore we think, oh, they don't need fertility care?
Tia: Absolutely. It's an enduring stereotype that has roots in American slavery. But black women aren't the only women who unfortunately suffer the stereotype. At different points of history, this was directed towards Mexican and Central American women, Puerto Rican women in both the island and in cities like New York and Chicago. Chinese women, you know, when they came to help the country and, and help with the railroads. Irish Catholic women - you may have heard that still some of that endures today. So there, you know, it's, it's been something that's observed during the course of history through multiple different populations and each one kinda carries their own stigma. But you know, I chose to focus on this black fertility myth because I think, you know, not only does it have an impact for how providers or how society views these women, but also how black women view themselves and their understanding of their reproductive health, of the limitations on a reproductive health and timeline and understanding when something is wrong or abnormal and needing to seek another level of care.
Rena: Thinking about it from a mental health perspective and, you know, the clients that I've seen over the years, and of course cultural background is something that, you know, we always talk about in assessments that can certainly play a role. And now that I'm, you know, really thinking about it in terms of the different populations that I've seen, different races and ethnicities. I mean, I certainly agree. I think culture totally plays a role in a lot of time I see people getting very upset feeling they can't share infertility with friends and family because culturally because it's very looked down upon to be infertile.
Tia: Absolutely. I think anyone, unfortunately who's been affected by infertility may feel the same. It can be so isolating, but in certain groups it may be more so than others. You know, for some of our patients, you know, having large families is so prized and valued even in today's generation, that to have any issue in that area can be really difficult. Sometimes even where a smaller family may be valued, understanding that if there's no one else around them who has expressed issues, or if even in the generation or two above them, everyone had such large families that they never even considered it could be an issue. I've had, you know, patients and professionals, even from other disciplines talk to me about how even their parents made very, you know, kinda inappropriate comments about their fertility, even in this day and age where they're saying, OK, I'm coming, we've been to the doctor and we've had these diagnoses and even one generation up saying things like that's not true or that doesn't affect us, or, you know, we don't have issues in that area and how stigmatizing that can be. But it just goes back to this idea at a population level that why would there ever be any issues? You know, one of the biggest contributors to, you know, the types of fertility issues that we're seeing today is the cultural shift later parenthood. And this is seen, you know, across the country, across the world where everyone's, you know, actually having smaller families than we did one or two generations ago. The average age of parenthood is slowly moving up. Once upon time, obviously was, you know, in the early twenties, even late teens and now it’s actually moved towards the late twenties at a national level. So you can understand that there are people who are older than that who are starting families for the first time and, you know, unfortunately like I’ve mentioned so many times before, particularly for women, ovarian has not followed this trend. You know, it's been a very rapid change that we're choosing to start families later or choosing to have children later in life. And so the, the very real limitations on female reproduction, aren't always as appreciated. And we see that reflected, you know, across the board in our patients. But particularly for black women, they are presenting to infertility care at a later age than most other women and with longer periods of infertility. That may mean even after meeting the definition for infertility with 12 months of trying, and they may have, you know, 18 months or longer sometimes double that of their counterparts at the time when they present and to me that represents some misunderstandings about when to seek care. It could also misrepresent opportunities for referrals. If they were seeing primary care provider during this time or talking to their OBGYN about their desires, but maybe that provider didn't recognize that there's an issue because in the back of their mind, they're saying this person shouldn't have an issue like that, or maybe they can't afford infertility treatment so why send them to and REI, then those are the things that can present as barriers to their care.
Rena: Well, I mean, that seems horrible to think that a physician, you know, or a healthcare provider would just would have this bias that, oh, this person can't afford care or they won't have an issue so I'm therefore not gonna treat them the same way as I would, you know, someone who's white.
Tia: Yeah. It's horrible, but it's true. And, you know, I think the thing that we all have to come to recognize is we all have these inherent biases, you know, biases evolved as ways to kinda, or stereotypes or groupings, categorizations of people evolve as a way to make a very kinda quick decision, right, in a short amount of time. Okay, I've seen this before, I recognize this before, I've been told this, this is, you know, the bit of information I have and this is an easy outcome and then you kinda continue on. So it's not an abnormal thing to have. It's just that, you know, in the healthcare setting, it can actually work against the aims that we're trying to achieve of having good healthcare for everyone. And so the best way to combat them is to first recognize that they exist so that we can all kind of get back down and treating everyone the same. A lot of providers say I treat all of my patients the same, and that is a very altruistic thing. And that is definitely our goal, but we have to recognize that physicians and providers are human beings, and we're all influenced by society around us, by interactions that we've had, by even our medical training. And so that's why it's very important to, you know, have these discussions now so that we aren't perpetuating these issues for the future, you know, social doctors, nutritionists, things like that.
Dara: Well, yeah, especially like I'm, I was thinking about bias training, how important bias training is, and in terms of, you know, different fields, the importance of continuing education, I think it should be just like how ethics are something that, that we all need to be updated on continuously. I would definitely think bias training should be a required continuing educations course for anyone in this field.
Tia: Yes. Certainly I can speak to medicine. It's something that has not always been a part of our continuing education or classic medical training, but now it is both at, you know, Mount Sinai and here at RMA, we try to have sessions for the providers specifically around, you know, not just racial biases, but also gender and sexual orientation. You know, it's an ever evolving and changing world and we all have to be holding each other accountable to keep up. It's also not something we can learn in a day, you know, you can't learn it in a single session or a single PowerPoint. And I do understand under the table kinda feedback that it feels overwhelming. That it feels like it's too much. It's in your face. And sometimes it can be very hard to kind of accept change, you know, even for providers, but we have to just, you know, kind of surrender to it being necessary and being for the greater good.
Rena: Yeah. I mean, you know, like we said, at the beginning, I had never really thought about this, you know, in this level before watching your presentation. And I'm so glad that this came my way, you know, it brought up a lot, a lot of thoughts and I think this is such an important dialogue. And, you know, as you said, the point, none of us can pretend that we don't have inherent biases. Every, humans just do, but to talk about it, start a dialogue, address them, you know, and, and continue to learn.
Tia: Absolutely, absolutely can I think that's important. You know, another thing that struck me is I, you know, kind of like fancy myself as a history buff. I really do. When I was in college really like, should I just major in history and minor in biochem? Or, or what should I do here? Cause I really loved it so much, but I also always loved social sciences and anthropology being one of those. And like, why are humans the way they are? The study of culture, anthropology is literally the study of man. And so, you know, when you're thinking about why do we act the way that we act, or why do we have the beliefs that we do and how are these things perpetuated? How are they kind shape the way that we live our lives? That's actually what culture is and traditions and values and, and belief systems and you know this came up as one of those to say that for long the legacy slavery for black people in American is something you really cannot separate from where we are now and I think that is something that's really hard for a lot of people to understand, but you know, on a very simple level, that's how we got here. So it's something that, you know, we can't exactly ignore. And what happened during slaevery was at certain points we were importing persons from Africa to be in this kinda indenture or, or how should I say, like a bondage, a servitude in this country. And so that was the initial source of slaves in the Americas. But at a certain point in there actually were limitations placed on importing Africans for slavery and, and why that is, you know, I think it's always important or, or interesting to me to understand, but for whatever reason, the founding fathers felt that, you know, they wanted to limit this. Maybe they didn't want this exchange of humans to be the lasting American legacy, but, you know, in some regards, it was already too late because the world economy depended so much on the work of these enslaved people that there was a huge demand for it. And this was the major economy in the Americas. And so we grew things like cotton. If you think about, you know, textiles, you know, made in America on cotton labels that came from somewhere. We grew sugar. So sugar production in not just the United States, but in the Caribbean was huge in fueling culinary arts and trade with Europe. We think about French chocolate and, you know, Italian pastries and the sugar for that was coming from the Americas, an insatiable kinda desire as well with spices. And tobacco. Tobacco was grown in the Southern United States. And, you know, the demand for that in Europe grew. And so this demand for slavery was really more than just what America could handle. It was a global kinda endeavor. And so as they limited the ability to import persons from Africa, we were tasked in the US with, well, how do you get new slaves? There were laws that said, if your mother was born a slave, or if your mother was enslaved, then you were a slave. Not so much about your father. So the children born to black women could be slaves. And if you needed to make new slaves, then you had to breed them. And so this was a violent of forcing sexual interactions between other slaves or between a person who held slaves or owned slaves, their female in enslaved persons. And so, you know, this created an industry, a demand for women who were able to get pregnant easily, who could carry a pregnancy to term and deliver and grow healthy children. And so, you know, you'll see in American history and in literature, and even in, you know, historical documents, this demand and very high prices for young women who could get pregnant easily. And so this represented a change in how black women were viewed. They were bred to create new humans, cause that meant new slaves, that meant new money, that meant more workers. And that's how, you know, the system was perpetuated. And so, you know, when we think about, well, where, you know, where did these things come from? Where did these ideas come from? Both within a person at the individual, but then also at the societal level, that's a big part of it. It's not the end of the story, but it's certainly one of the origins. And so I, I think about that a lot in terms of where did this all get started? It was the legacy of needing more people to work more land to give more crops to make more money.
Rena: I remember watching that part of your presentation and just, you know, sort of really being blown away. I never thought about that. You know, obviously slavery in terms of how it impacted, you know, fertility and reproductive health and, and our view on it today. So I think that it's so thought provoking that you traced it all the way back to that. I think it's fascinating.
Tia: Yeah. Actually a lot of what we know in the world of gynecology comes from interactions with enslaved women. You know, another part that I didn’t include in the presentation cause it was relatively short, but someone who was called for lack of better terms, the father of modern gynecology, J. Marion Sims was a provider at that time during American slavery who made a name for himself and a reputation addressing what is called obstetric fistula. Fistulas are connections that should not be there. And obstetric fistulas are between the vagina and bladder or the vagina and the rectum. And they came from having really long, hard labors, what we call protracted. Like, can you imagine if you were in labor for days as a young person, this is before cesarean sections were routine. And so, you know, unfortunately, sometimes these women had these incontinence issues of urine or feces and it made them very undesirable. You know, you would have this chronic infection, you would be, you know, odorous, it's hard for you to work. And so J Marion Sims started to for lack of a better term, collect women from plantation owners in Alabama, so that he could investigate the issue and he had a desire to try to address it. And so a lot of what we know about female anatomy, the vagina in relation to the, the, the uterus in relation to the, the bladder, pelvis, how to address these issues, how to fix them, came from his use of experimental surgery on enslaved women. And so we now have names for his 3 most commonly used both subjects and also his surgical aids because there were there performing these surgeries and helping retract and helping suture and learning all ofthese things. But Lucy, Betsy and Antarctica are their names and there's a huge kinda movement to recognize them more fully, but just goes back to show that a lot of what we know in this country about gynecology came from this desire to one make reproduction very profitable, but two also this was a loss of money if these women couldn't keep reproducing. So it was a desire to figure out how to fix it and how to move forward. And he was able to use what he learned by working on these women to help all women eventually. But there was this kind of disconnect with how we actually got there. So you may hear a lot of discussions now about kinda, you know, acknowledging this part of history and, and to some degree not giving him the honor that he, you know, had garnered all of these years because of how it was, how we arrived at this information. Actually, we still use instruments that are named after him. The Sims retractors, Sims was his last name, an instrument that we use in gynecologic surgery, as well as Sims forceps, which are used for vaginal delivery. And so there’s even campaigns to rename those instruments.
Rena: I feel like I'm learning not only about the, of, but the oppression of women in general.
Tia: Absolutely. And it endures today.
Rena: Yeah, for sure.
Dara: I'm so happy that you're sharing these stories because, or history basically that I feel like so many people have not heard about. And, and this is the first part of, of educating people and you know, continuing these stories, not these stories, these, these historical stories aren't lost.
Tia: Absolutely. You know, to a certain degree, we have to hold the American healthcare system, but the American education system responsible because we, we need to incorporate this into standard, you know, US history. You remember these classes from high school, you had to learn about the constitution and all of these things, well these should be included as, as well.
Rena: Absolutely. One other thing I wanted to ask too, from the presentations, I mean that struck me was this statistic that black mothers are four times more likely to die than white mothers. I thought that was obviously really striking. Can you speak on that a little bit?
Tia: Yeah. So this was from a study, it's a maternal, it's a morbidity and mortality review . And so the CDC obviously is always collecting data from the whole country, the centers for disease control, and published this kinda landmark paper that said that black women were dying due to pregnancy related complications at a rate up to 3 to 4 times more than white women. And so they, you know, it was very well laid out about what are the different factors that influenced this. And one of the most striking to me was that education and income did not close this gap. That means that if you were a white woman, particularly in New York City who had not finished high school, your chances of pregnancy success were better than a black woman with a college degree in a high income group. And for many people who do this work, that's important because a lot of times we say, well is it race or socioeconomics? We know that poor people don't have access to as much. They don't have good health insurance. Maybe they can't see the premium doctors or things like that. But what this proved was that it was something about black race that created this disparity. And you know we go back and forth all the time in this world - is it biologic or is it social? And I think something about this showed us that there's more of a social component to it than we ever really could, then we could ever really express before. There's something about how someone perceives your race, how you look to them, because again, race is a social construct. This is not a, a real defining way to categorize humans. This is based on the need to say, okay, this person looks this way. This person looks that way. That's how I divide them. It's easy. It helps us to check a box again, once this kind of goes back to who was born in this country and who was not, who counted as a citizen of this country, who did not at certain times. And it's just perpetuated. When you go to other countries, race is defined totally different, right? Because they may not care as much about skin color as about ethnic origin or language spoken or which indigenous group you belong to. You know, it's, it's totally a made up thing based on where you are. So in this country, we define it kind based on skin color and, and, and other people who come here then have figure out which box they fit into based on how we categorize things. And so that's, that's a big part it all too, is that you know, race is not this thing is a constant. It really is something that is kind of manmade and therefore it, you know, it allows for people to be treated differently regardless of social class or income or privately insured or, you know, zip code that you live in. Unfortunately, race is still that thing that stands out and that's what lets us know that there is a component of provider bias that relates to all of these outcomes.
Rena: I mean, this is fascinating. I feel I could talk about this all day. Another thing too, that I thought was interesting around the time we were in this interview, there was an article that just came out, you know, conversely about, on the topic of black women, feeling like they have to have a lot of children and that being a, a cultural or societal stereotype. There was an article that came out in Harpers Bazaar about choosing, about being black and childfree and how making that choice as a black woman. You know, it went into sort of all the, the thoughts behind that and how that is, is quite difficult as well. Since, you know, as you sort of talked about, it's sort of honored and you know, this…
Rena: Yeah expectations to have many children. And so on the opposite end of that, to choose to be child free is also quite difficult.
Tia: Yeah. And I think it, it goes into, you know, what we've kind of discussed. I think some, some part of it is the decision to be child free can just be very different than, you know, what a lot of people maybe expected, not only for themselves, but people around them expect of them. I see that particularly, you know, amongst friends and colleagues and even married couples, you know, people just naturally think, OK, you're partnered and next comes a baby, and that's not gonna be the case for everyone, and you know, I, I, remind people thank goodness we live in the times that we do now, we just have so many more options available and so many more avenues and, you know, I even follow a few kinda like childless by choice pages on social media beause I think it's just important to remember, you know, some people arrive there organically. Some people may arrive there after, you know, infertility struggles and realize that, okay, we don't wanna continue to pursue this, but I think it's important to keep a lane for everyone. I think we talked a little bit about how particularly devastating the diagnosis of infertility could be, but even more so for some persons who are coming from groups where there’s this expectation of fertility. And so to find yourself in this unwelcome club or this club that you never imagined of being infertile and also, you know, not having people in your community to relate to the expectation that you have to give your partner a child, that's how you prove your womanhood, that's how you manhood. Those can be really devastating. You know, kinda what are called realizations for some people. And particularly if they don't have good social support and, and good mental health support, that can be really tough.
Rena: Absolutely. Well, I'm so glad we had this conversation, you know, I think it was really thought provoking and to be honest, I was kind uncomfortable going into it. I just felt like, you know, again, as sort of two white women talking about such a sensitive subject, I really wanted to make sure to say the right things and, you know, honor this discussion. So I really appreciate you having it with us and being open. And this was really so thought provoking and educational for me. I, so I feel very stimulated by this and wanna really delve further in, into this and continue to learn more, you know, and make sure that I, myself, as a practitioner keep up with, with this, look at my myself and see how I can be better and continue need to learn and grow. I think that it's so important.
Tia: Absolutely. Well, I thank you so much, you know, for even acknowledging that, I think it does a great service to be honest with everybody, especially our listeners about how we're interacting, you know, and just because things are uncomfortable doesn't mean we can't take them on. We do uncomfortable things every day, you know, between the three of us, we do a lot. And I think that's important to be able to have the openness to have these kinda conversations and realize that it's more than just a black issue. You know, there's never been a time in history where advancement of a small group doesn't benefit everyone. And so when people think about civil rights and you know, that is, you know, the, the thing in the sixties and there were marches, but good for them. Well, actually that opened up doors for gender equality, right? So that we could have the kind of jobs that we have today. That opened up the doors for LGBTQ rights to say, actually, if you can't discriminate on the basis of race or sex, you cannot do that on the basis of sexual orientation. You know, so there's this precedent that, that is set from, you know, what we call the least amongst us. If they can obtain the same status and help as everyone else, we all benefit from it. So it's important to just kinda keep that in, in mind and know that even having these important discussions and difficult conversations, there will be good that comes with it.
Dara: I agree. I think it's important to continue having these conversations as uncomfortable as they may be for some people. And even in terms of now that, I mean, I've learned so much today. Are there any resources or places that we can get some quality information if we wanna learn more?
Tia: That's a great question. You know, I do feel that ACOG, the American College of Obstetrics and Gynecology has really done a lot in the last few years to highlight some of these issues, both the history, the current disparities and even just giving providers a voice. They have a campaign this month where they're just allowing, you know, people to submit kinda like little essays about different topics during black history month. And I thought that was even refreshing. So going to acog.org you can find a lot of different resources. There are a lot of groups that actually, you know, help to support women of color black women who find themselves in the infertility space. And so I think that's important. You know, I do a lot of these kinda social media posts and podcasts and writing and all kinds of things. And so maybe some things on my Instagram page may be helpful for some people as well. But yeah, those, I would say that, you know, through ACOG, Fertility for Colored Girls, which is a great organization, The Broken Brown Egg is another one that I love by Regina Townsend. She is the founder of this group and she's actually a librarian. So we share the same love of history, and so, oh man, she comes up with things that are just so incredible and how culture kinda informs this whole experience. And she's, she's really great at that too. So I would recommend her page as well.
Dara: Thank you. A lot of great resources. And what's your, what's your handle again? Dr. Tia?
Tia: Oh, it's just @drtiajacksonbey on Instagram and Twitter.
Rena: Well, and you have fantastic information. I love your pages. So I, we'll, you know, link everything and, you know, our Instagram post, so people can find you.
Rena: Well, thank you again so much for, for being on and, and sharing all of this. This was a wonderful discussion. And, you know, if anyone has comments, thoughts, anything we would love to hear them. And so the way we like to end our podcast is with a note of gratitude to something that you are grateful for.
Tia: Wonderful. Well, you know, I am grateful for so many things. Today I’ll say I’m grateful for my family. I may have said this before but I feel like it always kind of comes up in these topics and these discussions that we have, but I'm also from a large family on both sides. So I'm only one of two children of my parents, but each of my parents had many siblings. And so I, I, you know, in these discussions, I also think about how our large families kind of informed our ideas about fertility and reproduction. And on my father's side, my paternal great- great-grandmother, Alice Scott, she was born a slave in 1859. She used to tell stories. I never met her. She died before I was born, but my father knew her. And she used to tell stories about her job to fetch water in the morning. And that was her job as a little girl. She was about, I believe she was about five or six when slaves were emancipated, but she also served as a midwife. She delivered probably all of her grandchildren. My grandmother used to tell us stories about, you know, when they saw her coming up the road with her bag of tools for birth and things like that. And so just even thinking of about this legacy of, you know, reproductive care and health in my own family, I'm just so grateful for, you know, all of them and all of their work in getting me here, but also that legacy.
Dara: Wow. That’s beautiful. Rena?
Rena: You know, I'm really grateful for this conversation. You know, I just thought it was really different. It really made me think a lot. I, I do enjoy being uncomfortable. I think that's how you learn and grow. You know, it's not the easy things in life that push you, it's the hard things. And so I'm really grateful for this conversation. It was, it was definitely different. It was something that I needed to think about. And, and I hadn't, so I'm really grateful, Tia, for you coming on, sharing this, being open to this and educating us. So thank you. Dara, what about you?
Dara: I was gonna say something very similar. Yeah, I'm, I'm grateful about learning new things, just like you, Dr. Tia, I'm fascinated by history and especially, you know, my own culture and, and, and my own family and, and how, you know, generations, how they lived and how they came to, came to Canada and to America. But it made me realize today in many ways, my ignorance and the idea of, you know, it's important to learn about all different people and, and, and races and cultures and really just learning and listening and, and, and passing that on to our next generation to, to our kids and to people ahead of us.
Rena: Well, thank, thank you so much. This was super enlightening and always a pleasure to have you on.
Tia: Thank you guys.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself, and remember - you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.