POV: If You’re a Doctor or Med Student Thinking about Having a Family, You May Want to Get Pregnant Sooner Rather Than Later
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 firstname.lastname@example.org.
“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 email@example.com. 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.
I was a med student in 1958 in first year, and became pregnant with my
first child. The dean called me into his office when he heard that I was pregnant and made a serious suggestion that
I was not serious about medicine and should go home and forget medicine. I refused, maintained decent grades, and had my second child in my third year. I did specialty and fellowship training and com-
pleted my career as professor at a Canadian university 36 yrs later
With all due respect, but given the current overpopulation and environmental crisis, plus the mental crisis on both children and professionals (you have acknowledged burnout, suicide, stress, etc.), why would you put a new human being through all of this?
Please give a second thought to your reproductory impulses and spare a human life from all the suffering awaiting her in this world. If you truly care about your kids, it would be better not to bring them to this world in the first place. Your selfishness is blatantly clear.
If you are so serious about wanting to take care of a human being, please adopt. There are thousands of living kids worldwide who would appreciate a caring and loving family. There is no need to have more of your genetic material consuming and discarding resources on the planet. Have you also considered how much time you will be able to provide them with the demands of a medical profession?
You are an educated person. Please think about your decisions and their impact on the planet and on these potential new humans very carefully. Especially before encouraging other people to follow suit
I completely agree with you. Even though most of the people insist having a child and having a career can happen at the same time for women, it is extremely time consuming to raise the child. Being a medical professional will make that even harder, considering the limited time they will have exclusively for the child, and the uncertainty of their schedules. Just to be clear, I do not judge people planning to have a child being a medical professional. However, bringing a child to earth is not only about pregnancy, but also about education and the long term plan.
Like, sure, but did you know that the human population is not actually increasing? The only reason the number seems to be going up is that more people are living through childhood and into very old age. People are having fewer kids.
Plus, it’s fulfilling to some humans to have little versions of themselves… having children (to them) is as much a necessity in life as food or air.
Plus, there author is calling for doctors to change the toxic doctor work culture, not for all female doctors to freeze their eggs or have kids…
“Give second thought to your reproductory impulses”? “Have you also considered how much time you will be able to provide them with the demands of a medical profession?” Wow. Just wow.
Do you think female physicians should be held to different standards than their male counterparts? Do you ask the same question of men in medicine? This is the exact environment being discussed in this article. Do better. Support women and their right to have children (or not, depending on their choice). Hold men to the same standards we hold women.
I believe the original comment is not aimed at female physicians in particular but at any individual, male or female, who decides to have children.
It brings a point about the morality of reproduction that I think is totally valid and worth exploring. As a society, we generally do not question the implications of having a child for that child’s sake. Most parents lack a coherent and rational explanation for bringing people into existence that has that child’s sake as a central motive. Reasons are always centered around parents’ desires and dreams (selfish reasons) but ignore the countless misfortunes awaiting any human being.
We must realize that bringing people into the world is, first and foremost, an unnecessary and arbitrary death penalty marked by decades of struggle and, in many cases, futile suffering.
Playing devils advocate (but actually true) I find myself pushing childbearing years and thinking about adoption, but to the authors point, I don’t work in an environment or have the benefits (FMLA isn’t going to pay my bills) to care for a child that might have extra needs. So as much as I know I could provide a loving, supportive home, I am still not confident my career will allow me the extra time needed to take good care of another child. This is what needs to change.
100% agree w/you, anon. And bless you for considering adoption
Wow, Barbara, how completely insensitive are you in your post. Think about the environment and don’t have kids?? How are her children or the children of any hard working female physician not worthy of life?? By your logic everyone who is living now should just kill themselves so that the earth can live forever, right?? Your comment is just ludicrous!
It is a natural desire for a woman to want to be a mother, and there is nothing wrong or evil about wanting to have children who share your DNA. I agree that adoption is beautiful and wonderful, but this is not an easy road and adoption is not the right fit for every family. Did you adopt your own kids? You should never tell a woman that she is not worthy to have a family the way that she sees fit – genetic children or adopted children. It is her choice! Your comment is unreal. You should be ashamed of yourself.
Have some compassion and let’s hope that the next time you see your female physician that you develop some compassion knowing that she put some of her deepest desires on hold so she could better help you. Unbelievable.
Is this comment satire? Do you know that it is difficult to adopt a child? Since when was it reasonable to ask *ONLY THE WOMEN* in a profession to forego a family or to suggest that wishing to participate in the joys of family life is somehow selfish? Several large studies have suggested that female physicians and surgeons have slightly better outcomes than their male counterparts. Is it a satisfactory outcome to insist that the women who give of themselves to strangers are denied access to life’s basic joys or divert their talents to other specialties? Or to block some of those most dedicated and educated members of our society from raising their own children?
My mother was a physician in training when I was a young child. She did not make it to every sports practice but she raised 3 successful adults who each contribute to society in their own way. I am better for her example. Motherhood brings stresses to every woman. A physician mother may not make every bake sale, but she is able to provide a stable home and all the advantages that come with her socioeconomic status -access to healthy food, safe neighborhoods, and a good education. This is far more than the parents of many of my patients provide.
You are welcome to forgo your own family for the greater goal of overpopulation and resource allocation, but the freedom to build one’s own family on one’s own terms strikes me as closer to a human right. If we conduct a thought experiment carrying your argument to its logical conclusion, do you consider all medicine that prolongs life as a crime to the planet? Is all childbearing unethical due to overcrowding or just the childbearing of busy female physicians? Is the only appropriate mother one who stays at home and is unable to provide for her child should the father depart from the picture? Who should we let die to conserve precious resources? Please check your discriminatory and authoritarian impulses.
“…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. Secondly, while early education availability of fertility treatment options is increasing among physicians and trainees, it needs to be more accessible. Thirdly, 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.”
This shift should apply to the work culture of our nation. This country is solely focused on production (go figure, that’s capitalism for you), which is shrouded in messages like “follow your dreams” or “pursue your passion” manufacturing our consent from a young age, fostering a work oriented culture in our country rather than a family (and really human) oriented one (but that’s what makes this country such a “great nation” to live in and one of the top world powers, does it not? And the “benefits” that come with it?). And this is deeply ingrained in our country’s culture. As the saying goes, you can’t have your cake and eat it too, but this country makes you think you can from a young age. Thus your experience is the experience of many in this country, unfortunately.
Appreciate the posting of this piece which provides “food for thought” for individuals in medical training programs who may be considering pregnancy. I would like to take this opportunity to thank the editor of this POV piece for revising the title to be gender inclusive. The original title, offered by the author of this POV, was fraught with language that erased individuals in our society who do not identify as female, yet have the ability to become pregnant. Presenting pregnancy as a “female only enterprise” does nothing to advance the inclusive climate that BU is trying to obtain and maintain. I am hopeful that not only BU, but society at large will embrace the diversity of gender identities and be mindful of this diversity when conducting research, engaging students in classrooms, and offering their opinions.
Thank you for this incredibly important piece and your perspective as a reproductive specialist, a female physician who has been through the training process, and a mother.
To those above who have commented to the effect of “it’s selfish to want your own biological child in this era of overpopulation while not being able to give them your time because you’re a doctor” — I would really encourage some introspection, and to consider perspectives outside your own. We went into this career to heal others and to save and improve lives (a task that has been fraught with record burnout during this pandemic, when we are met with an inordinate amount of resistance by patients to the knowledge we worked for years to acquire). To say that the dream to become a physician should not be able to coexist with the dream of having a biological family is narrow-minded and callous.
This piece also touches on the financial and logistical realities of our residency training process, which falls during our prime childbearing years. Like many of my colleagues, it was not realistic for me to have children while in residency, as I matched into a program in a high cost of living area, with a spouse who worked full time, with no family in the area, and a meager resident salary that could not support quality childcare. I therefore waited to start trying, which took longer than I thought, had a miscarriage (confirmed due to chromosomal reasons out of my control — I am still well under 35yo), and am hopeful my current pregnancy will make it to term.
Even excluding the statistics of physician infertility, getting and staying pregnant is not as easy (for even healthy non-physicians) as our society tries to portray. Something HAS to change — we need to compensate our medical trainees more appropriately, be it in time or money, to allow this journey to realistically start for us when it should.
Thank you for this piece. Culturally in the US, many of us are raised to achieve first and foremost. Once we’ve achieved career success, then we consider growing a family. Of course this occurs in all fields, not just medicine. But the lengthy training leads many, especially surgeons, to attempt pregnancy at older ages.
I hope that American culture starts to value family more. Millennials and Gen Z value quality of life more than the boomers. Family building would be a nice next step.
unfortunately I have experienced this both as a trainee and as the chief of graduate medical education…we were told that pregnancy is an inconvenience for our colleagues and our program, so deferred childbearing during 9 years of training, also our most fertile years… so I went into private practice out of training just in time to have to shell out big bucks for ivf…many of my childbearing surgeon colleagues had similar issues, or elected to remain childless…fast forward to being chief of gme, and having the same issues from the other side; who makes up for the pregnant resident having to take time off? The current structure of training depends upon being on call and day time clinical duties that have to be fulfilled…time for a new paradigm…
I very much agree with the points you made in your article. That said, the headline should be re/written to stress that the physician workplace needs to do better to make it comfortable for women to plan families earlier, rather than put the onus on women to just get pregnant earlier. Also, we truly need more research into miscarriages before concluding the possible causes, like age.
There is another choice also that is not considered by most women (or men) who go into medicine. That is to go to medical school at an older age. That was my situation although not by choice. I originally went to work after college as a computer programmer at IBM ( in 1957). I had no earlier thoughts of becoming a doctor. I had my older son in 1965 and had to leave IBM for 2 years, which was there rule at the time. I continued doing programming consulting work and then had another child in 1968 while still being a consultant. My husband was working full-time but I could work at home and I had a housekeeper who also helped with my children. I decided to leave the computer world in 1970 and enrolled briefly and sequentially in 2 different graduate programs, neither of which I liked. In 1973, at the age of 36, I suddenly decided I wanted to be a physician. My husband was very supportive of my choice and learned to cook so he could feed himself and my sons while I was in premed classes at dinner time which I had to take because I had not had chemistry in college even though I had been a math major. I got no help from the head of the premed program I was in because she thought I wouldn’t get in—too old—and would spoil her statistics. When I was admitted in 1975 (age 38) she was astonished.
My sons were 10 and 8 when I started medical school and my husband continued as a major supporter of me and caregiver for them, as needed. I had 4 years of school and 5 years of an orthopaedic surgery residency so did not start a private practice at the age of 47. I became a full-time academic physician doing surgery, teaching of the residents in the OR and clinic, having a small private practice for a few years at the hospital and eventually becoming the assistant chair person of my department. I retired at 74 but could have continued in that position for years more if I had wanted to. I will say that without my husband’s support of me and help with our family, I wouldn’t have been able to give all the time that was needed to medicine. I was accepted by the entirely male staff of my department but in some ways I had to prove myself. I was our second female resident but there have been many after me. There is no question that it was easier already having children when I started my medical career than it would have been to have them while I was in school or residency, especially in a surgical subspecialty. They did sometimes question why I wasn’t around all the time in my early years of med school but they were old enough to continue being involved in their own lives and I managed to be at important events for them.
Thank you for sharing your story and reminding us not to forget that physiology has not progressed as rapidly as women in medicine has. As an REI fellow I hoped to have access to a discounted rate to freeze my eggs but found that not to be the case. My program/hospital/insurance did not cover fertility preservation (or fertility treatment) and thus I had to delay treatment even further. I have heard of other programs covering egg freezing or embryo banking for residents in all fields while in training and although this is a bandaid on a much deeper systemic problem, it’s a tangible way we can support the generations coming after us, right now. After all isn’t the goal to make this world, and medical training process, better than we found it?
Great article and much needed conversations.
I am one of the people who took the unpopular road of deciding to have kids during residency, because I didn’t want to have AMA as a risk factor. It was not easy, but I am so glad I did it. I remember doing a pulmonary critical care rotation while in my 3rd trimester and looking ready to pop. The nurses were very concerned for me, but my attendings were generally not; they treated me just like any other resident, running down staircases or what-have you. Initially I appreciated this attitude from my attending but now I realize I had been trying to reassure them that I can do anything my non-pregnant residents can do. The critical care environment, however, was too much for my pregnancy and I started having some bleeding though and had to switch a more pregnancy-friendly elective or be put on bed rest. I am grateful that my residency program chief residents helped to find a fellow resident to switch with me. My peers are surprised that I have a pre-teen child while they’re either still having babies or are having trouble with fertility.
In summary, I agree that if you know you want kids, prioritize it and make it happen sooner rather than later. If you do decide to have kids during your medical training, do NOT pretend to be superwoman. A pregnant resident has different needs and capabilities than a non-pregnant resident. I also agree that medical school and residencies need to accept that doctors or doctors-in-training are still humans and entitled to all the benefits of humanity. If my residency program hadn’t switched my critical care rotation, I would have had to be on bed rest (thereby prolonging my residency) or I might have lost my daughter (had I willfully decided to finish the rotation).
My husband and I married at the end of our Senior year in Medical school. We both came from large families and wanted to have children. After 3 years of Pediatric Residency in the late “70s, I had the first of my four children while completing an Ambulatory Fellowship. We went into private practice together, he being in Internal Medicine, and we both worked 6 days a week getting, but gratefully had some help from family. Juggling full time physician and full time Mom finally caught up to me and I experienced depression at age 40 years with 4 little ones under the age of 10 years. I sought help and recovered and readjusted . My kids did not go into medicine, but I’m proud to say that they’re happy, productive adults. After going through what I did , I feel it has humbled me and made me a better physician. I have learned and I agree that women physicians are human and need to understand their limits. I try to mentor the younger generation of women with the knowledge I ‘ve gained. Today, my 3 sons have become wonderful Dads , husbands and share home responsibilities equally. I’m still in private practice after 38 years ; my husband died unexpectedly(11 years ago) after 30 years of marriage, but I picked up the pieces and am enjoying my life as well as 5 grandchildren.