The road to becoming a practicing physician is both long and grueling. While all aspiring physicians sacrifice a tremendous amount of time, energy, and finances in pursuit of a medical degree, some female physicians pay the additional price of an increased risk of infertility and pregnancy complications. 

With awareness of these potential problems, female physicians-in-training can better understand the choices they may need to consider in making plans for a family. 

 

Infertility statistics for female physicians

 

According to a survey published in the Journal of Women’s Health, 24% of female physicians who attempt to conceive will be diagnosed with infertility, a rate that is double that for the general public.

Stentz NC, Griffith KA, Perkins E, et al. Fertility and childbearing among American female physicians. J Womens Health (Larchmt). 2016;25(10):1059–1065.

Female physicians face higher rates of infertility and pregnancy complications. ASH Clinical News. November 24, 2021.

Additionally, results from a 2021 survey published in JAMA Surgery indicated that 42% of the 692 female surgeons surveyed had suffered a pregnancy loss—again, double the rate observed in the overall population.

Rangel EL, Castillo-Angeles M, Easter SR, et al. Incidence of infertility and pregnancy complications in US female surgeons. JAMA Surg. 2021;156(10):905–915.

 

It takes an average of 10 years to complete the journey of medical school and any associated residency and fellowship training required. For female physicians, this means completing their medical training at an average age of 31. 

While on the surface this 5-year difference may appear inconsequential, female fertility is heavily impacted by age. According to the American College of Obstetricians and Gynecologists (ACOG), a woman’s peak reproductive age is from her teens to her late 20s; a decline begins by age 30.

Having a baby after age 35: How aging affects fertility and pregnancy. American College of Obstetricians and Gynecologists. February 2023.

By age 32, the decline in fertility becomes significant, and by age 37, fertility declines at a much more rapid pace than in prior years.

Female age-related fertility decline. American College of Obstetricians and Gynecologists. Committee Opinion, Number 589. March 2014.

 

 

 

High-stress work doesn’t help

 

Science aside, there is also a tremendous lifestyle burden that contributes to infertility and pregnancy-associated complications for women in the medical field. 

Despite this increased risk of infertility for female physicians, it should not deter women from pursuing this career path. Recent studies suggest that patients may have better health outcomes when they are treated by female physicians as opposed to male physicians, as reported in Academic Medicine.

Marshall AL, Arora VM, Salles A. Physician fertility: a call to action. Academic Medicine. 2020;95(5):679–681.

 

 

Awareness could head off fertility problems

 

Being aware of potential complications with fertility allows female physicians to plan ahead and/or consider alternative options in the event complications arise.

Based on data from the American Medical Women’s Association, 53% of female doctors would have tried to conceive earlier, and 16.7% would have utilized cryopreservation to maintain their fertility, had they been informed about downstream fertility issues.

AMWA’s Physician Fertility Initiative. American Medical Women’s Association. 2023.

 

Because of this, it is of vital importance to educate pre-med students, med students, and even physicians in residency and in real-world practice about the higher incidence of fertility issues. ACOG and the American Society of Reproductive Medicine offer various online educational content regarding fertility management and evaluation, and this content can serve as a component of the medical school curriculum. 

Beyond the educational component of building awareness of the problem, relevant policy initiatives could improve the fertility outlook for female physicians. The authors writing in Academic Medicine propose several strategies as a call to action.

 

Policy changes as remedies

 

Access to fertility evaluation and management is a means to modulate the fertility disparity. It would be ideal if fertility checkups and assessment of ovarian reserves and/or sperm quality could be included as part of the default health screening for new trainees or faculty at any institution that employs physicians or sponsors medical student training programs. By including these types of assessments in a default program for all participants, some of the peer resentment or workplace negativity that arises when women take time out to seek these interventions could be remedied. 

Institutions should communicate with insurance companies and induce them to offer affordable insurance coverage to overcome the steep costs associated with fertility treatments or egg freezing. Particularly for physicians in training, these costs could be deterrents, as students have suboptimal salaries at this stage. 

Finally, institutions need to put in place flexible work policies and clinical coverage for female physicians who need to be away to pursue fertility treatments. 

For female medical students, the Accreditation Council for Graduate Medical Education recommends that clinical programs have written policies for maternity/paternity leave to ensure the well-being of students.