THE UNINTENDED CONSEQUENCE OF MEDICAL TRAINING: DELAYED CHILDBEARING. A SURVEY OF REPRODUCTIVE GOALS AND FERTILITY KNOWLEDGE IN MEDICAL RESIDENTS

Abstract

To assess reproductive goals and baseline fertility knowledge in residents and fellows across various specialties in a university teaching hospital. Residents and fellows at the McGaw Medical Center program of Northwestern University were invited to attend informational seminars hosted by the REI division. Postgraduate trainees have insurance coverage for infertility and oocyte vitrification. Participants were asked to complete a 38-question REDCap survey to assess their reproductive goals and baseline fertility knowledge prior to the sessions. Answers from the survey were compiled and descriptive statistics were analyzed. 112 residents and fellows attended the seminars and 59 of these attendees completed the survey (54 females and 5 males). with only 3.4% aged 35 or older. The largest percentage of participants were in their third post-graduate year (27.1%) and were training in surgical specialties (35.6%). One third of the participants were single, a third were married, and the remainder were partnered. No participants had children, although 2 experienced infertility and had pursued treatment. Over 80% planned to have children and nearly 90% of those individuals hoped to have their first child by age 35. More than 70% of participants reported that they delayed childbearing due to their career. Other reasons identified for delaying pregnancy included plans for ongoing training (50.8%), as well as concerns about time (49.2%), cost (49.2%), childcare (40.7%), and parental leave (27.1%). Nearly half of participants delayed starting a family due to their partner or lack of partner. Over 70% of participants were not aware of fertility benefits and reported desire to pursue fertility treatment or oocyte cryopreservation if covered by insurance. Barriers to pursuit included cost (74.6%), lack of knowledge regarding the procedure (59.3%), initiation (55.9%), and time commitment (54.2%). Ten percent of participants reported that female fertility does not decline until age 40. One third believed that success with one IVF cycle is 80% in women under 35. Nearly 10% of participants underreported miscarriage rates for all age groups. Sixty-five percent of respondents overestimated the upper age limit for IVF success with autologous oocytes, estimating 50.5 years and 14.3% of participants believed that women over age 60 could conceive with their own eggs. Over 80% recognized that males continuously produce sperm but greater than 30% were not aware that sperm concentration decreases with age and 11% were not aware that sperm quality similarly declines. Most medical residents and fellows delay childbearing due to training. Knowledge gaps are highly prevalent in this educated population who desire children but are delaying childbearing. Education focused on the impact of age on fertility and options such as oocyte or embryo cryopreservation should be taught in medical school or during residency training.