POV: If You’re a Doctor or Med Student Thinking about Having a Family, You May Want to Get Pregnant Sooner Rather Than Later
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POV: If You’re a Doctor or Med Student Thinking about Having a Family, You May Want to Get Pregnant Sooner Rather Than Later
We’re more likely to have a difficult time getting pregnant and are at higher risk of complications
If you’re a doctor, resident, or medical student of childbearing age, and you’re thinking about having a family now or in the future, you may want to start planning your pregnancy earlier than you had expected. Female physicians and medical students who are facing decisions regarding timing of family-building—some of whom are also providing fertility care—have a more difficult time getting pregnant and are at greater risk of complications. A 2016 study found that the prevalence of infertility among physicians was 24 percent—more than double the prevalence of infertility in the general population (10 to 11 percent).
Narratives of physicians confronting this issue have been reported by numerous media outlets, including the New York Times, helping to raise awareness of this issue. In May 2020, the journal American Medicine published a call to action for female physicians, which proposed several strategies to address physician infertility, including “increasing fertility education and awareness starting at the undergraduate medical education level and continuing throughout training and practice.” Several recent studies also have shed light on the issue, including a recent story in JAMA Surgery reporting that 42 percent of female surgeons have had a pregnancy loss, above the population-based expected loss rate for women aged 30-40 years of age. Furthermore, few took time off after the pregnancy loss.
The reasons for complications and the higher rates of infertility requiring expensive fertility treatments among female physicians remains unclear. There is a lack of research into whether these issues stem from physical stress or other factors, like delayed childbearing and pushing physiology (lack of sleep, altered eating habits, emotions). Historically, that may have been due to the fact that there weren’t a lot of female physicians, and studies focusing on the physician experiences were predominantly about male physicians.
After delivering high-quality care to hundreds of patients over the course of a seven-year training—including residency in OB/GYN, and a fellowship in reproductive endocrinology and infertility—I too faced challenges throughout my fertility journey. I experienced early miscarriages and did not take time off after experiencing them. During my years attempting conception and being pregnant, I sometimes felt like my body was failing me. When I was expecting my first daughter, I went into preterm labor at around 33 weeks and was put on bed rest for the remainder of my pregnancy. When I became pregnant with my twin daughters a year later, I experienced preterm labor on the day of my fellowship graduation at 30 weeks of gestation. There were many challenges and surprises during pregnancy as I underwent fetal screenings and risk assessment for genetic concerns. More surprises occurred after their birth at 36 weeks. One twin weighed 5 pounds, 12 ounces, and the other twin weighed 6 pounds, 4 ounces. One twin suffered an undiagnosed congenital diaphragmatic hernia and cardiac anomaly, while the other experienced lung cysts and a number of respiratory ailments. They both had multiple food intolerances requiring amino acid–based formula for three years before a long desensitization process to milk, egg, and complex carbohydrates. After their birth, I began to measure my time as the time between hospital admissions for these babies.
Female medical students, residents, and physicians are constantly pulled in polar directions in regard to their family planning. I was a third-year OB/GYN resident when I got married and I felt that the timing for getting pregnant was not right given the stress of my work. Feeling the pressure to delay having children in order to complete years and years of training to be an expert in the field of reproductive medicine, I decided to attempt and schedule my pregnancies and anticipated births to fall during key blocks that were very light on clinical duties and night calls. Of course, this type of planning is hard to do given the unexpected timing on how long it can take to get pregnant and stay pregnant.
As the medical field has shifted more towards gender parity, studies have linked stress with other health outcomes—mental health (suicide), burnout. I was fortunate to have a supportive work environment, as well as a safe place to be a patient. First, I had long-term relationships with my providers and the benefit of knowing them in multiple contexts, which set me at ease. The physicians that assisted my high-risk twin delivery were people with whom I had performed emergent cesarean sections in the middle of the night, and conducted some of my first research. While I had access to any medical test or potential intervention I needed, I also had the knowledge of what the tests mean, and was fully aware of the limitations of interpretation and medical intervention. I wasn’t always the best patient, and I had beloved nurses tell me during my pregnancy with my oldest daughter that I was putting my unborn child at risk by refusing admission and thinking I could go on working. My colleagues—doctors and nurses (mostly female and some male)—helped me overcome my self-perception of invincibility.
Not everyone has such a supportive environment when it comes to pregnancy planning, fertility preservation, and attempting conception. I’ve had numerous conversations with friends, physician colleagues, and family about finding the best treatment option to: preserve fertility, such as through oocyte cryopreservation (egg freezing); attempt conception, using best practices for ovulation prediction and intercourse timing; and reduce life-threatening pregnancy complications with the help of surrogacy. My clinical practice experienced an increase in egg freezing consultations and cycles over the pandemic. Many of those seeking consultation for egg freezing were also physicians. Furthermore, conception timing and attempts may also be challenging given work schedules and decreases in libido.
We need to shift this mindset to a healthier inclusion of the experience of pregnancy, childbirth, and family care, one that provides support and inclusivity for pregnant people to reduce stigma and shame associated with motherhood in medicine. Besides defining it and calling it out at trainings and other events, we need to think of tangible ways of shifting the culture. These may include transparent and standardized benefits to support family-building and parenthood, including insurance policies that support fertility journeys and treatments. Second, while early education availability of fertility treatment options is increasing among physicians and trainees, it needs to be more accessible. Third, we as a profession need to find options and paths so that physicians don’t have to choose between having a family or being a doctor.
As part of the solution, we need to continue encouraging the next generation of female physicians to enter the workforce, encourage peer support in the environment, call out toxicity and provide alternative options. We need to prioritize reinvesting in the human rights of healthcare workers by reducing long work hours to avoid burnout. We also need to reduce overhead, unnecessary administrative work, and increase the number of people in appropriately trained medical support roles—much of what doctors do now is administrative work that can be done by others. And finally, we need to increase fertility education in undergraduate and medical education, increase access to fertility counseling and preservation counseling and services for trainees and physicians, and destigmatize and provide support for those physicians experiencing infertility, undergoing treatment, or having pregnancy complications. We owe it to the young women now entering the medical field and the generations that will follow them.
Shruthi Mahalingaiah (SPH’15) is an assistant professor of environmental, reproductive, and women’s health at the Harvard T. H. Chan School of Public Health environmental health department. She specializes in ovulation disorders, reproductive endocrinology, and infertility at Massachusetts General Hospital and is a Boston University School of Medicine adjunct associate professor of obstetrics and gynecology. She can be reached at shruthi@bu.edu.
“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact John O’Rourke at orourkej@bu.edu. BU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.
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