Fertility, family planning, and the physician life

By | March 1, 2019

Every morning the alarm clock goes off, I hit snooze once, twice, three times — and eventually get out of bed and on with the day. “Snoozing” is a bad habit for sleep hygiene. Unfortunately, I’ve realized the downside of snoozing also is a euphemism for other aspects of my life.

Several times a year, I attend medical student networking events or speak on panels about residency and what surgical practice is like. These events are energizing. Training to become a surgeon was an amazing opportunity and sharing that experience with future surgeons is one the best parts of academic practice. I have a lot to say about it. At these sessions, someone invariably asks how I maintain work-life balance and children. This is where I stumble. The truth is, I can’t advise on work-life balance because like so many physicians, I don’t do it terribly well. Moreover, I pressed the snooze button on my biological clock for a long time. I don’t have children — at this point, not by choice — and I can’t offer much insight into balancing family life.

During medical school, a professor advised us to have children when we were 75 percent ready because if we waited until we were 100 percent ready, the time would never come. The reasoning seemed sound and it stuck with me. My version of “75 percent ready” came in my third year of practice. I was healthy. I looked young for my age and felt even younger. The potential for infertility was not on my radar nor had I considered that I’d someday pursue IVF.

Fast forward three years, one fertility tracking bracelet, a hundred ovulation predictor kits, two IUIs, several dozen hormone injections, three egg retrievals and one unsuccessful embryo transfer. I’m even more ready to be a parent, but not yet one. When my husband and I first started down the IVF path, I assumed it would immediately succeed. As a physician, I believe in science and medicine. Reality set in after the first IVF cycle when 24 eggs (a good number for my age) ultimately resulted in no viable embryos. We haven’t given up hope for children. I’ve become quite competent at fitting injections, blood work, ultrasounds, and procedures into life while maintaining a practice. With a little faith, science, and luck I’ll be able to opine on balancing child-rearing with practice at a student event in the future.

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In the U.S., approximately one in eight women experience difficulty getting pregnant or staying pregnant. Studies suggest that for female surgeons, the number is as high as one in three or four. Residency training is rigorous and early practice even harder, so it’s understandable many women surgeons postpone starting a family. But here is the reality — that metaphorical “biological clock” is real. While surgeons and other physicians are accustomed to surmounting challenges with grit and determination, the age-related decline in fertility is something we can’t change no matter how hard we work at it.

The good news is that awareness about infertility in female physicians is growing. Recent op-eds by surgeons Arghavan Salles MD, PhD and Britney Corey, MD shined a light on the human impact of infertility. Groups like the Association of Women Surgeons and the American Society of Plastic Surgeons are focusing long-needed attention on infertility in surgeons and childbearing during residency. Open dialogue is important. Now we must make a concerted effort to include the medical students we mentor in the discussion because they stand to benefit the greatest from it.

Most medical students are in their late 20s at graduation, just beyond a woman’s peak fertility. After three to six years of medical training or six to 10 years of surgical training, fertility is waning. Childbearing during residency is increasingly common but still very challenging. For those looking to delay children (who likely still constitute the majority), oocyte cryopreservation may offer an option to prepare in advance while pressing snooze on their biologic clock. Unfortunately, the time to freeze eggs isn’t when trouble arises or when prospects are looking bleak. The most effective time is before the mid-30s when fertility is highest. This means before or during residency for many. Although the cost of oocyte cryopreservation is daunting for the average heavily-indebted medical student, it may be a better option than looking wistfully in the rearview mirror at reproductive youth.

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Topics like fertility and family planning can feel like professional minefields. Despite this, with residency and fellowship training becoming increasingly long and greater numbers of women entering fields like surgery, more dialogue needs to happen. Family and children are an important part of life for many male and female physicians. As mentors, we do a good job of teaching students how to excel in residency or their career. It also behooves us to share our personal successes and struggles to help the next generation of physicians and surgeons envision and plan for the life they want 10 to 20 years from now.

Carolyn R. Rogers-Vizena is a pediatric plastic surgeon. She can be reached on Twitter @crogersvizena.

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