A medical career at a price: infertility

From the start, Dr. Ariela Marshall, a hematologist at the Mayo Clinic in Minnesota, remained convinced that if she worked harder, longer, and better, she would be successful. And she did it: she graduated as a valedictorian, attended an elite college, and was accepted into a major medical school.

But one realization escaped him: having a baby. She had postponed her pregnancy until she was firmly established in her career, but when she finally decided to try to have children, at 34, she was surprised to find that she couldn’t even with fertility drugs. Dr Marshall attributed it to working frequently at night, as well as stress and lack of sleep, which can affect reproductive cycles.

When she reached out to other female doctors to share her story, she learned that she was far from alone; many women in her labor also struggled with infertility or full term delivery.

“For many doctors like me, everything is so planned out,” Dr. Marshall said. “A lot of us decide to wait until we’re finished training and be financially independent to have children, and that doesn’t happen until we’re in our mid to late 30s.”

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

The high rate of infertility also applies to female surgeons. A survey of 692 female surgeons, published in JAMA Surgery in July, found that 42% had suffered a miscarriage, more than double the rate for the general population. Almost half had experienced pregnancy complications.

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

Often times, doctors have to go through 10 years of medical school, residences and scholarships. The average age of women to complete medical education is 31, and most female doctors give birth for the first time at age 32, on average, according to a 2021 study. The median age of non-doctors to give birth is 27 years old.

Through social media, Dr Marshall got in touch with two other female doctors who were also battling infertility, and last year they wrote about the issue in the journal Academic Medicine, calling for more education and awareness of fertility among future physicians, starting with the first cycle. They also offered to provide insurance coverage and access to fertility assessment and management, and to offer support to people undergoing fertility treatments. (In December, Dr Marshall gave birth to a healthy baby boy after completing a successful IVF cycle.)

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

In 2019, she wrote an essay in Time about spending her most fertile years training to be a surgeon only to find that it might be too late for her to have a baby. Subsequently, many female doctors contacted her to tell her that they had also treated for infertility.

“They all felt so lonely,” Dr Salles said. “They had all been 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 medical school and residences. We need to do a better job of urging the leaders on the ground to say, “Please go and take care of what you need to do. “

Sleep deprivation, poor nutrition, and lack of exercise – inherent in the demands of medical education and the medical profession – take their toll on women seeking to become pregnant.

Even finding a mate 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. “You could look back and say, ‘I should have frozen eggs in my early twenties,’ but the technology wasn’t that good back then. We are seeing older women who are celebrities in the news having babies, and we think it will be good, but it isn’t. Now we all realize that we have no control over our lives.

Dr. Vineet Arora, dean of medical education at the University of Chicago’s Pritzker School of Medicine and other author of the article, assesses how she and other educators can best advise medical leaders to resolve these problems.

“What surprised me most is that infertility is a silent struggle for a lot of these women, but when you see the data, you realize it’s not uncommon,” said the Dr Arora, who underwent numerous rounds of IVF in her forties and finally had her second child last March.

She and Dr Salles analyze data from a large study they conducted asking doctors and medical students about their experiences of building families and accessing infertility treatments.

Residents who manage to get pregnant also face health issues; many of them start labor early or miscarry due to the long hours and stress of the job. Yet pregnant residents still have to work 28-hour shifts without sleeping. Dr Arora and others would like to see this change.

Dr. Roberta Gebhard, governance chair and past president of the American Medical Women’s Association, said the group is pushing for more accommodations for pregnant physicians, such as allowing female physicians to cope with their heavy workload. at the start of their residency if they know they want to try for a baby later in their training.

“We educate medical students and pre-med students about fertility issues so that they are aware of it,” she said. “People say you can’t be a mother and a doctor, and we’re telling you you can, but you have to keep your options open. It’s not just about being able to get pregnant. Some of these women are so focused on their careers that they don’t commit to a relationship.

For female doctors with babies, even finding the time and a private place to express breast milk during labor can be a challenge. Dr Gebhard said a doctor who had requested time to pump was ordered to go behind a potted plant in a public space to do so.

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

Dr. Racquel Carranza-Chahal, 30, recently completed his residency in Obstetrics and Gynecology and is now practicing in private practice in Tucson, Arizona. She has a son, whom she gave birth to while studying medicine, and a daughter.

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

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

In 2019, she founded a nonprofit organization called Mothers in Medicine, which she hopes will increase the visibility and community awareness of pregnant or mother female doctors.

“I want moms in training to know that they have to take up space, that they have their place and that there are resources available to them, including legal ones,” said Dr Carranza-Chahal. “Many residents end up giving birth early and have complications. Someday I will change that.