Normalizing the Fertility Conversation for Women in Medicine; Four Tips for How to Learn More

By Jenna Miller, MD (Guest Contributor)

Like many women, I took a typical route through medical school, residency and sub-specialty training. I didn’t finish my pediatric critical care training until I was 32 years old. I moved back to my home state and within a year, began a serious relationship. Like many others my age, I had not really talked about fertility preservation at that time. I had always wanted to be a mom and when my relationship ended and I found myself turning 36, I sought the expertise of a reproductive endocrinologist. By that time, my Anti-Mullerian hormone (AMH) level was already low. The AMH is generated by small egg follicles that house immature eggs, so the higher the number, the higher one’s ovarian reserve. The AMH level can give a sense of how successful the egg retrieval process or “freezing your eggs” will be. I was subsequently devastated by my low AMH level, and it was recommended that I not pursue egg retrieval due to the likelihood of poor success. I really felt I had missed my window.  In fact, 24% of women in medicine have experienced some form of infertility (1) as compared to 12% of the general population (2).  

Even though my AMH was not optimal, I proceeded with fertility preservation due to some additional health factors. I started with one round of egg retrieval which only yielded five mature eggs. It is desirable to have >10 eggs retrieved per cycle, so my cycle fell far short which wasn’t surprising given my low AMH. With this number, I had approximately a 30% chance of having a successful pregnancy in the future.  I then went through three rounds of intrauterine insemination (IUI) after agonizingly selecting a sperm donor. All three rounds were unsuccessful.

The IUI cycles were followed by a final round of egg retrieval with the intent to make embryos with my selected sperm donor. I also only produced five mature eggs during this cycle. This process is commonly referred to as IVF, or In Vitro Fertilization. The one embryo that was successfully made during my IVF cycle was chromosomally abnormal and non-viable.

Each infertility treatment cycle requires medications, most being injectable and thus painful. My final cycle required two injections twice a day. There are also numerous lab and ultrasound appointments that must be done on certain days. This schedule is difficult to achieve with most working physicians in practice. However, I relied on my amazing work colleagues to assist me with coverage during these times. I have ultimately stopped pursuing fertility treatments and am now engaged in the adoption process.

I am sharing my story because infertility planning is not discussed with women or men in medicine. Yet our careers lead us to paths where many do not start families until four years after the average age of the general population (3). I would encourage training programs, including medical schools, residencies, and fellowships, to incorporate fertility preservation information in their available resources. Insurance packages should be transparent about their coverage of fertility preservation. This is not only true for our trainees, but also for our faculty. My costs including, lab work, ultrasounds, procedures, sedation, and cryopreservation of the eggs, were entirely out of pocket.  This financial burden can be prohibitive, especially during training and early faculty years. Obviously not everyone needs this service, and some may not wish to receive this information, however, normalizing the conversation so people are able to speak about it freely is imperative. I hope that future women in medicine will be informed as to how common infertility is in our profession and that there are resources to plan for possibilities in the future. Reflecting on my journey, I wish someone had shared this information with me during my training, and I hope this information can reach those who need it.

Here are 4 steps to get you started on your journey of information discovery in the world of infertility.

• 1. Contact or review your insurance. Ask about coverage for fertility visits, labs, and treatments.
• 2. Research local clinics. Read reviews of the practices. Investigate success rates and how they communicate with patients. There is frequent back and forth communication required so this needs to be efficient and effective. Check with colleagues; it will surprise you how many people have pursued fertility conversation and/or therapy.
• 3. Make an appointment for a consultation. There are often wait times at busy practices and then required lab work and paperwork before any decisions can be made. Ask about payment plan options as well.
• 4. Read “It Starts with the Egg, by Rebecca Fett”. There is not much control we have during this process but this book has been widely read by patients and reproductive endocrinologists and gives some suggestions for lifestyle modifications and supplements that may be helpful.

Acknowledgement: Dr. Lauren Weissmann, Reproductive Endocrinologist, for assuring my vocabulary was accurate and for fighting infertility every day.

References:

1. Stentz NC, Griffith KA, Perkins E, Jones RD, Jagsi R. Fertility and Childbearing Among American Female Physicians. J Womens Health (Larchmt). 2016;25(10):1059-1065. doi:10.1089/jwh.2015.5638
2. https://www.cdc.gov/reproductivehealth/infertility/index.htm
3. Martin CE, Hipp HS, Kottke M, Haddad LB, Kawwass JF. Fertility, Pregnancy, and Postpartum: A Survey of Practicing Georgia Obstetrician Gynecologists. Matern Child Health J. 2019;23(10):1299-1307. doi:10.1007/s10995-019-02801-9

Jenna Miller, MD
Dr. Miller is a Pediatric Intensivist at Children’s Mercy Hospital in Kansas City, Missouri. She trained at Texas Children’s Hospital in Houston, Texas, and is the current Pediatric Critical Care Fellowship Program Director. She has interests in ECMO and burns and does research in Bactrim-Associated ARDS.

Twitter: @JennaMillerKC
Email: Jomiller@cmh.edu