This article includes discussion of infertility that may be challenging for some readers.

March 29, 2022
By Safiye Unlu, MS4, Drexel University College of Medicine

One in four female physicians struggle with infertility, almost double the rate of the general public (Rangel et al., 2021). When I first read this, I was truly shocked and scared. Somehow, I tried to justify to myself that it was not real, and that I had only read one research article and maybe there was sampling bias. However, the more I delved into the topic, the more research I found supporting it and the more stories I found of female physicians detailing their struggles with infertility. Haven gotten married just two weeks before the first day of medical school, I knew I would be putting off having children for the foreseeable future. A few times during the last four years of medical school I have found myself doubting my decision – was I jeopardizing my fertile years?

A survey of 692 female surgeons, published in JAMA in 2021, found that 42% had suffered a pregnancy loss – more than twice the general population’s rate. Female surgeons had fewer children than their male counterparts, had delayed having children because of surgical training, and were more likely to use assistive reproductive technology. Once pregnant 48.2% had pregnancy complications. This all begs the question – is this because of the years and rigor it takes to become a physician?

From undergraduate school to end of residency is 11 to 15 years depending on your chosen field, taking you through your entire 20s and often into your 30s. The average age at which women complete their medical training is 31. The average age female physicians give birth is 32 years old. For non-physicians it is 27 years old. Many female physicians are delaying pregnancy until after training due to their busy schedules and lack of financial independence, increasing their risk of infertility and health issues as they push closer to the age of high-risk pregnancy – 35 (Cusimano et al., 2021). Those who are pregnant while in training are still expected to take calls and work upwards of 28 hours with no sleep. This leaves women at higher risk for complications such as miscarriages, early labor and postpartum depression (Stentz et al., 2016).

Many female physicians have described very similar stories – spending their fertile years training to become a physician, only to discover that it may be too late to have a baby once they decide to. An accumulation of sleep deprivation, stress, poor diet and lack of exercise takes an unseen toll on women’s bodies, in addition to the already present challenge of finding a partner given the demanding hours. Currently over 50% of medical school students are female. That is over half of the future physicians of our country potentially struggling to conceive one day.

So, what can we do?

First, we start by having a conservation to dispel the stigma surrounding infertility within our society. Second, we need to bring awareness to this very real issue. Many women are unaware of the sheer volume of infertility within our society, especially amongst female physicians. Second, we need to educate and protect the young women in medical school, counseling them in advance. The conversation needs to be had so that women are aware of the risks. Finally, we need more research so that we can use the data to create policies to truly protect and support women in medicine who either want to preserve their fertility through IVF or conceive while in training.

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Sources/Resources:

• Cusimano MC, Baxter NN, Sutradhar R, McArthur E, Ray JG, Garg AX, Vigod S, Simpson AN. Delay of Pregnancy Among Physicians vs Nonphysicians. JAMA Intern Med. 2021 Jul 1;181(7):905-912. doi: 10.1001/jamainternmed.2021.1635. PMID: 33938909; PMCID: PMC8094034.
• Rangel EL, Castillo-Angeles M, Easter SR, Atkinson RB, Gosain A, Hu YY, Cooper Z, Dey T, Kim E. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021 Oct 1;156(10):905-915. doi: 10.1001/jamasurg.2021.3301. Erratum in: JAMA Surg. 2021 Oct 1;156(10):991. PMID: 34319353.
• Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and Childbearing Among American Female Physicians. J Womens Health (Larchmt). 2016 Oct;25(10):1059-1065. doi: 10.1089/jwh.2015.5638. Epub 2016 Jun 27. PMID: 27347614.