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Regret, Strain, Infertility – Building Families as Physicians and Medical Students

September 22, 2023

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Written by Vivian Lei

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Growing a family while also navigating medical training is associated with delayed childbearing, and many physicians on this path experience regret, infertility, relational strain, and specific stresses associated with the use of assisted reproductive technology (ART).

Growing pains
Physicians desiring children and family-building are likely to encounter significant psychosocial burdens. In this survey of 3,310 physicians and medical students, most (60.1%) reported delaying childbearing due to training and 55.8% of those that did expressed regret for doing so. Almost half of those delaying childbearing cited the demands of their medical training as the reason for the delay. A diagnosis of infertility was reported by 21.1% of participants, and 19.2% reported using assisted reproductive technology (ART). Over a quarter (27.9%) reported their well-being was affected by fertility concerns. In particular, those who used ART reported significantly higher rates of relationship stress (43.5% vs 7.2%) and use of therapy specifically to deal with stress related to family-building (38% vs 9.2%) compared with those that did not use ART.

The researchers administered their family-building questionnaire to physicians and medical students in April and May of 2021 through social media and email listserv recruitment. Most participants identified as women (90.1%) and expressed a desire for biological children (92.7%). The average age was 35.3, and over half (52.5%) had completed training.

Clearly, there are limitations inherent to the questionnaire’s design, including response bias and a nonrepresentative sample. However, this study begins to illuminate the burdens that physicians and medical students encounter when attempting to build their families while also developing their profession.

How will this change my practice?
This study resonates with my own experience. I began attempting to have a child during medical school, decided to delay family-building during my residency, obtained a diagnosis of infertility after completing my training, and then embarked upon several years of ART. Over that period spanning a decade, I received very little support for family building and struggled to reconcile my desire to start a family with the demands of becoming a physician. I also kept quiet about my personal burdens due to a perceived stigma surrounding challenges with fertility. Clearly, these issues are common within the medical profession, and I am hopeful that there will be more attention and support given to the psychosocial and family-building needs of physicians.

Editor’s note: Thanks to Dr. Lei for speaking out. Feel free to comment on this post about your experience. ~Clay Smith

Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA Intern Med. 2023 Jul 24:e232570. doi: 10.1001/jamainternmed.2023.2570. Epub ahead of print. PMID: 37486671.

What are your thoughts?