A Medical Career, at a Cost: Infertility

From the outset, Dr. Ariella Marshall, a hematologist at the Mayo Clinic in Minnesota, began moving forward with the belief that if she worked harder and harder, she would be successful. And she did: She graduated high school as a valedictorian, attended an elite university, and was accepted into a top medical school.

But there was one feat she didn’t achieve: having a child. She had postponed getting pregnant until she was solidly established in her career, but when she finally decided to try having children at age 34, she was surprised to find that she was also on fertility drugs. could not. Dr. Marshall attributed this to frequent night shift work, as well as stress and lack of sleep, which can affect the reproductive cycle.

When she reached out to other female physicians to share her story, she learned she was not alone; Many women in his field 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 financially independent to have kids, and it’s not until we’re in our 30s. Not in the middle of the decade.”

To raise awareness of the issue, Dr. Marshall helped form an infertility task force with the American Medical Women’s Association. In June, the association held its first ever National Physician Fertility Summit, which included sessions on egg freezing, benefits and insurance coverage for fertility treatments, and infertility and mental health. The association plans to hold another summit next year.

Higher rates of infertility are also there for female surgeons. A survey of 692 female surgeons published in July in JAMA Surgery found that 42 percent had a pregnancy loss More than twice the rate of the general population. About half had experienced pregnancy complications.

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

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

Via social media, Dr. Marshall connected with two other female physicians who also struggled with infertility, and last year she Written about this issue in the journal Academic MedicineCalling for more fertility education and awareness among aspiring doctors starting from the undergraduate level. He also proposed to provide and access insurance coverage for fertility assessment and management and support for those undergoing fertility treatment. (In December, Dr. Marshall gave birth to a healthy baby boy after completing a successful IVF cycle.)

Dr. Arghavan Salles, 41, tried to freeze his eggs for a year, but none was viable. Dr. Sales, the author of the article and a Stanford surgeon, is also grappling with the cost of the procedure, which can cost up to $15,000 per attempt. She is looking for intrauterine insemination, which is more affordable but has less chance of success.

In 2019, she wrote Time. an essay in About to spend her most fertile years training to be a surgeon only to find that it may be too late for her to have a baby. Later, several female doctors contacted her to say that she also dealt with infertility.

“They all felt very alone,” Dr. Salles said. “They all went through this roller coaster ride of dealing with infertility on their own, because people don’t talk about it. We need to change the culture of med schools and residences. We have this to say to field leaders A better job of urging would be to do, ‘Please, go and take note of what you have to do.'”

Lack of sleep, poor diet and lack of exercise – rooted in medical training and the demands of the medical profession – take a toll on women seeking to become pregnant.

Given the demanding working hours, including nights and weekends, finding a partner can also be a challenge.

“The problem is you have to spend a lot of time in the hospital and it’s very unpredictable,” Dr. Salles said. “Anyone can look back and say, ‘I want frozen eggs in my early 20s,’ but then the technology wasn’t great. We see older women who are celebrities in the news, And we think that would be okay, but it isn’t. Now we are all realizing 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 in on how he 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 look at the data, you realize that it’s not unusual,” said Dr. Arora, who had several IVF cycles in her 40s and finally had her second child last March.

He and Dr. Salles are analyzing data from a large study in which they asked physicians and medical students about their experiences building families and accessing infertility treatment.

Female residents who manage to become pregnant also face poor health outcomes; Many people go into labor early or experience a miscarriage 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 Gebhardt, who is chair of governance and former president of the American Medical Women’s Association, said the group is advocating for more housing for pregnant physicians, such as allowing female doctors to complete their heavy workloads at the start of their residency. If they know they want to try to have a baby later in their training.

“We are 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 doctor, and we’re telling you you can, but you need to keep your options open. A lot of it is just not 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 infants, finding the time and a personal space to pump breast milk while on the job can also be a challenge. Dr. Gebhardt said a doctor asking for time to pump was instructed to do so behind a potted plant in a public area.

She is 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. Raquel Carranza-Chahal, 30, recently completed his OB-GYN residency and is now in private practice in Tucson, Ariz. They have a son, whom they gave birth to in medical school, and a daughter.

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

She was on-call the day she spoke and had 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 non-profit called Mothers in Medicine, which she hopes will increase visibility and community outreach for female physicians who are pregnant or are mothers.

“I want the training to let moms know that they should take place, that they are concerned and that they have resources at their disposal, including legal resources,” Dr. Carranza-Chahal said. “Many residents deliver early and develop complications. One day I’ll change that.”

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