Recently while scrolling through my Twitter feed, I ran across an article on Senator Tammy Duckworth1. I can’t help but admire her tenacity and the sacrifices she has made for our country, plus I was intrigued by the headline that described her having a baby at age 50. The article describes how Duckworth spent her primary childbearing years moving up in military rank. As a helicopter pilot, she would have received mandatory grounding if pregnant. Duckworth is quoted as saying, “If you’re not flying, you’re not competing.”
Sounds a bit familiar, right? Duckworth went on to spend over nine years in fertility treatments prior to having her first child. Her second child made her the Senate’s first member to give birth while in office.
My story of infertility is much different in many ways. But it may be more like your story.
I married at age 29, while in my third year of general surgery residency. I told everyone that we planned on waiting at least 5 years, but by the middle of my chief year, I was getting nervous and my husband was dropping hints. With my fellowship in Minimally Invasive GI Surgery coming up, we decided that having a baby during my fellow year was perfect. 3 months in, I cried at my OB/Gyn routine appointment, afraid that things weren’t going as I had hoped. I passed my written boards. Initial tests showed that maybe I had polycystic ovarian syndrome, so I lost 20 pounds. 6 months in, we went to the Reproductive Endocrinology and Infertility department and underwent more testing. It was mostly normal; we were diagnosed with unexplained infertility. I deferred starting treatment until I passed my oral boards. For 6 months, I dodged out of cases, arranged resident coverage, or anxiously counted the minutes during OR turnover as I went to the REI department for ultrasounds, blood work, and repeated cycles of Intrauterine Insemination (IUI’s). I was hired as faculty at my institution, and we bought a house. We added more medications. My doctor started mentioning In vitro fertilization (IVF).
Finally we faced the inevitable and scheduled an IVF cycle. I told my Division chief. I cried before I even got the words out. He was supportive and I apologized profusely for the tears. I stressed over my early “big” cases an attending and over having enough embryos. I set alarms during the day so I could excuse myself to take the required medications. I spent evenings catching up on clinic notes, and staring off into space. I never took a burnout inventory during this time, but I questioned every career decision I ever made. I didn’t know it would take so much from me.
As it turns out, things went well. We had a successful egg retrieval. More than half of our embryos progressed normally. We had a fresh transfer that resulted in a pregnancy on the first cycle, and 39 weeks later had an uneventful delivery of a beautiful baby.
What I discovered along the way was that a remarkable number of the female physicians around me had similar stories and struggles. Right around the time that I first began considering pregnancy, Phillips et al. published their work in the Journal of the American College of Surgery titled “Does a surgical career affect a women’s childbearing and fertility? A report on pregnancy and fertility trends among female surgeons.”2 The conclusions are depressing but not surprising: female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility. 32% of female surgeons surveyed reported fertility difficulty, while 10.9% of the general US population report infertility. Of all children born to female surgeons, at least 13% were conceived using assisted reproductive technology. Interestingly, the more I spoke up about my infertility and need for ART, the more I heard similar stories from everyone around me, including my male surgery colleagues. This leads me to wonder if all surgeons may face higher rates of fertility difficulty.
If you are a surgeon, medical student considering surgery, or work with or around female surgeons, please consider the following:
- There is never a convenient time to have children. If you think now is the right time for you, then please go ahead. Your career will wait for you. Your biological clock may not.
- Seek help early. The reality is that the career I blamed for causing my infertility also provided me with the resources (financial and personal) to quickly get help.
- Consider proactive options to protect your future ability to conceive, such as egg preservation, etc.
- Find someone outside of your significant other to discuss the topic with. This is particularly helpful if that individual is within your specialty. I am so thankful for the (male and female) surgeons who were a listening ear and provided endless encouragement to me.
- If your doctor or colleague says, “give it more time,” “just relax,” or some other well-intentioned but unhelpful response, then take it with all of the good will that is intended, and get a second opinion or find someone else to discuss it with.
- Never say “it will all work out” because the reality is that for a portion of the population, all the fertility treatments in the world won’t work. Facing that unknown was one of the worst things about infertility. Instead, say “I’m so sorry, is there anything I can do to help?” or “let me know if you ever need me to cover a case or clinic.”
My journey with infertility continues. I am currently in the second trimester of my second pregnancy. This time there were a few hiccups, including an operation to increase my likelihood of a successful embryo transfer. I’d like to say I don’t take one day of this for granted, but the reality is I think I’ve found a happy medium. I love my job again. I deeply appreciate the support and help of the community around me, including my colleagues who have treated me or filled an absence for me. On good days, I still think this profession was worth it. And on bad days I have the perspective to know they will pass.
- Johnson, R. (2018 September.) Senator Tammy Duckworth on the attack that took her legs – and having a baby at 50. Vogue. Retrieved from https://www.vogue.com/article/tammy-duckworth-interview-vogue-october-2018-issue.
- Phillips EA, Nimeh T, Braga J, Lerner LB. Does a surgical career affect a women’s childbearing and fertility? A report on pregnancy and fertility trends among female surgeons. J Am Coll Surg. 2014 Nov;219(4):744-50.