WORCESTER MEDICINE
Infertility
Delaying Childbearing During Medical Training Gianna Wilkie, MD
I
t is well known that medical training is not
easy and is all encompassing of your time. Between medical school, residency and sometimes a subspeciality fellowship, seven to 12 years of a women’s reproductive life may be spent buried under books in medical libraries or working 80 hours a week dedicated to taking care of patients. Many medical residents cite concerns related to negative career repercussions, clinical duty coverage, board certification requirements and possible extended training as reasons for delaying childbearing. (1) Therefore, many female physicians may choose to delay pregnancy to pursue their career goals, putting them at increased risk of age-related adverse pregnancy outcomes including miscarriage and infertility. My personal experience is like that of thousands of female physicians across the country. I started medical school at the age of 22 and obstetrics and gynecology residency at the age of 26. I then decided to pursue a maternal-fetal medicine fellowship at the age of 30 and will finish my medical training at the age of 33. My husband is also in medicine and currently completing a three-year cardiology fellowship. While we have both always planned to have children, we have chosen to delay pregnancy until I am finished with my medical training, because no point in our training seemed like the “right time.” There was always another clinical experience or board exam in the future that seemed like a hurdle that we should complete before thinking about building a family. While I have never been told that pregnancy was not allowed during training, I have seen the struggles of my colleagues. They have taken short parental leaves to avoid extending medical training and often had to work every weekend leading up to their deliveries, and upon their return, to make up for their absence. While everyone tries to be supportive of their pregnancies, it creates significant scheduling difficulties and strain on their co-workers. Medical training is also a time of high-intensity immersion and learning, and I have seen my colleagues feel
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personal guilt for missing clinical experiences and learning opportunities. While pregnancy is not discouraged, it’s uniquely challenging in medical training. As a maternal fetal medicine fellow, I deal with the complications of pregnancies complicated by advanced maternal age – 35 or older – daily. Therefore, the effects of delayed childbearing, including preterm birth, are not lost on me. The struggle between being ready to have children, achieving my career aspirations and avoiding the negative consequences of a pregnancy associated with advanced maternal age are definitely present. Given 65% of physicians reported concerns about future fertility, I know I am not alone in my feelings. (2) Many medical professionals have sought options to stop the aging ovarian clock by, for example, pursing oocyte cryopreservation. While I have not personally done this, many of my colleagues have and maybe I missed my window of opportunity. However, the process of undergoing oocyte cryopreservation is not easy and is also time consuming, which may not seem feasible to medical trainees either. As I reach the midway point of my fellowship, I have started to think about whether or not there will ever be a right time to be pregnant. I see many female physicians balancing successful careers and life at home giving me hope for the future. + references
1. Willett L, Wellons M, Hartig J, Roenigk L, Panda M, Dearinger A, Allison J, Houston T. Do Women Residents Delay Childbearing Due to Perceived Career Threats? Academic Medicine 2010; 85(4): 640-646. 2. Nasab S, Shah JS, Nurudeen K, Jooya ND, Abdallah ME, Sibai BM. Physicians attitudes towards using elective oocyte cryopreservation to accommodate the demands of their career. J Assist Reprod Genet 2019; 36(9): 1935-1947. Gianna Wilkie, M.D. Maternal Fetal Medicine Fellow University of Massachusetts Chan Medical School
JANUARY / FEBRUARY 2022
