For many, medical training is a race against the biological clock.
It is no surprise that 1 in 4 female physicians struggle with infertility — a rate markedly greater than that of the general population. Many trainees spend their most fertile years in residency, overworked and sleep-deprived, before they can consider starting a family. By the time of residency completion, one’s natural fertility has already begun to decline. Egg preservation offers a safe, reliable solution for female trainees who plan to start a family toward the end of their training. But staggering out-of-pocket costs put these treatments out of reach for many.
Despite this, most residency programs do not cover the costs of fertility preservation for trainees. One survey found that a meager 12.5% of trainees had fertility preservation covered by their program’s insurance and that the majority of residency program directors were unaware of their programs coverage for fertility preservation services. This is an unacceptable scenario. Residency training, particularly for surgical specialties, places significant constraints on trainees’ time. For those who hope to balance starting a family with fostering the start of their career, the demands of training can dissuade talented, qualified applicants from more time-intensive specialties. Fertility preservation offers an opportunity for trainees to have a pregnancy and live birth at a later date, permitting them to focus on training and career development during residency.
Fertility preservation is prohibitively expensive, starting at upward of $11,000, a conservative estimate that does not account for those who undergo multiple cycles or require additional medications to support the process. This estimate also does not account for storage, which can cost around $500 annually. Meanwhile, the average first year resident makes $63,800, and 73% of medical graduates entering residency have educational debt. It is impractical and unrealistic to expect residents to fund their own fertility preservation treatments out-of-pocket given their financial constraints. To support the health and well-being of female trainees, residency programs must eliminate this financial stressor by covering the costs of fertility preservation.
At this year’s Women in Medicine Summit (WIMS), Dr. Serena Chen and Dr. Stephanie Thompson presented on the utility of egg preservation. They provided an overview of the process and clarified mistruths, such as the disproven idea that frozen eggs are less successful at resulting in a live birth compared to frozen embryos. As I listened to this talk, I felt empowered by this information, knowing I had the ability to take control of my future fertility through egg retrieval. But I was soon reminded of the current landscape surrounding fertility preservation. The recent IVF ruling in Alabama slowed egg retrieval and preservation to a halt in many clinics, creating a barrier for women seeking this service. Another attendee of this talk mentioned that her residency covered the cost of storing frozen embryos, but not frozen eggs. This is a sexist, paternalistic practice that pressures individuals into selecting a sperm donor and punishes those who did not have a partner to contribute sperm. While the AMA has encouraged residencies to provide coverage for fertility preservation, few programs currently cover these services. This culture must change. Fertility preservation is essential for many trainees, and it should be treated as such.
As part of this culture shift, residency programs must offer greater institutional support for those who choose to undergo fertility preservation. This includes providing trainees with formal education through workshops and seminars as well as access to fertility counseling. With greater access to fertility education, female trainees can make informed decisions and plan effectively. For those who plan to undergo egg retrieval, women under 34 have a 74% chance of a successful egg freezing cycle, but that number drops to 18% by age 38. Therefore, it is important that trainees are made aware of the statistics surrounding fertility preservation early on in their training so if desired, they are able to schedule these procedures seamlessly. Residency scheduling should allow flexibility to take time off for fertility-related appointments, so trainees are able to take the day off after egg retrieval for their health. These measures would create a supportive environment for those who plan to undergo fertility preservation.
Some may argue that egg preservation is an unnecessary expense whose responsibility should not fall on the employer. Covering this service may increase cost burdens on hospitals and academic institutions. Additionally, egg preservation is an elective, non-life-saving service, making it a questionable priority for a tight hospital budget. However, this perspective does not take into account the unique demands placed on medical trainees. Residency training is grueling. Work schedules and maternity leave policies can make it challenging for female trainees to start a family during this busy time of career-building. With high patient volumes staffed by few residents, one trainee’s absence can cause a domino effect on colleagues and significantly increase their workload. As long as this system exists, residency programs must do more to support female trainees who are making an intentional choice to focus on career now and family later. Competing priorities of family and career can discourage some female trainees from pursuing particular specialties of interest. Covering the cost of fertility preservation for trainees would empower trainees to pursue the specialty they are most passionate about without feeling restricted by concerns about delayed family planning. Institutional support would allow trainees to excel in their field while balancing future plans to start a family. Apple and Facebook began covering this service for employees nearly a decade ago. It is time for the medical field to catch up.
Residency training requires significant sacrifice. Offering institutional support, both in terms of finances and education, would recognize the sacrifices trainees make and provide them with the resources to plan for their reproductive future while balancing the demands of medical training. Fertility preservation is not a luxury. It is health care, and it is time it is treated as such.
Maryam Bolouri is a 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.
Image by YULIIA ANTOSHCHENKO / Getty Images
