(306) Physician Infertility: A Growing Problem
Authors: Kassab J , Garcia Keeme-Sayre A , Lipshultz L 
Published: February 2024

Abstract

Introduction
Physician infertility has become a growing concern, documented by the high rates of infertility physicians experience as a result of their strenuous work schedules, environmental exposures, and delayed childbirth due to their extensive years of training. The implications in fertility extend beyond an individual's desire to have children, as it can impact their physical, emotional, and social well-being; furthermore, the inability to conceive can cause significant emotional distress, resulting in depression, anxiety, and a decrease in overall quality of life. Assisted reproductive technologies (ART) are a viable, although imperfect, option for both male and female physicians who have had to postpone starting a family due to career-related concerns. We seek to explore the magnitude of this problem, including the pros and cons of assisted reproduction techniques in aiding physicians’ family planning.

Objective
To understand and document the complex issue of the prevalence of physician infertility, as well as current barriers and proposed solutions from an in-depth organized literature review.

Methods
We compiled and synthesized available data to better understand the role of infertility in physician family planning using 49 articles regarding various aspects of the current state of physician infertility. We included specific analyses for surgeons and comparisons of both male and female physicians. Further, we assessed the existing barriers to correcting this issue as well as prominent proposed solutions for alleviating this complex phenomenon.

Results
Infertility has been documented to affect 24.1-32.0% of physicians in studies surveying 3153 physicians across various specialties, starkly contrasting with the national rate of infertility of 13.4%. Compared to physicians in non-surgical specialties, surgeons tend to have fewer children, be older at first pregnancy, work longer hours, experience more pregnancy complications, and have more preterm births. The data further reveals even greater disparities in examining just female surgeons, showing how gender plays a role in this problem. Physicians both seek the help of ART (18%-28% vs 5.2-12% in non-physician populations) and conceive through ART (8%-13% vs 1.7%) at higher rates than the general population. Given these threatening realities of infertility for physicians, we have compiled corrective suggestions in the literature, including executing changes to residency programs regarding insurance coverage and work flexibility, implementing longitudinal family planning educational initiatives geared toward trainees, and a need for greater support for family planning.

Conclusions
Physicians' reproductive health is crucial to their well-being, and policy and advocacy should address their specific infertility risks and management. While ART advances offer opportunities for infertility treatment, their high costs and arduous processes make them challenging for physicians to use. There's a need for more education, research, and support to allow young physicians to freely choose a medical career without overwhelming concerns about future family growth.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant), American Medical Systems/Boston Scientific (Speaker), Augmenta LLC (Stockholder), Aytu BioScience (Consultant), Contraline, Inc. (Consultant), Endo Pharmaceuticals (Consultant/Speaker), Inherent Biosciences (Advisor), Lipocine (Consultant).