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How Training Affects Your Fertility

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I can’t breathe. I can’t breathe. Why can’t I breathe? This was the one thought running through my head on that day. You know the kind of day I’m talking about, right? The kind of a day when you have 12 patients on your inpatient list, another 2 to review in ED and 3 scheduled reviews in the day treatment unit. All waiting for you, just for you – and I couldn’t breathe. No, this wasn’t an anxiety episode that I was dealing with because of the overwhelming amount of work and sense of burnout that so many of us are predisposed to.

As was to later find out, during a corridor consult with a respected colleague, there was no audible air entry in either of my lungs. This explained why I couldn’t bend over to examine patients without feeling like I was going to die. A chest x-ray revealed bilateral pleural effusions. It was a stark moment. I realised that I had been trying to push through a regular work day on less than a quarter of aerated lung.

I was diagnosed with ovarian hyperstimulation syndrome, secondary to my first round of IVF. It had caused fluid overload, leaky capillaries and the effusions. Because the embryo transfer was successful and I was finally pregnant meant that the pleural effusions would take a while to “self-resolve”. Well, long story short, they didn’t. My exertional dyspnoea got so bad that I had to take a break to catch my breath every ten steps and I developed a pericardial effusion resulting in a “cardiac strain” pattern on my ECG.

I bit the bullet and called medical workforce to let them know I was being admitted to a local hospital to have a chest drain inserted. It was over the weekend, so the hit to the team and the hospital wasn’t that bad, but the guilt I felt at letting the team down was palpable. On my discharge a week later, I was “off clinical duties” due to residual effusions. I had to spend the next 3 months doing discharge summaries and various service improvement projects. It felt like a demotion. Despite the pause in training, and the potential career setback, it was a vital step for the health and well-being of myself and my baby.

36% of female doctors in Australia and New Zealand have suffered a pregnancy loss. This is a staggering number when compared with the general population. The average risk, for women under the age of 35, is about 6% and double that if older than 35 years.

That’s 6 times the rate of the non-medical population. Let that sit with you for a while. This figure is replicated across the world.

A study investigating fertility and pregnancy complications among Australian and New Zealand doctors discovered 36% of us have suffered a pregnancy loss, while 50% have experienced pregnancy complications.

Kevric, J., Suter, K., Hodgson, R. and Chew, G., 2022. A survey of Australian and New Zealand medical parents’ experiences of infertility, pregnancy, and parenthood. Frontiers in Medicine, p.2128.

They analysed survey responses of 1,099 doctors and found more than 60% delayed starting a family because of their careers. Some of their key findings were:

The median age of female doctors at the time of their first child was 32.4 years. This is slightly above the rest of the Australian population, according to the Australian Institute of Health and Welfare at 29.4 years.

However, fertility testing was undertaken by 37% of female doctors. 27% went on to have in vitro fertilisation (IVF). This, again, is higher than the rest of the average population (4%) according to Professor Michael Chapman from the Fertility Society of Australia and New Zealand.

Concerningly, more than 60% of respondents admitted to delaying family planning due to work. In those that did go ahead, pregnancy loss was reported as high as 36% of respondents and 50% suffered a pregnancy complication. 

When it comes to working, a staggering 75% of medical mothers worked more than 8 hours a day in their third trimester, compared to just 23% of non-medical mothers. This study also highlighted significant differences between specialists, with surgeons working longer hours before and after pregnancy.

Despite all of these barriers, 69% of medical mothers breastfed exclusively for more than six months. This is significantly higher than the average population (15.4%). Compared to physicians and general practitioners, however, surgeons did not have sufficient time to express at work (41.7% vs 63.8% vs 35.2%). A third of surgeons stated that there was not an appropriate space to express in the workplace.

Lastly, male doctors with non-medical partners were more likely to have more than two children (30.8%) compared to female doctors (15.6%) yet again highlighting the gender disparity that still exists in our society.

Primary author and Royal Australasian College of Surgeons (RACS) trainee Dr Jasmina Kevric, said delaying family planning due to training requirements can increase age-related pregnancy complications. “Long working hours increase the risks of neonatal complications, while options for part-time training are limited and only suit those in early pregnancy,” Dr Kevric said.

Dr Russell Hodgson, a RACS Fellow and specialist HPB and general surgeon said the current system is not making it easy for surgical trainees to start a family. “Something radical needs to occur because it’s unacceptable one in three female doctors suffer a pregnancy loss,” Dr Hodgson said. “There needs to be a greater emphasis placed on balance, where medical graduates can start their specialties earlier or undertake part-time training.”

This study is not about achieving work-life balance. It is more fundamental than that, it’s about the right to be a parent, the right to have a family and the right to live life the way you want. It’s about being a part of a profession that cares about each other.

It’s time we start putting ourselves and our families first. This is easier said than done and requires a shift towards a culture that allows flexible working arrangements and recognises that trainees are not all the same and may be at varying stages of their lives.  The Hippocratic Oath that we took at the beginning of our professional journey states “Primum non nocere – First, do no harm”. Was this intended to only apply to our patients and not to ourselves?

Until we can recognise, and respond, to this need for better work and training conditions, we risk alienating not only our colleagues but also providing a great disservice to our patients. Maybe it’s time to swear a different oath?

Dr Kevric, Dr Hodgson and Dr Chew’s research was presented at The Royal Australasian College of Surgeons Annual Scientific Congress in Brisbane 2022.

References

Australia’s mothers and babies web report (2019) AIHW. Australia’s mothers and babies, Maternal age – Australian Institute of Health and Welfare (aihw.gov.au)

Australian Institute of Health and Welfare 2011. 2010 Australian National Infant Feeding Survey: indicator results. Canberra: AIHW.

Miscarriage, Stillbirth and Infant Loss Support, (2018) Pregnancy Loss Australia.

Pregnancy Loss Australia – Support and Guidance for Miscarriage

Pregnancy and Employment Transitions, Australia Nov 2017. ABS. 4913.0 – Pregnancy and Employment Transitions, Australia, Nov 2017 (abs.gov.au)

About the authors

  • Dr Sabrina Barrett is a Paediatric Advanced Trainee at Perth Children’s Hospital and an accredited motivational interviewer. She is interested in paediatric neuropsychiatry and developmental medicine, with a research focus on improving outcomes in children with functional disorders. Passionate about educating the next generation of doctors she can often be found mentoring medical students or giving presentations at grand rounds and journal clubs about functional disorders.

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