Why I Chose to Freeze my Eggs: An EM Physician’s Personal Account

By Amanda J. Deutsch, MD, on behalf of the SAEM Wellness Committee and SAEM Academy for Women in Academic Emergency Medicine

Becoming a doctor comes with its fair share of sacrifices. There are weddings I’ve been forced to miss but sent gifts; vacations and family events that have caused major FOMO; a never-ending list of acclaimed movies that I never had the chance to watch yet am confident I will find time to watch in the future. These missed opportunities are just a glimpse of the consequences I knew came with the job. However, one consequence I was oblivious to until I entered residency was the additional risk being a doctor posed to my future children.

In this account, I want to highlight two crucial aspects of a complex topic. Firstly, I aim to raise awareness about the prevalence of infertility among women physicians. The number of female physicians in the workforce increases yearly, as highlighted by the recent AAMC report, which states that over a third of physicians are now women. Secondly, I want to share my personal journey of facing the reality of aging eggs. Let me preface this with where I am in this journey. I am a few months past my 35th birthday, happily committed to a long-distance relationship due to my career, and nowhere near ready to have children. However, someday I want the option to have children. Sadly, I am all too aware of the odds of infertility faced by female physicians. I wonder if my fellow physicians, both women and men, are aware of this as well.

Medical schools fail to emphasize the increased risk of infertility for female physicians. It still isn’t considered normal to discuss one’s journey to starting a family, as it may seemingly contradict the goals of our profession — to help others. Due to this prevailing silence, by the time decisions about starting a family arise, it’s often riskier or, worse, too late. In a recent publication, Academic Medicine issued a call to action, urging for increased education and awareness about available options for female physicians starting from undergraduate education and advocating for changes such as insurance coverage and support.

Let me be clear: women in medicine face a higher risk of infertility. According to the CDC, the general female population has an estimated infertility risk of 12 to 19%. In contrast, female physicians have an increased rate of

24.1%, meaning that 1 in every 4 female physicians is infertile. This higher rate is often attributed to women in medicine choosing to establish their careers before starting a family. On average, female physicians have their first child at age 32, while non-physicians had theirs at age 27. Fortunately, we are starting to discuss this topic, albeit within smaller circles within the medical community. However, it still leaves a bitter taste in my mouth, and I wonder why we don’t openly address this personal sacrifice during the first year of medical school. As women now constitute more than 50% of matriculating students in medical schools nationwide, the moral tension between career and life decisions will only persist, if not worsen. So, why don’t we talk about alternative options, such as egg retrieval and freezing? And if we do, why don’t insurance companies cover the costs?

Women in medicine dedicate most of their 20s and even some of their 30s to training as doctors. Unfortunately, during these crucial years, a woman’s egg quantity and quality diminish. Even dating while pursuing a medical career poses unique challenges, as humorously depicted in shows like “The Mindy Project.” Regardless of one’s dating life, women doctors should have the autonomy to decide when to embark on their reproductive journey, armed with all the available knowledge.

In my personal experience in 2023, I discovered that the process of egg freezing is expensive and offers no guarantees of success. I waited a few extra months, accepting the added risk of aging, before undergoing the procedure, hoping it wouldn’t drain my fellow’s salary entirely in Palo Alto, CA. Anxiously, I waited to see if my new insurance coverage, effective from January, would contribute towards the initial price tag of $15,000. It’s worth noting that this price only covers the procedure itself and doesn’t include the cost of hormone medications or the annual fee for storing my eggs. Fortunately, my current insurance partially covers the egg retrieval, bringing the price down to around $6,000. However, this doesn’t account for the additional expenses such as storage fees, ultrasound tests, juggling clinical shifts to attend clinic visits and manage side effects, and the stress of finding someone to accompany me for the procedure, as it requires anesthesia. There are numerous logistical considerations that I continue to discover, but the point is clear – it’s far from a simple procedure, even when there is discussion and support.

The decision to have children is a unique journey for every individual. However, I believe that more conversations among physicians and those in training are needed regarding this topic. Egg retrieval, as an alternative to having children during the peak of one’s career when work takes precedence over family life, remains relatively unknown, even within the medical community, let alone outside of it. Being a woman in medicine already presents several challenges without adding the conversation about starting a family into the mix. Having open discussions about these added risks and sacrifices earlier in one’s career will hopefully empower women to inquire about insurance coverage for the process, involve their OB-GYNs in considering egg retrieval and freezing even before finding a partner, or simply preserve the option of having children in the future. A woman’s choice to pursue a medical career should not come at the expense of her future family. Studies surveying women physicians have revealed that a significant portion of them regrets their family planning choices and faces infertility. In fact, 16% of women physicians would have used cryopreservation had they known the risks. By sharing my story, I hope to normalize conversations about fertility for women in medicine and encourage everyone, regardless of gender, to advocate for change.

Allow me to share my actual experience: continued on Page 50 continued from Page 49

• It took eight days of injections before I noticed any bruising.

• Over the course of nine days, I injected myself with a needle 22 times.

• My medication dosages were adjusted four times.

• I reached the lifetime fertility policy limit of my insurance, which was $10,000, within the first week of the process.

• I experienced significant symptoms, to the point where I couldn’t work a shift, with mild ovarian hyperstimulation syndrome (OHSS) for nine days after the procedure.

• In the end, I had 32 eggs retrieved, of which 24 were deemed mature.

• I craved cake daily, though it remains unclear if there was any relation.

As emergency physicians, we need to hear more narratives like this. It’s perfectly acceptable to prioritize something for ourselves, even when it means intentionally safeguarding our fertility. My friends, fiancé, and family reminded me that I took a deliberate and courageous step towards securing my future. By sharing a glimpse of my experience, I hope to provide others with an understanding of what they can expect, make them feel less alone if they share the same worries and internal monologue, and empower them to protect their future families while fearlessly owning their roles as doctors.

(*Note: Women under the age of 35 generally require fewer eggs, on average, to ensure a viable pregnancy. According to my reproductive endocrinology team, a woman aged 35 needs 25-30 eggs to maximize the chances of a future pregnancy. Research has shown that storing 10 eggs provides a 60.5% probability of a live birth for women under 35, compared to just under 30% for those over 35.)