A Medical Career, at a Cost: Infertility

on Sep14
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From the start, Dr. Ariela Marshall, a hematologist at the Mayo Clinic in Minnesota, proceeded with the conviction that if she worked harder, longer and better, she would succeed. And she did: She graduated as high school valedictorian, attended an elite university and was accepted into a top medical school.

But one achievement eluded her: having a baby. She had postponed getting pregnant until she was solidly established in her career, but when she finally decided to try to have children, at 34, she was surprised to find that she could not, even with fertility drugs. Dr. Marshall attributed it to having worked frequent night shifts, as well as to stress and lack of sleep, which can affect reproductive cycles.

When she reached out to other female physicians to share her story, she learned that she was far from alone; many women in her line of work were also struggling with infertility or with carrying a baby to term.

“For many physicians like me, everything is so planned,” Dr. Marshall said. “Many of us decide to wait until we’re done with our training and are financially independent to have kids, and that doesn’t happen until we’re in our mid to late 30s.”

To raise awareness of the issue, Dr. Marshall helped to create an infertility task force with the American Medical Women’s Association. In June, the association held its first national physician fertility summit, with sessions on egg freezing, benefits and insurance coverage for fertility treatment, and infertility and mental health. The association plans to hold another summit next year.

The high rate of infertility holds for female surgeons as well. A survey of 692 female surgeons, published in JAMA Surgery in July, found that 42 percent had suffered a pregnancy loss — more than twice the rate of the general population. Nearly half had experienced pregnancy complications.

Like other female physicians, many surgeons delay pregnancy until after their residency, making them more susceptible to health problems and infertility issues.

Often, doctors must navigate 10 years of medical school, residencies and fellowships. The average age for women to complete their medical training is 31, and most female physicians first give birth at 32, on average, according to a 2021 study. The median age for nonphysicians to give birth is 27.

Through social media, Dr. Marshall connected with two other female physicians who also struggled with infertility, and last year they wrote about the issue in the journal Academic Medicine, calling for more fertility education and awareness among aspiring doctors, starting at the undergraduate level. They also proposed providing insurance coverage for, and access to, fertility assessment and management, and offering support for people undergoing fertility treatments. (In December, Dr. Marshall gave birth to a healthy baby boy after completing a successful I.V.F. cycle.)

For a year, Dr. Arghavan Salles, who is now 41, tried to freeze her eggs, but none were viable. Dr. Salles, an author of the article and a surgeon at Stanford’s school of medicine, is also struggling with the expense of the procedure, which can cost up to $15,000 per attempt. She is looking into intrauterine insemination, which is more affordable but has a lower likelihood of success.

In 2019, she wrote an essay in Time about having spent her most fertile years training to be a surgeon only to discover that it might be too late for her to have a baby. Afterward, many female physicians contacted her to say that they had also dealt with infertility.

“They all felt so alone,” Dr. Salles said. “They had all gone through this roller coaster ride of dealing with infertility on their own, because people just don’t talk about it. We need to change the culture of med school and residencies. We have to do a better job of urging leaders in the field to say, ‘Please, go and take care of what you need to do.’”

Sleep deprivation, poor diet and lack of exercise — inherent to the demands of medical training and the medical profession — take a toll on women seeking to become pregnant.

Even finding a partner can be a challenge, given the demanding work hours, including nights and weekends.

“The problem is you have to spend a lot of time in the hospital and it’s very unpredictable,” Dr. Salles said. “One could look back and say, ‘I should have frozen eggs in my early 20s,’ but the technology wasn’t very good then. We see older women who are celebrities in the news having babies, and we think it will be fine, but it’s not. Now we’re all having this realization that we don’t have control over our lives.”

Dr. Vineet Arora, dean of medical education at the University of Chicago Pritzker School of Medicine and another author of the paper, is weighing how she and other educators can best advise leaders in medicine to address these issues.

“The thing that surprised me the most is that infertility is a silent struggle for many of these women, but when you see the data, you realize that it’s not uncommon,” said Dr. Arora, who underwent many I.V.F. cycles in her 40s and finally had her second child last March.

She and Dr. Salles are analyzing data from a large study they conducted asking physicians and medical students about their experiences building families and accessing infertility treatments.

Female residents who do manage to get pregnant must also contend with poor health outcomes; many go into early labor or experience miscarriages as a result of the long hours and stress of the job. Yet pregnant female residents are still expected to work 28-hour shifts, without sleeping. Dr. Arora and others would like to see that change.

Dr. Roberta Gebhard, who is governance chair and former president of the American Medical Women’s Association, said the group is advocating for more accommodations for pregnant physicians, such as allowing women doctors to complete their heavy workloads at the beginning of their residency if they know they want to try to have a baby later on in their training.

“We’re educating med students and pre-med students about fertility issues so that they are aware of them,” she said. “People say you can’t be a mom and a physician, and we’re telling you that you can, but you need to keep your options open. A lot of it isn’t just being able to get pregnant. Some of these women are so focused on their careers that they don’t get into a relationship.”

For female physicians with babies, even finding the time and a private place to pump breast milk while on the job can be a challenge. Dr. Gebhard said that one doctor who asked for time to pump was instructed to go behind a potted plant in a public area to do so.

She’s optimistic that things will start to change in the near future, as more than 50 percent of all medical school students are now women, although there are still more male physicians than women.

Dr. Racquel Carranza-Chahal, 30, recently completed her OB-GYN residency and is now in private practice in Tucson, Ariz. She has a son, to whom she gave birth while in medical school, and a daughter.

“When I became a resident, someone told me that I needed to divorce my husband and lose custody of my child if I wanted a fellowship,” Dr. Carranza-Chahal said.

The day she spoke, she was on-call and had just completed her second 24-hour shift in seven days while eight and a half months pregnant with her second child.

In 2019, she founded a nonprofit called Mothers in Medicine, which she hopes will increase visibility and community outreach for female physicians who are pregnant or are mothers.

“I want moms in training to know that they should take up space, that they do belong and that there are resources at their disposal, including legal ones,” Dr. Carranza-Chahal said. “A lot of residents end up delivering early and having complications. One day I’ll change that.”

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