AAP Voices Blog

I took a typical route through medical school, residency, and sub-specialty training.

I didn’t finish my pediatric critical care training until I was 32. I moved back to my home state and, within a year, began a serious relationship. Like many others my age, I had not really talked about fertility preservation at that time. But I had always wanted to be a mom, and when my relationship ended and I found myself turning 36, I sought the expertise of a reproductive endocrinologist. 

At that time, my anti-Mullerian hormone (AMH) level was already low. The AMH is generated by small egg follicles that house immature eggs, so the higher the number, the higher one’s ovarian reserve. The AMH level can give a sense of how successful the egg retrieval process, or “freezing your eggs,” will be.

I was devastated by my low AMH level, and it was recommended that I not pursue egg retrieval due to the likelihood of a poor result. I felt I had missed my fertility window and was an outlier in a sense.  In fact, 24% of women in medicine have experienced some form of infertility, according to a 2016 study,  compared with 12% of the general population. Many of us are extremely busy with school and residencies and training, and so we put off having children.

“I hope that future women in medicine will be informed about how common infertility is in our profession and that they have plenty of resources to plan for it.”

Even though my AMH was not optimal, I proceeded with fertility preservation due to some additional health factors. I went through three rounds of intrauterine insemination (IUI) after painstakingly selecting a sperm donor. All three rounds were unsuccessful.

The IUI cycles were followed by a final round of egg retrieval with the intent to make embryos with my selected sperm donor. The one embryo that was successfully made during my in vitro fertilization cycle was chromosomally abnormal and non-viable.

Each infertility treatment cycle requires medications, most being injectable and painful. My final cycle required two injections twice a day. There are also numerous lab and ultrasound appointments that must be done on certain days. This schedule is very difficult to accommodate for most working physicians. I was lucky I could rely on my amazing work colleagues to assist me with coverage during these times.

I finally decided to stop pursuing fertility treatments and I am now engaged in the adoption process.

I am sharing my story because infertility planning typically is not spoken about with women or men in medicine. Yet our career paths often mean putting off having children. On average, female physicians have their first child 7.4 years later than the general population.

I encourage training programs, including medical schools, residencies, and fellowships, to incorporate fertility preservation information in their available resources. This is not only important for our trainees, but also for our faculty. Insurance plans also should be transparent about their coverage of fertility preservation.

My costs including, lab work, ultrasound, procedures, sedation, and cryopreservation of the eggs, were entirely out of pocket. This financial burden can be prohibitive, especially during training and early faculty years. Obviously not everyone needs this service, but normalizing the conversation so people are able to speak about it freely is imperative. It also can help reduce the stress that surrounds this process among your colleagues who are struggling with infertility.

I hope that future women in medicine will be informed about how common infertility is in our profession and that they will have plenty of resources to plan for it. Reflecting on my journey, I wish someone had shared this news with me during my training, and I hope this information can reach those who need it.

Even if infertility doesn’t affect you, you can be supportive of those colleagues who are dealing with it.

For those looking for help, here are four steps to get you started in the world of infertility.

• Contact or review your insurance. Ask about coverage for fertility visits, labs, and treatments.
• Research local clinics. Read reviews of the practices. Investigate success rates and how they communicate with patients. There is frequent communication required, so this needs to be efficient and effective. Check with colleagues; it will surprise you how many people have pursued fertility conversation and/or therapy.
• Make an appointment for consultation. There are often wait times at busy practices and then required lab work and paperwork before any decisions can be made. Ask about payment plans as well.
• Read “It Starts with the Egg” by Rebecca Fett. There is not much control we have during this process, but this book has been widely read by patients and reproductive endocrinologists and gives some suggestions for lifestyle modifications and supplements that may be helpful.

Special thanks to Dr. Lauren Weissmann, a reproductive endocrinologist for assuring my vocabulary was accurate and for fighting infertility every day.