Fertility and family planning challenged by medical training

By Mardi Chapman

4 Dec 2023

Doctors have higher rates of assisted reproduction and pregnancy loss and are older at the time of their first pregnancy than other Australian women, according to data presented at the Endocrine Society of Australia annual scientific meeting.

The findings highlight some of the challenges that doctors, particularly female doctors, face regarding family planning, the researchers say.

An online survey distributed by specialty colleges and societies received 423 responses primarily from physicians and emergency medicine specialists. Just over half the respondents were consultants (56%) and 38% were accredited registrars.

Endocrinologist Dr Lisa Raven, from St Vincent’s Hospital in Sydney and the University of NSW, told the meeting that specialist training occurs during women’s prime reproductive years.

“So our hypothesis was that doctors delay family planning and face unique challenges in this area,” she said.

The survey found the mostly female respondents (90%) had a mean age of 36 years and either already had children (71%) or were trying / wanting to have children (24%). Fewer than half (46%) had the number of children they wanted.

It found 31% of couples had undergone testing for infertility and 20% had used assisted reproductive technologies.

Almost a third of women had experienced a pregnancy loss compared to 25% in the general Australian population. Most occurred in the first 12 weeks of pregnancy

Dr Raven said in keeping with other data, many women did not have any time off work or they had less than seven days off work, despite wanting more time off.

As well, many women did not disclose their loss and it went unacknowledged in the workplace.

“So, many people are going through this that we just don’t know about,” she said.

The median age at first childbearing for respondents was 32 years – two years older than the Australian average of 29.7 years.

The findings were consistent with a 2021 US study [link here] which found increased rates of infertility and pregnancy complications in female surgeons.

Dr Raven told the limbic that systemic reform of a ‘rigid’ medical training system would be ideal but was unlikely to happen.

She said stress, fatigue, overnight and on-call rosters, older maternal age and possibly even potential exposures at work probably all contributed to the poorer pregnancy outcomes.

“The fact that many people didn’t take any time off work after they’ve lost a pregnancy which is obviously such a big emotional stress shows the mindset of doctors is to just get on with it.”

“I think on a micro level, it’s about being aware of this for female colleagues. We’ve got to think about individuals, but we also have to service a population and provide health care. So there is a balance required and I don’t have the ideal solution. But the more awareness and discussion, the more people can think of changes that could occur.”

The survey also found the childbearing parent carried most of the caregiving role during the child’s early years with higher rates of working part time and increased hours of domestic duties.

“In the first year of childhood the childbearing parent is the main caregiver and as we progress into the second year of parenthood, still the predominant caregiver is that childbearing parent but the proportion does certainly drop,” she said.

The pattern continues into the third and fifth years of parenthood with a predominance of care provided by the childbearing parent but with a shift towards paid childcare and sharing of the caregiving role.

“We did ask specifically of the people who identified as the primary caregiver, whether they had reduced their work schedule during the past five years of parenthood and 70% of the childbearing parents said yes.”

The survey also reported that 55% of childbearing parents reported that they had delayed having children because of their medical training, as opposed to 42% of non childbearing parents.

As well, 51% of childbearing parents said they would recommend medicine as a career for their children compared to 71% of non childbearing parents.

“People don’t necessarily always think about the rigid system that we work in, particularly for specialist training… but it’s not an easy thing to change and the best possible solution isn’t clear,” Dr Raven told the limbic.

More qualitative data from the survey is yet to be analysed.

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