“I wish I had known how common this is. I would have started sooner.” It is currently estimated that one in four women physicians has infertility (compared to one in eight in the general population). Why do I care? Because I’m one of them. But truly, we should all care. These women are our partners, colleagues, trainees, and friends. Their experiences shape the landscape of physician wellness for all of us. To better understand the unique issues of navigating infertility and a career in medicine, I conducted an anonymous survey of women physicians with infertility about their experience. Over 150 responded. I want to share their voices with you. “I didn’t realize how long and emotionally taxing this journey would be.” Many of us suffer in silence for myriad reasons. Being a physician with infertility presents a perfect storm of stress, anxiety, guilt, and shame – all of which we know don’t contribute to managing any medical problem. Consider what it’s like to undergo a typical cycle of in vitro fertilization. You administer nightly hormone injections to grow your follicles in preparation for an egg retrieval procedure. The process usually takes 1-2 weeks, but you don’t know exactly how fast your follicles will grow. For the first week, maybe you just need to arrange to get away from the hospital or clinic for a couple of blood draws. But during the second half of your stimulation cycle, you must physically go into your clinic for daily transvaginal ultrasounds to monitor the progress. “Labs have to be done by ten, but I have to be at work at six. At one point, the nurse provided needles and vials, gave me access to the back door, and I drew my own blood and dropped it off on my way to work.” The final call of when the follicles are mature enough for ovulation trigger and egg retrieval is completely out of your control. Every day you go in and wonder: will I be having a surgical procedure 36 hours from now? And once the trigger injection is given, the clock is ticking. You must undergo your egg retrieval (a surgical procedure with anesthesia) before precious time runs out. Does this process sound compatible with a typical clinic schedule, ICU or ED shift, surgery schedule, or day in the OR? On top of the timing uncertainty, things sometimes go wrong. Cycles get canceled. Complications occur. Sure, you could use all your vacation time (if you’re allowed to ask on that short of notice) – this is what I did. But if you must start all over, you might be looking at thousands of lost dollars, lost rapport with colleagues previously willing to help you in a pinch, reprimand by administration for last-minute schedule switching, and the worst consequence of all, lost time being pregnant or being a mother. “This has been the most stressful part of the whole process, the inability to know when my cycle starts and then having to switch my shifts for tentative dates in a cycle.” It’s difficult enough to get coverage when emergencies come up, and we all know that not taking time off for illness is ingrained in the culture of medicine. Now imagine begging colleagues to switch shifts on short notice for a medical problem you may not really want to talk about. Even among the medically knowledgeable, a diagnosis of infertility still carries shame and stigma. On top of this, the period of life that seems right for building a family often coincides with either residency training or setting down roots in a new job as an attending. “Many, many hours went into rescheduling shifts/coverage. And it was difficult because I did not want to disclose to everyone why I needed to do this. It was very stressful!” When it comes to how partners, colleagues, and health care leadership can help, these women most often mentioned the word flexibility. Please know that infertility procedures can’t be scheduled far in advance, so the best thing you can do is help cover shifts and patients without probing too much into why. Please do not design or promote policies that involve punitive consequences for last-minute scheduling changes or vacation requests. “I work outpatient family medicine. I’m expected to give 90 days’ notice for more than two consecutive days off and 30 days’ notice for one day off. Often impossible to do and resulted in a write-up in my annual review for ‘unplanned absences.'” In the workplace, we need to move toward treating infertility just like any other medical diagnosis; we help our colleagues with shift coverage when it involves cancer, surgery, or a death in the family. Why don’t we readily do this for fertility procedures or recovery after a miscarriage (a.k.a. death in the family)? It’s time we destigmatize a health problem that is so common amongst physicians. “I’ve had to work while actively and painfully miscarrying because I don’t have enough vacation time to use (nor is this a vacation).” “I had to be hospitalized due to a complication and was reprimanded by not telling my boss when I was discharged so I could take over the call he was covering. So I couldn’t take prescribed pain medications and was miserable.” If you’re a leader in your organization, consider advocating for insurance policies that cover infertility treatments. Among the cohort of women I surveyed, the average cost of their infertility journey has been $60,000. Better financial health for your physicians trickles down in so many ways: less burnout, more retention, better morale, more effective patient care. “People with infertility already feel like a burden and nuisance, and they don’t want to cheat anybody so allowing flexibility in scheduling is beneficial for all.” What can you do as a woman in medicine? The advice these physicians would most commonly give to other women on the path of a medical career is to investigate their fertility earlier rather than later. “Freeze your eggs before 35!” In addition, because infertility can be very isolating, these women commonly advise against keeping it a complete secret. Consider notifying key players at your workplace, such as a supervisor or scheduling partner. Find a support system; look to trusted colleagues, coaches, therapists, or even physician Facebook groups for help. Advocate for yourself with your fertility clinic and your workplace. Be aware of your present priorities. Lastly, I want to point out that not all these voices ring cautionary or punitive. While there is no guarantee that it will work out, many of us go on to become physician mothers. Even though the path is not what we expected. “I wish I knew when I started that I was not alone.” “In the end, it was all worth it.” If you’re a physician suffering from infertility and want someone to talk to, please let me know. You are not alone. Source
