Medicine robs physicians of their fertility. Here’s how to fix it

“The Retrievals,” a disturbing podcast from Serial and the New York Times released this summer, painstakingly tells the stories of women who sought fertility treatments at the Yale Fertility Center in 2020. Over the course of five months, women underwent egg retrievals without any pain medication. Although this procedure is typically done under heavy sedation, a nurse at the clinic had replaced fentanyl with saline.

This is not the first time a health care worker has diverted pain medications away from patients. One thing that stands out, though, is how the clinic ignored up to 200 women’s pain for such a long time. Imagine men undergoing vasectomies without pain medication. How many times would that happen before someone believed them? It’s safe to guess fewer than 200.

As the podcast illustrates beautifully, these procedures are emotionally charged and physically painful even in the best situations. Our team has been studying infertility and the family-building process (defined, in this context, as the addition of children to one’s family) among the physician workforce for years. Two of us have even used assisted reproductive technologies (ART) ourselves, motivating our interest in this area. One of us (Arghavan) chronicled her unsuccessful efforts to freeze her eggs at age 38 after completing surgery training and is still hoping to be able to have a baby using ART five years later, at age 43. After multiple failed cycles of ART, one of us (Vineet) sought professional therapy to heal before continuing and now has a healthy 3-year-old boy.

Physicians are at high risk of experiencing a burdensome family-building journey because our prime reproductive years intersect with lengthy years of training. Some, like one of us (Morgan) become aware of these challenges in medical school, especially when encountering a graph of female age-related fertility decline: the subtle descent at age 32, a steeper drop up to 36, and the sharpest plunge after 37. Recognizing the tug of war between their career path as physicians and their personal goal of building a family, students may look into egg-freezing success rates — and likely be underwhelmed. The chance that a single frozen egg leads to a live birth is about 6%.

While, as a profession, we have started to talk about the high rates of infertility and the need for improved education, we are still not openly discussing the negative enduring impacts of family-building journeys.

Our recent study published in JAMA Internal Medicine begins to unpack the burdens physicians and medical students face on their journey to building families. We surveyed 3,310 physicians and medical students of all sexes, genders, and sexual orientations and found almost two-thirds delayed childbearing due to training. Most (55.8%) who had delayed regretted doing so. More than one-fifth (21.1%) of the whole sample, whose ages ranged from 18 to 81, reported meeting the criteria to be diagnosed with infertility; 31.5% of those age 32 and above met the same criteria. More than a quarter (28%) of those with infertility reported it negatively affected their well-being. And approximately 19.2% of those in our sample said they had undergone ART.

Although we know many physicians utilize ART to build their families, our study is the first to show they are six times more likely to report relationship strain and four times more likely to go to therapy to cope with family-building stress. This is consistent with previous evidence  showing that infertility patients experience elevated levels of depression and anxiety. Even if you have a clinically “good” outcome, the wounds sustained in this process often turn into permanent scars.

These psychosocial burdens and career pressures not only affect physicians’ personal lives; they also affect our careers. A recent study in JAMA Network Open showed many women physicians altered their career paths to accommodate family-building by reducing work hours (47.1%) or passing up opportunities for advancement (47.2%). Our workplaces can do more to support those who want to grow their families. Along with improving fertility care coverage, which we have previously advocated for, physicians and medical students should be supported to access coverage or arrange schedules so they can attend necessary appointments without guilt.

Access to therapy during these times is also critical, including before and during pregnancy and postpartum. A previous study of physician mothers found that 25% experienced postpartum depression, compared with 1 in 7 women in the general public. To better support physicians building their families, workplaces should also provide appropriate leave to both birthing and non-birthing parents and minimize the stigma around seeking accommodations that support family building.

The often-irreversible damage experienced by physicians and medical students who lose their fertility due to systemic pressures in medicine is unconscionable. Many in the current generation of medical professionals have suffered immensely, and future generations will continue to do so if positive change is not made. Those who dare to want to build a family and become a physician at the same time will continue to fare poorly in their personal lives, even as they dedicate their professional lives to supporting their patients’ health.  The pain of infertility isn’t just in the procedures; it’s embedded in the very path we have to walk to do what comes effortlessly to so many.

Morgan S. Levy is a medical student in the M.D. and masters in public health program at the University of Miami Miller School of Medicine. Vineet Arora, M.D., MAPP, is the Herbert T. Abelson professor of medicine and dean of medical education at the Pritzker School of Medicine at the University of Chicago. Arghavan Salles, M.D., Ph.D., is a senior research scholar at the Clayman Institute for Gender Research and the special advisor for diversity, equity, and inclusion programs at Stanford University Department of Medicine.