Women in Emergency Medicine: Infertility: Using Knowledge to Advocate for Change

WOMEN IN EMERGENCY MEDICINE

Infertility: Using Knowledge to Advocate for Change

Danielle Goodrich, MD FAAEM FACEP

Erin Andrews, an American sportscaster and television personality, recently spoke with People Magazine about her infertility journey. This singular interview was monumental. In our culture, infertility treatments are commonplace, and yet it is far less common to hear open discussions in the media regarding infertility or even within the medical community. Let’s follow Erin Andrews’ lead.

The first step towards addressing our cultural blindness to the issue is acknowledging and understanding how widespread it is in our society. Infertility is defined as the inability to conceive after a year of unprotected, regular intercourse. Infertility has historically been considered a female issue with current estimates suggesting that one in eight women in the United States are affected by infertility. However, fertility affects all persons, men and women, including those who are practicing physicians. It can also affect physicians who have same sex partners and/or opposite sex partners, as well as physicians who are transgender or nonbinary, single physicians, and it can affect those physicians with underlying medical comorbidities. Many of our own colleagues are experiencing fertility difficulties, but may be keeping their struggles to themselves. The ability to openly discuss fertility conversationally is critical to increasing awareness and fostering empathy.

In the medical field, it is estimated that one in four female physicians are diagnosed with infertility and research is just beginning to shed light on how widespread infertility (and its related complications) is within the physician workforce. JAMA Internal Medicine recently published a retrospective study showing that female physicians appear to delay childbearing compared to females in other fields. This is not surprising given the extensive schooling and training it takes to be a practicing physician. When physicians and nonphysicians were compared, it was found that physicians were less likely to have children at younger ages and more likely to delay having children until older ages. This delay in childbearing contributes to more potential risks of infertility as well as adverse maternal and fetal risks. Another study, in JAMA Surgery, demonstrated that female surgeons, in particular, were more likely to delay childbearing, more likely to use assisted reproductive technology, and also more likely to experience pregnancy loss compared to the general population. The article also showed that female surgeons had 1.7x higher odds of pregnancy complications including more musculoskeletal complaints and preeclampsia.

Whether or not you have personally experienced this, there are things that we all can do to address this common medical condition. First, advocate for your colleagues. A number of states mandate coverage of fertility benefits, but very few healthcare organizations outside of these states offer any form of fertility coverage at all. This is highly problematic, but change may be on the horizon. Several notable, large corporations, including Google, Facebook, and others have now upgraded their employee health benefits to include fertility coverage in order to improve employee recruitment and retention. The same can and should be done on a local level within your organization, at least until we can build a critical mass of advocacy to effect change on a national level with mandated coverage across the country.

Additionally, you can also educate your colleagues and your trainees. Consider adding family planning as a part of your wellness curriculum. By helping to reduce the stigma and by having open conversations with residents and trainees about family planning and infertility, we can enable students and trainees to make more informed decisions regarding their futures. Infertility is common and through knowledge and advocacy we can make changes to support our colleagues and future physicians.

References

1. Rangel, Erika L., et al. “Incidence of Infertility and Pregnancy Complications in Us Female Surgeons.” JAMA Surgery, 2021, doi:10.1001/jamasurg.2021.3301.

2. Cusimano, Maria C., et al. “Delay of Pregnancy Among Physicians vs Nonphysicians.” JAMA Internal Medicine, vol. 181, no. 7, 3 May 2021, pp. 905–912.