Dr. Christina Yannetsos’ patient was about her age, 38, and extremely sick with Covid-19.
“I remember having a conversation with her kids who were probably anywhere from 10 to teenagers, and them asking me if their mom was going to die,” Yannetsos, an emergency medicine physician at the University of Colorado Hospital, recalled. “It was one of the most difficult things to have that conversation while I was also trying to build a family myself.”
Yannetsos got married when she was 34 and tried to have a baby for a year but couldn’t.
In March of last year, she was scheduled to do in vitro fertilization, but her procedure was canceled because of the pandemic.
Covid got in the way again eight months later when she was scheduled to have an embryo transfer.
“We did our pre-transfer Covid test, which came back positive. The day before the transfer. So, I was heartbroken,” she said. “It made me feeling sick a little bit more miserable, waiting to feel better and be able to be a candidate again for an embryo transfer and a chance at a family.”
A tough situation worse
Since female physicians are training during their prime reproductive years, infertility is not an uncommon problem. In the US, infertility affects an estimated 1 in 8 women, but for female doctors, it’s 1 in 4.
Covid has made a tough situation worse.
“Physicians who have taken on the physical and emotional burden on the front lines caring for patients throughout the pandemic, who are also struggling from infertility, are facing compounded challenges and stressors,” Dr. Erica Kaye, a pediatric oncologist at St. Jude Children’s Research Hospital in Memphis, said.
Last year, writing in the New England Journal of Medicine, Kaye shared her experience with repeated infertility treatments, and how she “grieved the loss of five desperately wanted pregnancies.” When the pandemic started, she was hoping to do another round of egg retrieval, but no new workups were being done.
Dr. Soha Patel, a high-risk obstetrician at Vanderbilt University Medical Center, was planning to undergo a cycle of IVF treatment when Covid patients started arriving at her hospital.
“We started wearing masks that were mandated while I was going to get ultrasounds and still doing the four-times-a-day injections,” she recalled.
Patel was taking care of women with high-risk pregnancies, and there was a lot unknown about the coronavirus.
“It’s terrifying from a professional level because you don’t know how to counsel patients, and you’re not sure how this will affect their babies,” she said. “But at the same time, I was terrified for myself as well, to contract something that could potentially affect my infertility treatments.”
Because of the virus, Patel had to attend procedures by herself, without her husband.
“He was not able to attend a lot of my ultrasound appointments. In fact, he wasn’t able to attend any of them,” Patel said. “He wasn’t able to attend any of the retrieval procedures, as well. And so, while I was going through that process, he was actually in the garage, waiting in the car.”
His absence made a lonely process even lonelier.
“I think what people don’t understand is that this process can be very isolating. It can be very lonely for women,” Patel said.
Patel has had a successful IVF cycle and is now moving on to the next stage in the embryo transfer process.
Yannetsos recovered from Covid-19 and finally got pregnant through IVF. Her twins are due in December. As someone still taking care of Covid patients, she said the anxiety does not stop.
“Patients who are pregnant have an increased risk of getting severe Covid,” she said. “I think that once they are born, I will feel much better about the situation.”
Infertility in female doctors
It’s not clear why infertility disproportionately impacts female physicians.
“There is a paucity of research literature,” Kaye said. “We know that it is a significant problem and a problem that, until very recently, few people were talking about.”
Medical training is incredibly intense and generally overlaps with prime fertility years in the mid-20s and early 30s. Many women training for various positions are working long and strenuous hours.
“There’s an enormous amount of stress during that decade of medical training. There’s a lot of sleeplessness and disruption of circadian rhythm,” Kaye said.
Kaye went through a pediatrics residency and two sub-specialty fellowships for more than a decade. She would often be awake for 30 hours or more at a stretch taking care of critically ill patients.
“I suspect that that, at least for some women, plays a role in the struggles with fertility and pregnancy loss, but a lot more research needs to be done,” she said.
The arduous training can also make it difficult for women to meet a partner they want to have children with until they are older.
“In residency I would spend rotations just five weeks of night calls,” Patel said. “It’s very difficult to sustain or even start a relationship. You go out with someone, and you can say, ‘I’ll see you in five weeks.’ I mean, that’s very difficult for others to appreciate what physicians go through in terms of training.”
Dr. Ariela Marshall, a hematology physician at the Mayo Clinic, experienced and sought treatment for infertility. She says medicine doesn’t make the atmosphere family friendly for people who may want to build their families during training rather than waiting until afterward.
“It’s kind of damned-if-you-do, damned-if-you don’t. If you try to build a family during training, the environment is not supportive,” she said. “But then, if you wait until you’re done with your training and more financially stable, then it may be too late.”
The situation may even be driving some female doctors out of the profession.
“We have a shortage of surgeons, and we wonder why weren’t not recruiting and retaining the best, talented candidates. And 50% of incoming medical students are women. And so, it’s really not a surprise. If you take something that’s the cornerstone of the lives of so many people, and you make it a very, very difficult journey, it makes the profession less appealing,” Dr. Erika Rangel, a gastrointestinal surgeon at Brigham and Women’s Hospital in Boston, said. “So, there’s something in it for all of us to make this better.”
Strategies for change
Last year, Marshall co-authored an essay in the journal Academic Medicine calling for change. She’d like to see insurance coverage provided to doctors struggling with infertility.
“Most plans will cover workup of infertility,” she said. “But once you find the cause, if you want to do something about it, not all plans cover it.”
Each cycle of IVF treatment can be costly. Patel had some coverage that was helpful, and it still cost about $10,000 to $15,000. She said her medications alone were $7,000 to $8,000. Yannetsos said she went through three rounds of IVF treatment, each one paid for out-of-pocket.
“Unfortunately, many, many hospital systems in our country do not offer fertility benefits,” Kaye said. “We need to look to business and organizations in other sectors, for example, industry and tech, which have done a pretty good job of ensuing access to fertility coverage for their employees.”
Patel doesn’t want the message to young women to be: “Don’t go into medicine.” She says she’d tell young women going into medicine is probably one of the best decisions she made in her life.
“I do believe that women can be successful both professionally and personally, and it think it starts with starting the conversation at an early level,” she said. “If we talk to medical students, pre-med students, early on, especially our female trainees, early on, to say, hey listen, this is something we should think about — change the system so that trainees feel that they’re supported through this process.”
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