Facing the challenge of physician infertility

Rebekah Bernard, MD

In 2023, the Medical Student Section of the Florida Medical Association (FMA) submitted a resolution asking for recognition of the issue of physician infertility and more education on the topic. In response, the FMA hosted a webinar with experts on various aspects of physician fertility. This is part 2 in a series based on that webinar.

Emergency physician Melissa Parsons, MD is on a mission to get physicians to say the ‘F’ word. “Not the four-letter word, but one that has also been considered explicit in the past,” she explained to a physician audience at the Florida Medical Association. “I want to talk about fertility and the silent struggle of female physicians and reproduction in medicine.”

Parsons has been speaking out about physician fertility since she faced her own struggle in 2018. “I started telling my story after being diagnosed with an ectopic pregnancy while I was on shift working in the emergency department,” she said. “I started researching and learned that while CDC data shows that infertility affects one in eight women on average, that’s not true for women in medicine. Our rates are closer to 25%, or one in four.”

This was new information for Parsons, who, like many physicians, received little education on the topic in medical training. “I remember sitting in the classroom in medical school and hearing the data about genetic and chromosomal risks with age, but nobody was telling us that we might struggle to create our own family,” said Parsons.

In vitro fertilization

Like many women physicians, Parsons said she spent most of her young adult life trying not to get pregnant to focus on her education and career. When the timing was right to start her family, she learned that she had endometriosis and diminished ovarian reserve and would require in vitro fertilization (IVF) to conceive.

Initially, Parsons felt confident about her chances. “I thought, ‘This is going to be easy. It's science, right? We all believe in science.”’ Parsons underwent IVF, with eight eggs retrieved, five fertilized, and two embryos implanted. A few days later, she had her first positive pregnancy test. “We were overjoyed. Everything was going the way we thought it would.”

But her initial blood test result was not as encouraging. “I had a quantitative HCG level of 49, which was much lower than you would expect,” she said. As an emergency physician, Parsons knew the next step. “You have to do a two day repeat blood test,” she said, “We do this all the time for patients in the emergency department.”Her two-day level was 98—exactly doubled.Parsons was told that she could either have repeat 2-day blood tests or wait until her six-week ultrasound.

“I know that patient in the emergency department coming in repeatedly for beta quants and I didn't want to be that patient,” she said. “I didn't want to be any patient.”Feeling that it would give her more control, Parsons decided to wait for the ultrasound. But when she saw the images on the monitor, Parson’s training as a physician confirmed the bad news—she had an ectopic pregnancy.

“The minute I saw my uterine stripe completely uninterrupted, I knew that we had a problem,” she said. Further scanning confirmed a gestational sac without a fetal pole. “My doctor, who was wonderful, looked at me and said, ‘I’m sorry. You probably diagnose these way more than I do,’” said Parsons. “I was like, ‘Yep, I probably do.’”

Rounds 2-6

A few months later, Melissa Parsons and her husband underwent another round of IVF. “We retrieved seven eggs, three were fertilized, and I had one embryo implanted,” she said, but her pregnancy test was negative. To improve her chances of success, her doctor recommended laparoscopic surgery. “I had stage two endometriosis, which they cleaned out and I was supposed to be good to go for my next round of IVF,” she said.Unfortunately, two cycles of ovarian stimulation failed. “It was a waste of money on drugs,” said Parsons, who began to feel discouraged. “This was kind of the stopping point for me, and the first time I gave a lecture on infertility.”

With a new protocol to try, Parsons underwent a fifth attempt at IVF. “I had eleven eggs retrieved, three fertilized, and one embryo frozen,” she said, only to learn that the embryo did not survive the thawing process. “My doctor told me that this was so rare—less than 1%--that she couldn’t remember the last time it happened.” Parsons was heartbroken. “I was absolutely tired of being the patient, and I was tired of being the patient in which nothing was right, where I was consistently the 1%.”

In April 2019, Parsons underwent her sixth attempt at IVF. “I retrieved nine eggs. We had five that were fertilized and four embryos. On June 25, we transferred one of those four embryos.” This time, the process succeeded: Parsons had a positive pregnancy test. Unfortunately, her challenges were not over. “Sometimes I think for physicians, nothing is smooth,” she said.Parsons experienced a chorionic hemorrhage at six weeks. During delivery, she developed pre-eclampsia and severe hemolysis, elevated liver enzymes, and low platelets (HELLP syndrome), and required intensive care. “That ended my future pregnancy journey,” she said, “But I’m very happy to say that we finally got that little ‘pumpkin’ we were hoping for—and this little guy was worth the wait.”

Lessons learned and shared

Melissa Parsons is using her story to increase discussion about physician fertility. “We have to start talking about this,” she said, acknowledging that it is not always easy to do. “Sometimes I cry when I get on stage and have these personal conversations,” she said, “But I do it to create a safe space for other people.” In addition to speaking, Parsons created a website called SheMD to share information about fertility and other topics important to women physicians.

According to Parsons, it is especially important to counsel medical trainees about the risk of infertility so that they can be better prepared and feel supported. “I think the most impactful part of sharing my story is when residents come to me and feel safe, including those in other specialties,” she said. “Being able to be a sounding board for others has been really special.”

Parsons also said that more data is needed on infertility and the impact on physicians. “When I started researching this a few years ago, I only found a few studies—one had just 300 female physicians, and a larger study of 3,000 women doctors in Hungary.” To improve knowledge about the subject, Parsons published a study of over 2,000 women emergency physicians. “We found a 24.9% rate of infertility among these physicians, compared to a national average of 12.2%,” she said. “We also found a potential association between infertility and longer work hours and more night shift hours.”

While many of us will not experience infertility, we are all likely to interact with colleagues who are facing this issue. With her unique perspective as both physician and patient, Parsons urges colleagues to show compassion and empathy, which can be as simple as reassuring patients that pregnancy challenges are not their fault. “You CAN do something to make a difference in this woman's story,” Parsons writes. “She is going to blame herself. Reassure her that it is NOT her. That she could NOT have done something different to change the outcome. Let her take one sigh of relief in her suffering and grief.”

Rebekah Bernard, MD is a family physician in Fort Myers, FL and the author of four books, most recently Imposter Doctors: Patients at Risk.