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An Rx for Reproductive Life Planning

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One in four female* physicians struggle with infertility. Imagine spending years working toward your career in your 20s and early 30s — your most fertile years — finally entering the workforce as an attending physician, then trying to have a child only to realize that you cannot have the family you’ve always dreamed of.

Medical trainees spend upward of a decade in training between medical school and residency — and for some, fellowship as well. In an effort to advance their careers, many trainees forgo starting a family or even considering family planning until it is far too late. This leads to disappointment and frustration atop the massive financial burden posed by fertility treatments, which are rarely covered by insurance. By educating young trainees on reproductive life planning, these fertility challenges can be discussed and potentially avoided.

For trainees like Maryam in the midst of pursuing what is considered a selfless profession, we must remind ourselves that it is not selfish to take the time to plan aspects of our lives such as having children. Investing this time in reproductive life planning early on in our training can prevent an emotional, physical, and financial burden later on.

IGNITEMed partnered with the Women in Medicine Summit (WIMS) to offer a lecture on Reproductive Life Planning at the student pre-conference. In their remarks, Dr. Julia Files, founder and CEO of IGNITEMed and myself (Dr. Marshall), the organization’s Curriculum Chair, emphasized the fact that women's fertility rates begin to decline sharply around age 35 — the age at which many women are completing training or trying to build momentum in their early careers, and a time at which planning a pregnancy might seemingly jeopardize future opportunities. Taking time away from medicine to bear and raise children can prevent one from forging crucial relationships with mentors and sponsors, cause burnout, and even affect the status of one’s medical license.

Dr. Files and I worked to create a “formula” to help women in medicine with reproductive life planning, not in an attempt to encourage earlier child-bearing, but simply to get women thinking early about the potential risks to their fertility and future child-bearing potential. This encourages trainees to consider what steps (such as ovarian cryopreservation) can be taken to potentially mitigate these risks in the future. The formula: Multiply one’s desired total number of children by the ideal spacing (in years) between each child, then subtract that value from the age at which you’d like to have your last child. The resultant value is the age you should start having children. If that age doesn’t work with the demands of medical training, then perhaps reproductive technologies such as cryopreservation are worth considering. Dr. Files and myself, along with Lauren Green (“Dancing with Markers”) assembled a straightforward worksheet depicting this formula, demonstrating that reproductive life planning doesn’t have to be complicated.

Previously, we had dismissed the need to consider when we might start families. We found the idea to be intimidating and overwhelming. As we heard more about the prevalence of female physicians struggling with fertility, these difficulties felt like an inevitable reality.

After attending the Reproductive Life Planning lecture, I (Maryam) realized that reproductive life planning isn’t as complex as I once thought. As a trainee, I now feel empowered to take agency over my future family plans. I am grateful I had the privilege to hear this talk, and I hope to share this knowledge with my peers who may not have had the impetus to consider their own reproductive life plan.

Medical schools offer a platform to start the conversation surrounding reproductive life planning. While preclinical coursework and clerkships place large demands on trainees’ time, even a single lecture on reproductive life planning would expose students to ideas they may not have considered about their future fertility. Institutions must empower their trainees to prioritize both their careers and their personal goals outside of medicine, which may include starting a family. Planning for a family, navigating maternal leave and cryopreservation, if necessary, have massive ramifications on one’s professional life. In my medical school, “cura personalis,” or care for the whole person, is a cornerstone of patient care. It’s time we start adopting this attitude toward ourselves as medical trainees and professionals.

IGNITEMed’s worksheet alone offers a concise, digestible summary that would certainly have an impact if dispersed on a larger scale. By imparting knowledge on reproductive life planning early on in trainees’ careers, we may reshape the culture of conversations about fertility in the healthcare space. During their Fireside Chat at WIMS, Dr. Vineet Arora and Dr. Arghavan Salles spoke candidly about their own fertility challenges in front of an audience of hundreds. The more we openly discuss these challenges, the more we may foster a dialogue on improving the culture surrounding infertility in medicine instead of suffering in silence.

It is important to note that education comprises a small step toward the solution of a broader systemic issue. The journey to becoming an attending physician is extremely costly, and cryopreservation can be even more financially burdensome. Shady Grove Fertility demonstrates support for residents’ fertility journeys by offering a cost-reducing program for residents intending to freeze their eggs. Aside from financial support, residency programs must create a cultural shift in their discussion of pregnancy and fertility. We must reduce the shame that is cast upon candidates who strive to start a family during residency. Lastly, on a societal level, taking time off to have children shouldn’t negatively impact a physician’s opportunities for professional advancement. We need more women in leadership positions in medicine. Therefore, we must be more accommodating of career interruptions that ensue due to pregnancy and fertility treatments. Empowering women in medicine requires a multifaceted approach. Education offers a first step in the right direction.

Infertility is not inevitable. You can have a successful career in medicine and start a family with the proper guidance and foresight. While the medical education system currently fails to offer trainees support in reproductive life planning, medical schools have the opportunity to play a significant role in reshaping the culture and conversation surrounding infertility.

*Note: In using the terms “woman” and “female,” we intend to refer to all people with uteruses. We aim to be inclusive of all individuals regardless of their gender identity, as the issues of fertility and reproductive life planning extend beyond gender lines.

Maryam Bolouri is a second-year medical student at Loyola University Chicago Stritch School of Medicine. She is passionate about medical education and health equity. You can find her on Twitter @maryam_bolouri. Dr. Ariela Marshall is a hematologist at the University of Minnesota and leads multiple national advocacy initiatives supporting women in medicine.  She is on Twitter @AMarshallMD.

Image by Visual Generation / Shutterstock

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