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In medicine, there is an added pressure among female physicians to be “strong.” To work extra hard as a physician (while also being a perfect “mom,” “wife,” or “daughter” outside the hospital), and to exhibit resiliency when faced with micro aggressions and inequality in the workplace. Yet, even after years of clinical practice, it feels like there is an underlying need to continually prove to those around us that we are capable physicians. As a trainee, I found certain unfortunate encounters with both physician leaders and patients fueling my drive to be smarter, more assertive, and to exude less “femininity” in order to be taken more seriously.
In doing so, I pushed the idea of being a mother out of my head early in training. I was still young, and I knew I wanted to create a family at some point, but in a work environment where fertility and family planning weren’t really even acknowledged, I felt the right thing to do was focus solely on being the best resident I could be. I became efficient at work, constantly trying to be better, make good impressions, listened to medical podcasts on my commute, read after work, became involved in research, quality improvement, and more. Outside of work I managed to maintain friendships, had a social life, and appeared “I had it all together.” I was under a common delusional spell that many female trainees have, thinking that after training life will all of a sudden turn amazing- we’ll be rich, stress free, not tied to strict training schedules and requirements, and therefore super ready to start a family.
Then, toward the end of residency I remember hearing about a nine month pregnant attending, on night shift, doing several procedures, rounding the next day, and eventually going to her other kids at home. She also gave a lecture that day and was heading several research projects and committees. There were whisperings around me - “Wow she is so strong. A superhero.” There was that word, “strong.” Is this the path I’m headed on? Is that the life I am obligated to aspire to have in order to gain respect from those around me? Should we really continue calling these women “strong” or “super-heroes?” Doesn’t it highlight the fact that we work in a broken system where we are expected and pushed to work like this?
I had been consumed by career advancement, but with that came anxiety, stress, and perfectionism, and I lost a piece of myself along the way. I pushed away my creative interests, I realized I undervalued my female identity in the workplace, and was avoiding the decision of when to start a family.
So, I decided to start trying to have a baby, despite being hesitant that as a pregnant woman in training I would be a burden, and worried that I wouldn’t be taken as seriously by patients or peers. I had realized that although I didn’t feel completely ready, I never would, and that time was working against me. I wanted three kids, and I would be graduating fellowship at 34. I knew friends and colleagues who had struggled with infertility-what if that would be me? I decided to reach out to several female attendings-all who said that even if we are close to ready, to start trying now. Training provides you with flexibility, back-up, and built in coverage that you don’t have as an attending, and hey here’s another reality check- things definitely don’t magically get better once you graduate. It’s like the spell broke and all of a sudden, I realized I needed to start now.
Fast forward to a year later: I made an appointment with an REI (reproductive endocrinologist) physician, and was diagnosed with unexplained infertility. Now, almost an additional year after that, I have gone through multiple IVF cycles, countless labs, injections, procedures, physical and emotional distress, doctor appointments, experienced unimaginable grief and loss, mental breakdowns, and no baby yet, all while trying to juggle being a first year Pulmonary and Critical Care fellow. Sadly, I am one of many infertile physicians (1 of 4, as has been studied) with no end to my journey in sight. I have seen female colleagues suffer through pregnancy complications or miscarriages still showing up to work silent and “strong.” I was also silent in the beginning of my journey. Why should I outpour all my misery to those around me and look like I’m weak or want to be pitied? I didn’t want to be a burden to my colleagues. I would put it all on myself to figure out how to navigate unpredictable appointments and insane medication protocols in the hospital. People knew I was doing IVF, but I downplayed what I was going through. Stress and guilt accumulated inside me. My mental health was at an all-time low. I was bitter and resentful toward the profession. I was way past burned out. I had multiple other stressors in life on top of my infertility. I was hanging by a thread.
I decided to take 2 months off- a decision that took a lot for me to do. We’re immersed in a culture where we’re expected to push through difficult times and suck it up. But I needed to put my mental health first. Taking that time put things in perspective. I realized that unless I am vocal about my journey, nobody will truly understand what the infertility/IVF experience is like. In turn the silence, the ignorance, and the stigma that surrounds infertility in the workplace will only continue, and people will continue to go through infertility alone. I realized it’s ok to put myself and my health first above my career. I will forgive myself for not being perfect. My identity is more than just doctor. I am an infertility patient, a wife, a writer, and much more. I am a human at my job, trying to be the best version of myself I can be at any moment.
As I began to be more vocal about my infertility journey, I became passionate about spreading awareness and educating others in the medical profession, specifically trainees like myself, about taking control of their fertility. It’s now been two years since I decided to have a baby, and because of that I’m grateful that I did not delay this decision until after training. But I know many others still will. It’s time to normalize talking about fertility (a conversation that should be led by leadership). Normalize time off for appointments and treatments without guilt, distress, or burden of finding coverage. Normalize fertility benefits including egg freezing, IVF treatments, and baseline fertility evaluation. Incorporate fertility related lectures to the onboarding process of residency to educate trainees that this is a problem in our field. Introduce family planning as a thing that matters, and include information and resources so that trainees don’t feel guilty pursuing this if they are ready. Have guest speakers implemented in the curriculum speak about their infertility journey not only to inform both male and female trainees, but to allow trainees who may be suffering in silence feel more empowered to face administration with their struggle and take the mental health break they deserve. The culture needs to change, and it will slowly if we continue to share our stories, raise awareness, modify preconceived notions, and educate our colleagues.
I went through 6 years of infertility then had twins by IVF born at 27w1d after 6 weeks of hospital bedrest (not even allowed to sit up). Long NICU stays followed. I was very fortunate in that my program was very supportive, but it was years of stress to get pregnant then years of stress due to health issues with the boys. I had always longed for a girl and so 6 years after the boys were born we hired a gestational surrogate who became pregnant on the 2nd IVF cycle. It was the most beautiful, stress-free pregnancy ever! I induced lactation while she was pregnant to help with bonding and found it a wonderful experience. If it is finan…
I too put off trying to get pregnant during Med school and residency for all the reasons you listed, as well as financial concerns— big school loan debt.
When we started trying I was about 37, I started with the fertility doc a couple of years later, like you went through rounds of AI and then IVF at huge expense and mental anguish. I do have good news— we decided to adopt. In CT one can adopt from DCF without cost, but one has to go through many weeks of 3 hour training sessions. We adopted a boy and a girl 2 years apart, they are now 19 and 17. I would do it all the same way to have…
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It took me 6 years of trying to have a successful pregnancy. I started during medical residency, but had 3 miscarriages along the way, as a resident, cardiology fellow and attending, and became very depressed as well. A supportive husband was very important. After IVF and other interventions, I becamse pregnant at age 35 with twins. While I was breastfeeding, I became pregnant again, without intervention. I think I was too thin during training, at BMI about 19, but we never had a reason for sure. Having 3 children close together did impact my career, and I had to give up my academic position and arrange a part-time practice for several years. However, I enjoyed motherhood and wo…
Hi Dr. Hukku, I am a physician and dealt with infertility for 9 years, so your story resonates with me, IVF and treatments are emotionally and financially taxing to say the least. I am not sure where you are in your journey but the Reproductive medicine doctors could never help me, instead I turned to a FUNCTIONAL medicine dr ( holisitc, if you will) where I had success within months. I am happy to share more if interested, I am trying to raise awareness that there are options beyond expensive infertility treatments (I wish someone had told me that 9 years ago!)
During my residency, the director of the program made a point to tell me that he did not think of the women residents as women. And when one of us became pregnant and had a baby, he commented that her surgical skills had declined since she became a mother. Terrified of being seen as less capable, which is ridiculous, I delayed attempting pregnancy until age 34 after completing my ObGyn residency. Unexplained infertility then greeted me, and beginning practice while pursuing treatment was overwhelming. But I persisted and was successful at building my practice. I was not successful in bringing home a baby: miscarriages and failed cycles were my other full time pursuits. This must change. The author offers severa…