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Women physicians experience high rates of infertility and often delay childbearing, in part due to career-related pressures, two recent survey studies showed.

In one survey, three-quarters of cisgender female physicians delayed family building despite knowing the risks of fertility decline, and more than a third experienced infertility, reported Jennifer B. Bakkensen, MD, of Northwestern University Feinberg School of Medicine in Chicago, and co-authors in .

Furthermore, nearly half of women with children passed up career advancement opportunities to accommodate the demands of parenthood.

"In our minds, this points to a huge yet previously understudied factor in gender disparities in medicine," Bakkensen told 番茄社区.

A separate research letter published in found that a fifth of women physicians experienced infertility, as well as high rates of regret about delaying family building, reported Arghavan Salles, MD, PhD, of Stanford University's Clayman Institute for Gender Research in Palo Alto, California, and colleagues, noting that the main reason for delaying pregnancy was the sheer number of hours required by residency.

Co-author Morgan Levy, a medical student in the MD/MPH program at the University of Miami Miller School of Medicine in Florida, told 番茄社区 that not much time is spent assessing "the long-term impacts on the well-being of physicians and the emotional toll that this whole process to build a family can take when they're juggling the demands of their career."

Another co-author Vineet M. Arora, MD, MAPP, of the University of Chicago Pritzker School of Medicine, said that "both studies identify a problem, which is that the medical career is unforgiving, especially with long training times that overlap with primary reproductive years."

Bakkensen and team's questionnaire explored fertility experiences and knowledge, parenthood, and career choices.

"It is well-established that gender disparities exist within medicine in terms of time to promotion, achievement of academic rank, and appointment to leadership positions," Bakkensen said. "Our team wondered if career-specific fertility and family building challenges among women physicians may be playing a role, given the unique set of challenges faced [during] the duration and intensity of medical training."

Most respondents (93.6%) were concerned about the length of physician training combined with family planning. Of the 75.6% of women who said they delayed family building due to their career, 22.8% delayed by more than 5 years. Lack of schedule flexibility or time, stress, financial strain, and concerns about burdening colleagues contributed to that delay.

While 42.4% had considered freezing their eggs, only 11.5% went through with it; 30.6% of these women had insurance that covered it. Women who delayed family building were more likely to also experience infertility than those who didn't delay (52.6% vs 32.4%, P<0.001).

The authors concluded that their results "highlight the degree to which women in medicine altered their careers to accommodate pregnancy and parenthood."

Salles and team's survey tackled questions about delayed childbearing, infertility, assisted reproductive technology (ART) use, well-being, and relationship strain among mostly women physicians.

"A good number of participants cited the fact that their fertility challenges did have a long-term impact on their overall well-being ... [and] they definitely saw some strain put on their relationship. Many went to therapy specifically to cope with the stress of building their family," Levy said, adding that these psychosocial impacts are understudied.

Nearly a fifth of participants used ART, and those who did reported higher relationship stress compared with those who did not (43.5% vs 7.2%, respectively).

The average age at first birth in the general population is 27, and 32 among physicians. As a whole, women physicians are twice as likely to experience infertility, Salles and colleagues noted.

"If we said cancer affects physicians twice as likely as the general population, we would be throwing tons of money at that. But because this tends to be a women's issue, it kind of gets brushed under the rug," said Arora.

Arora told 番茄社区 that her own children were conceived via in vitro fertilization (IVF) and that she didn't tell many people due to the stigma. In her view, the work culture was to do your job and not share how or why you're struggling.

Another barrier, according to Levy, is that many residency programs don't cover fertility treatments. Coverage for egg freezing, paid parental leave, and support for therapy are key ways institutions can support the family building aspirations of physicians and residents, she said.

Bakkensen also noted that "in addition to offering insurance benefits and clinical flexibility to the nearly 20% of female physicians who use IVF to conceive, awareness of and access to fertility preservation services should be offered to those desiring greater flexibility in family planning."

Levy pointed out that people are starting medical school at older ages, which may further exacerbate these trends.

In the study from Bakkensen's group, electronic surveys through medical association email lists and social media were distributed from March to August 2022. Among the 1,056 female respondents (mean age 38.3), 67.6% were attending physicians and 26.8% were residents or fellows. Nearly 30% of respondents said they worked 60 or more hours per week.

Married and partnered women reported bearing more household maintenance, like cleaning, groceries, cooking, and laundry, compared with their partners. They also reported doing more family maintenance, such as child and elder care, school forms, or doctor visits.

In the study from Salles' group, a questionnaire was sent to physicians and medical students through social media and medical email lists from April to May 2021. Most of the 3,310 respondents (90.1% women) said they desired biological children (92.7%). Of the 60.1% of participants who delayed childbearing due to training, 55.8% said they regretted it, particularly those ages 32 and up.

Both studies were subject to response bias, the authors noted. Bakkensen and team said that future research should also look at cisgender men and gender-diverse people more specifically.

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