The ticking “biological clock”: Reproductive assistance, costs, and elective fertility preservation in female oncologists and trainees.

Abstract

11001 Background: Women in medicine are often in training during their peak fertility years. Many women defer childbearing until after training due to career concerns; in consequence, female physicians experience a higher rate of infertility than the general population. Experiences of infertility among female physicians and attitudes towards fertility preservation have not been well described. Methods: A novel 39 question survey was designed after comprehensive literature review to collect cross-sectional data on attitudes toward family planning and utilization of assisted reproductive technology (ART) among self-identified US female oncologists of all career levels. Descriptive statistics summarized frequencies of responses. Results: A total of 1005 responses were collected from female oncologists, of which 811 (81%) were attending/practicing physicians and 194 (19%) were trainees (192 residents/fellows and 2 medical students). 32% reported experiencing infertility. Of these 318 women, 9% reported no out-of-pocket expenses for ART while 39% spent more than $10,000 and 20% spent ≥$30,000. Side effects from infertility treatment required missing work for 22% and another 25% suffered mental health concerns related to infertility. Elective cryopreservation of eggs or embryos was reported by 6% of attendings and 4% of trainees. Among the 25 attendings who reported plans/desire to undergo fertility preservation in the future, most (76%) were unsure of feasibility. This was similarly reported in 72% of the 32 trainees with plans/desire to pursue fertility preservation. More trainees than practicing physicians (73% vs 65%) felt that fertility preservation should be discussed during medical training. Similarly, more trainees than attendings (58% vs 47%) felt that fertility concerns have a negative influence of their decision on when to start a family. While only 5% of all respondents reported using fertility preservation, an additional 6% were planning/considering using it and 21% felt that it would have benefitted them had it been available and affordable during training. Of the group that felt it would have been beneficial, 52% had experienced infertility. Conclusions: A third of surveyed female oncologists report experiencing infertility. Those that seek reproductive assistance can incur significant out of pocket costs with treatment related effects that can disrupt work or cause mental health concerns. Although fertility preservation was used by very few, one in five felt it could have been helpful to them if it was available and affordable. These results underscore the need to better support women in medicine to reduce the impact of infertility for female oncologists.