A Medical Career, at a Cost: Infertility

From the beginning, Dr. Ariela Marshall, a hematologist at the Mayo Clinic in Minnesota, believed that if she worked harder, longer, and better, she would be successful. And that’s what she did: she graduated from high school, attended an elite university, and was accepted into a top medical school.

But she missed one achievement: having a baby. She had put the pregnancy off until it was firmly established in her career, but when she finally decided to have children at 34, she was surprised that she couldn’t, even with fertility drugs. Dr. Marshall attributed this to frequent night shifts, as well as stress and lack of sleep, which can affect the reproductive cycle.

When she turned to other doctors to tell her story, she learned that she was nowhere near alone; many women in their jobs have also struggled with infertility or having a baby.

“For many doctors like me, everything is planned that way,” said Dr. Marshall. “Many of us choose to wait until we are finished with our education and financially independent in order to have children, and that doesn’t happen until we are in our mid to late 30s.”

To raise awareness of the problem, Dr. Marshall on establishing an Infertility Task Force with the American Medical Women’s Association. In June, the association held its first national physicians fertility summit, with egg freezing sessions, benefits and insurance coverage for fertility treatments, and 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 percent had suffered a pregnancy loss – more than twice the rate of the general population. Almost half had experienced pregnancy complications.

Like other doctors, many surgeons postpone pregnancy until after their specialist training, which makes them more prone to health problems and infertility problems.

Doctors often have to complete 10 years of medical studies, specialist visits and grants. The median age for women to complete their medical education is 31, and most female doctors give birth for the first time, on average, at 32, according to a study from 2021. The average age for non-doctors is 27 years.

Dr. Marshall with two other doctors who were also struggling with infertility, and last year they wrote about the problem in Academic Medicine magazine, calling for more fertility education and awareness among aspiring doctors, starting with undergraduate degrees. They also suggested providing insurance coverage for and access to fertility testing and management, and providing assistance to people undergoing fertility treatment. (In December, Dr. Marshall gave birth to a healthy boy after completing a successful IVF cycle.)

For a year, Dr. Arghavan Salles, 41, to freeze her eggs, but none were viable. Dr. Salles, author of the article and a Stanford surgeon, is also struggling with the cost of the procedure, which can cost up to $ 15,000 per attempt. She is looking for an intrauterine insemination that is cheaper but has a lower chance of success.

In 2019, she wrote an essay on Time about her most fertile years as a surgeon, only to find it might be too late for her to have a baby. After that, many doctors contacted her and said that they had also dealt with infertility.

“They all felt so alone,” said Dr. Salles. “You’ve all gone through this roller coaster ride of dealing with infertility on your own because people just don’t talk about it. We need to change the culture of medical school and residency. We need to better encourage leaders in this area to say, ‘Please, go and see what you have to do.’ “

Sleep deprivation, poor nutrition and a lack of exercise – the requirements of medical training and the medical profession – challenge women who want to become pregnant.

The search for a partner can also be a challenge in view of the demanding working hours, even at night and on weekends.

“The problem is you have to spend a lot of time in the hospital and it’s very unpredictable,” said Dr. Salles. “You could look back and say, ‘I should have frozen eggs in my early twenties,’ but the technology wasn’t very good then. We see older women who are celebrities on the news having babies and we think it will be okay, but it isn’t. Now we all have the realization 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 another author on the article, ponders how she and other educators can best advise medical leaders to address these issues.

“What surprised me most is that for many of these women, infertility is a silent struggle, but when you see the data you find that this is not uncommon,” said Dr. Arora, who had many IVF cycles in her 40s, finally had her second child in March last year.

You and Dr. Salles analyze data from a large study they conducted, interviewing doctors and medical students about their experiences with building families and accessing infertility treatments.

Female residents who manage to get pregnant also struggle with poor health outcomes; many go into early labor or miscarriage due to long hours and stress at work. Nevertheless, pregnant female residents are expected to work 28-hour shifts without sleeping. Dr. Arora and others would like to see this change.

Dr. Roberta Gebhard, chair of governance and former president of the American Medical Women’s Association, said the group is advocating more precautions for pregnant doctors to try to have a baby later in their education.

“We train medical students and medical students about fertility problems so they are aware of them,” she said. “People say you can’t be a mother or a doctor, and we tell you you can, but you have to keep your options open. Much of it isn’t just about getting pregnant. Some of these women are so focused on their careers that they do not enter into a relationship. “

Finding the time and private space to express breast milk while at work can even be a challenge for doctors with babies. Dr. Gebhard said a doctor, who asked for time to pump, was instructed to go behind a potted plant in a public area.

She is optimistic that things will 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 women.

Dr. Racquel Carranza-Chahal, 30, recently completed her residency in gynecology and now has her own 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 if I wanted a scholarship, I would have to divorce my husband and lose custody of my child,” said Dr. Carranza Chahal.

She was on call the day she spoke and had just completed her second 24-hour shift in seven days.

In 2019, she founded a nonprofit called Mothers in Medicine, which she hopes will increase visibility and publicity for doctors who are pregnant or who are mothers.

“I want mothers in education to know they should take their places, that they belong, and that they have resources available to them, including legal ones,” said Dr. Carranza Chahal. “Many residents give birth too early and have complications. One day I’ll change that. “

source https://www.bisayanews.com/2021/09/13/a-medical-career-at-a-cost-infertility/