National Infertility Awareness Week
Brief Summary and Commentary on “Physician Fertility: A Call to Action”
By: Brooke Wangler
Director’s Note: During National Infertility Awareness Week, we are featuring research that explores the statistics surrounding rates of infertility among physicians. Brooke Wangler, a former FACTS elective participant, summarized a review published in 2020 in Academic Medicine. [2] Titled “Physician Fertility: A Call to Action,” the article noted higher rates of infertility (1 in 4) among female physicians in the United States compared to the general population. Sharing her hopes of becoming both a physician and a mother, Wangler described the knowledge gap she had about her own fertility prior to the FACTS elective. She emphasized the value of educating physicians about their reproductive health beyond what’s available in the current curricula of most medical schools.
Introduction
Titled “Physician Fertility: A Call to Action,” the article noted higher rates of infertility (1 in 4) among female physicians in the United States compared to the general population. Sharing her hopes of becoming both a physician and a mother, Wangler described the knowledge gap she had about her own fertility prior to the FACTS elective. She emphasized the value of educating physicians about their reproductive health beyond what’s available in the current curricula of most medical schools.
“With growing numbers of women seeking careers in medicine, the potential impact of this choice on their fertility is an increasingly important topic … [as] 1 in 4 (24.1%) female physicians will experience infertility.”
Infertility has substantial negative consequences on a person, from emotional distress throughout the journey to the heavy financial burden it places on most individuals. This article aimed to propose specific strategies to address the high rates of infertility among physicians and to improve the lives of hardworking female physicians who desire a family.
Proposed Strategies
Education as the Starting Point
The first strategy outlined by the authors was to implement more formal education and awareness for medical professionals about fertility, beginning in medical school and continuing throughout training. Having received very little education in training about my own fertility prior to the FACTS elective, I agree that including this topic would benefit students prior to starting a career in medicine and having to decide whether and when to have children. According to the authors, all learners and medical professionals, from new medical students to practicing physicians, should be educated on the rates of infertility among physicians as well as the potential mental and financial consequences of managing infertility for individuals and their families. They propose using the online educational resources available through the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) as the foundation for an implemented training program.
Accessible Fair-cost Care
Alongside education, the second strategy recommended is improving access to fair-cost care to fertility evaluation and treatment. This would include providing a detailed fertility assessment for the couple by a specialist to enable more informed decisions about family planning. Beyond a detailed reproductive history and physical exam, an assessment of ovarian reserve or sperm quality would be performed. Yet, the FACTS course in fertility awareness cautions that using markers such as anti-müllerian hormone (AMH), inhibin B, and antral follicle count to determine ovulatory potential can be misleading, as they only reflect the “presence of growing follicles capable of stimulation and ovulation” as opposed to a direct measurement of the size of the whole follicle pool. [3] In fact, teaching women to chart their cycles would be an ideal cost-effective starting point, as it would enable them to more fully understand their cycles and their fertility potential.
Education about fertility awareness-based methods (FABMs) could be highly beneficial for this group of women so they can establish a baseline and possibly identify reproductive problems earlier. Without charting, many women have no way of knowing they could possibly have fertility problems until they start attempting to achieve pregnancy. This type of education would equip them with more information earlier so they can make more informed decisions. The improvement in access to care proposed by the authors would also involve institutions such as hospitals and residency programs working with insurance companies to provide coverage for fertility visits, education, and possibly fertility treatments or cryopreservation.
“Education about fertility awareness-based methods (FABMs) could be highly beneficial for this group of women so they can establish a baseline and possibly identify reproductive problems earlier.”
Increased Support
The authors also urge institutions to provide increased support for trainees and physicians navigating infertility management. They emphasize the negative effects treatment can have on the individual and couple, including physical, emotional, and financial burdens, particularly if it takes a long time to conceive or they never achieve pregnancy. The authors recommend providing mental health support through counseling and flexible policies, including time coverage for those who will miss work seeking treatment, and family leave if necessary.
A Medical Student Perspective
While these suggestions would help those working through infertility, providing more flexible scheduling in general would help change the current attitudes and reservations physicians have about having children in the first place. The reality is that most women in medicine will be in medical school, residency or early in their careers during their childbearing years. Time and nature will run their course no matter what plans we have for ourselves. There needs to be a way for female physicians to have both successful careers and families. We need to find ways to change the stigma around pregnancy and parenting during medical training.
Execution of these strategies and documentation of the outcomes would be very helpful for future research in this area to help improve fertility outcomes for physicians. Knowing the impact infertility can have on someone’s life and career, it would be valuable for all physicians to be educated on FABMs and female cycle charting not only for their patients but also for their health so they can track and understand their fertility. If by charting her cycles a woman can see clues about what is happening in her body and discuss it with a trained medical professional, she may be more inclined to seek fertility assessment before it is too late.
“Knowing the impact infertility can have on someone’s life and career, it would be valuable for all physicians to be educated on FABMs and female cycle charting not only for their patients but also for their health so they can track and understand their fertility.”
Beyond this essential education, we need to change the expectation and overall outlook on parenting within the field. It should not be as difficult as it is to raise a child and be a physician at the same time. Much work needs to be done to change the way we look at childbearing in this field and make it more achievable for any physician who desires a family.
References
[1] Boyle, P. “The Nation’s Medical Schools Grow More Diverse.” AAMCNews, 13 Dec. 2022, https://ground.news/article/the-nations-medical-schools-grow-more-diverse. Accessed 12 Dec. 2023.
[2] Marshall AL, Arora VM, Salles A. Physician Fertility: A Call to Action. Acad Med. 2020;95(5):679-681. doi:10.1097/ACM.0000000000003079.
[3] Golden-Tevald, J. “Perimenopause: Considerations for FABMs.” Class lecture, FACTS About Fertility Part B, Georgetown University. Accessed Dec. 2023.
ABOUT THE AUTHOR
Brooke Wangler
Brooke Wangler is a fourth-year medical student at Ohio University Heritage College of Osteopathic Medicine in Cleveland, Ohio. She completed her undergraduate education at Clemson University in Clemson, South Carolina. She plans to pursue residency in pediatrics and is interested in adolescent mental health and primary care. She enrolled in the FACTS elective to learn how to better counsel her adolescent female patients on charting their cycles. She hopes to empower them to feel in control of their health and to understand the underlying physiology as they go through menarche and beyond.
