Infertility affects one in eight couples in the general population and one in four female physicians. Many are unaware of these statistics, even in the medical community. When faced with infertility, there is an enormous emotional, physical, and even financial toll. While there is not a lot of data available on infertility in female physicians, a survey of 600 female physicians published in 2016 showed that 53.3% said they would have attempted to conceive earlier and 16.7% said they would have used cryopreservation to preserve their fertility if they had known the statistics of infertility. Meera Kirpekar, MD, Clinical Associate Professor in the Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU Langone, shared her personal experience with this important topic and her goal of change for the better in workplaces for female anesthesiologists.

Medical school, residency programs, and fellowship training take years and are extremely high stress. In addition to the stress, co-residents are dependent upon each other to be present not only day to day, but also for overnight calls, in a very structured work system that doesn’t leave room for sick days, let alone maternity leave. Dr. Kirpekar explained, “For many, trying for a child during this time can seem almost impossible. Once you are an attending, it takes a year or two to adjust to this new and extremely demanding role, while you are also studying for your board exams. As a result, building your family is put off, which can lead to difficulties later. I did not receive education regarding this in medical school or residency – education such as rates of infertility, how age and lifestyle factors in, how to freeze your eggs, the data regarding egg and embryo freezing, what insurance will and won’t cover, what the cost is, and more. It’s important that female physicians receive this education as early as possible so they can make informed decisions.” While males can face challenges as well, in general, the testing and treatment for infertility is far more invasive in women.

Dr. Kirpekar became interested in the topic of fertility preservation both due to her patients’ experiences and her own. As she treats pelvic pain, many patients also struggled with infertility and invasive treatments, which exacerbated their pain. On a personal note, Dr. Kirpekar struggled with infertility for two years, during which time she experienced multiple miscarriages and invasive testing, followed by several egg retrievals and IVF embryo transfers. Now the parent of a baby boy, she added, “During this time, I continued working, never taking any time off, and not even letting on about the physical, mental, or emotional toll I was facing. I only ever alluded to the struggle if I had to take a day off for an anesthesia procedure, for example. I know of many women in medicine who faced similar challenges and continued to do their jobs and live their lives in silence. We all had something else in common – we just didn’t know there would be a possibility of facing infertility because we received no education on the subject during our medical training.”

When discussing fertility preservation with other women in medicine, Dr. Kirpekar noticed how the discussions turned to the multiple obstacles women in medicine face because of the differing life cycle of females vs. males. For example, females endure massive swings in bodily changes throughout their lifetime, which contribute to their physical, mental, and emotional health. They also experience menstruation and menopause, and, possibly infertility, pregnancy, and lactation. After putting it all together through a collaborative effort with colleagues, the ASA panel on “Women’s Health Issues During Their Careers as Anesthesiologists and How to Support Women in the Workplace” was born.

Dr. Kirpekar’s presentation at ANESTHESIOLOGY® 2024 focused on objectives such as reviewing current data, discussing the toll on female physicians, choices for fertility preservation, and support options for the anesthesiology departments. A study out of Hungary with over 3,000 women physicians showed that amongst the group, infertility, high-risk pregnancies, and miscarriages have been associated with burnout, which can increase medical errors, risk of malpractice, and poor patient outcomes (BMC Womens Health 2014;14:121). As for the physical toll, enduring infertility often means rounds of testing, frequent blood work, ultrasounds, painful daily injections, and uncomfortable procedures, which causes stress to the body. Finally, the cost of IVF is extremely high, so the financial strain is significant, particularly if you must undergo multiple rounds of treatments. And if women need time off, there could even be loss of work and lack of support from their jobs. Dr. Kirpekar made it clear how all three of these factors (emotional, physical, and financial) all play a part, and how significant each stressor is depends on individual situations such as the type of testing and treatment they are undergoing, insurance coverage, workplace accommodations, stigma they may face, other personal life factors, and more.

As it relates to fertility preservation, many female physicians may not be aware of the most common options. Egg freezing, also known as oocyte cryopreservation, is a process in which eggs are extracted, frozen, and stored. For women 38-40 years old, freezing 25-30 mature eggs gives them roughly a 65-75% chance of at least one live birth. Another option, embryo freezing, is more involved and requires eggs retrieved from a woman combined with a partner or donor’s sperm, allowing embryos to grow, and mature for freezing. Dr. Kirpekar then addressed what three key strategies can be put in place to manage physician fertility.

  1. Early education on fertility preservation beginning in medical school, continuing through residency and early years in practice, with access to discussion groups and other resources.
  2. Full access to a reproductive endocrinologist and insurance coverage, to ensure fertility assessment and management.
  3. Workplace support to reduce stigma, increase psychological well-being, and increase time coverage. Time coverage is significant as women anesthesiologists, both residents and attendings, need time while undergoing fertility treatments for doctor visits, breaks from the operating room to administer injections, and even days off for procedures.

Dr. Kirpekar noted that medical schools and residences are starting to briefly incorporate fertility preservation into the curriculum, but not universally, nor comprehensively yet. She clarified, “I hope that the more we discuss this topic openly, the more commonplace it becomes to ask for and expect an increase in education and in workplace accommodations, and a decrease in stigma.” Anecdotally, because of discussing this topic openly with others, she’s also noticed more women feeling comfortable asking for accommodations to undergo treatment, such as time to go to appointments, more quick breaks from the operating room to inject fertility medications in a timely fashion, and even a day off to undergo a procedure. The hope is for this to become commonplace in the future and a part of institutional policy.