I always believed that if I worked harder, smarter, and longer, I would be successful—and although this is true, to an extent, I gave up my ability to become a mother.
I graduated at the top of my class in high school, attended a prestigious 4-year public university, graduated from medical school and residency, and in my 30s, I began my career as a physician. I worked long, grueling hours to pay off my medical school loans, purchase a modest home, and build the desired lifestyle. I purposely wanted to wait to start a family until I felt I was financially stable and gainfully employed.
For physicians, our lives are very planned out to the extent that many women decide to have children only after they finish their training and are financially stable, which usually means the mid-30s.
When I finally was ready and decided I wanted kids, I found out I could not bear children, even with fertility drugs and treatments.
Medical training comes at a cost
Although it is difficult to prove this, my fertility specialist and I firmly believe that my inability to conceive was due to the amount of stress, long hours, night shifts, and emotional and physical burnout that comes with being a physician and caring for patients. All of these factors can affect reproductive cycles.
"This news broke me, and it took me a while to grieve the loss of never becoming a biological mother."
— Kristen Fuller, MD
It also was a complicated reality to face that I potentially gave up becoming a mother so I could take care of patients, which in my opinion is the ultimate sacrifice one could make. However, I am not alone; many female physicians share my journey and heartbreak.
Unfortunately, infertility, pregnancy complications, and loss are more common in women physicians than in the general population, according to research.
Long work hours, prolonged standing without water and food while on the job, lack of paid maternity leave during training, reliance on assisted reproductive technology, and delaying childbearing due to the constraints of the job are some of the underlying factors associated with fertility complications in female physicians.
Looking at the research
Additionally, female surgeons operating 12 hours per week in their third trimester were at higher risk of significant pregnancy complications than those operating less than 12 hours per week. Female surgeons are also more likely to have musculoskeletal problems, emergency cesarean sections, and postpartum depression than females in the general population.
The authors proposed three recommendations to address these issues:
Training programs should include clear, widely disseminated policies to support pregnant trainees.
Institutions and practices should adopt supportive work plans for pregnant physicians and physicians on maternity leave.
Trainees and physicians should be provided with resources, time, and space to meet their reproductive and childcare needs.
Infertility among female physicians was the focus of a study published in the Journal of Women’s Health. Nearly 1 in 4 female physicians in the study who attempted to become pregnant were diagnosed with infertility.
The average age at the infertility diagnosis was 33.7 years.
Among the women with infertility, 29.3% reported diminished ovarian reserve.
When asked what they would do differently in retrospect, over half of the respondents (56.8%) would do nothing differently regarding fertility/conception/childbearing, but 28.6% said they would have attempted conception earlier. Others (17.1%) would have gone into a different specialty, and 7.0% said they would have used cryopreservation to extend fertility.
Maternal discrimination is pervasive
Female physicians who pursue pregnancy during their medical training have often reported discrimination against their decision to have a child during their training, which has resulted in negative career experiences.
Writing in the Canadian Medical Association Journal, researchers define maternal discrimination as referring to “gender-based discrimination specifically based on motherhood status.” This can take many forms: Women may experience it as a lack of support during pregnancy and postpartum, or as a lack of accommodations for childcare challenges.
They may hear disparaging remarks being made related to pregnancy and motherhood.
Ultimately, they may find that they are excluded from career opportunities.
Female medical students are often dissuaded from entering surgical specialties based on the assumption that they will have children. This can lead to a detour in their medical careers.
As a result of these many factors working against them, many women delay pregnancy until they have completed their medical training. This can come with a high personal cost that includes increased rates of pregnancy complications, miscarriages, and infertility.
Choosing between becoming a mother or having a medical career should not have to be a choice. Female physicians should be supported throughout their pregnancy and early stages of motherhood. They should be encouraged to have children without facing the complications of infertility and pregnancy loss due to advanced maternal age.
Unfortunately, we train and work in a broken system that breaks us in return. Hopefully, organizations such as the AMA, APA, AAFP, ACOG, and other medical societies can band together and propose training programs and policies to support females who desire pregnancy or become pregnant during training.
This can mean broadening the number of residency slots so female trainees going through fertility treatments or pregnancy can take ample paid time off. This also means reducing workloads and hours for females undergoing fertility treatments and pregnancy. Having in-house programs that offer mental health services for individuals undergoing fertility treatments and pregnancy would be beneficial, as would openly discussing pregnancy during training to break down the stigma. Offering fertility treatment through insurance plans is another measure that could have a positive effect.
This topic should also be openly discussed in medical school to educate female medical students on the options of fertility treatments, oocyte cryopreservation, and family planning so that female physicians can make informed decisions about their personal lives.