Physician fertility: To be or not to be child free?

When I was 11 or 12, my mother was diagnosed with a severely disabling illness. As the oldest child, I was already helping with housekeeping and child-raising duties, but once my mom became ill, my role rapidly expanded.I took over cooking dinner (I make a mean cube steak) and doing laundry. As we grew older, I supervised homework and picked my siblings up from school. Despite having just a few more years of experience, I tried to advise and guide them through major life decisions, and I’m so proud that despite much adversity, all four of us grew up to be successful in our chosen fields.

Rebekah Bernard, MD

While my siblings each had children themselves—I’m an aunt five times over—I never longed to have children of my own. Sure, I assumed that a baby or two would just come along as part of ‘normal’ life progression, but it wasn’t something that I hoped or dreamed of—perhaps because I had already experienced and fulfilled some of that role with my brothers and sister.

So, at the age of 34, when I learned that my fertility odds were just 3% without medical intervention, I felt an odd mix of emotions. There was a bit of hurt and sadness, but in some ways, it felt like I had dodged a bullet—the decision had been made for me by a higher power. I could explain away my childfree state as not really my choice, bypassing accusations that women without kids often hear of being selfish or overly career-driven or even, as one social media commentator recently said to me, disobeying God’s order to ‘Be fruitful and multiply.’

There was just one nagging doubt that I had: Would I regret my decision not to pursue fertility treatments once I was too old? Would I miss my one chance to know ‘true love’, as described to me by many a new mother?

Childfree physicians

We don’t talk much about women physicians who don’t have kids, either by choice or due to fertility issues. After scouring the literature, I couldn’t find a single study on the topic, but I was able to dredge up some demographic data on child status collected for other studies. The numbers I found indicated that between a fifth and a quarter of women physicians are childfree at the end of their reproductive years—ranging from 18% in a 2016 study intended to capture women physicians approaching or past childbearing age, 20% in a 2023 study of women reporting no children nor plans to have children, and 25% in a 2020 survey of retired women physicians. These numbers are higher than the 16.5% reported for the average American woman, perhaps because women physicians start their families later due to pursuing medical studies, leading to higher rates of infertility.

While there is no data specific to women physicians, a 2024 study examined why average Americans choose to be childfree. The top responses for those over 50 years old included: ‘It just never happened’ (39%), ‘Didn’t find the right partner’ (31%), and ‘Just didn’t want to’ (31%). To learn more, I asked women physicians without children about their journey and decision not to have children.

A lack of ‘maternal instinct’

“When I look back on the decision to remain childless, I realize I never thought about, imagined, or daydreamed about having kids at any point,” said Eva Crooke, MD, a Tampa, Florida, obstetrician. “When I would talk about my future, it always included what I would do for a career and not what my family would look like.”

Crooke suspects that this lack of desire for children stemmed from experiencing her parents’ divorce at age 7. “My mom and I moved out to an apartment and my brother stayed in our prior family home with my dad,” she said, noting the impact of her father’s absence in her life. “My dad would promise to come to various events but often would never arrive, using work as an excuse.” While Crooke and her father mended their relationship, she said she remained cognizant of how his absence affected her. “I knew that becoming a physician would consume much of my time, and the last thing I wanted was to be the ever-promising parent and let my child down over and over again.”

Crooke’s husband, on the other hand, always assumed he would have kids. “He’s the oldest of six kids, and always had his cousins and siblings around, so a large family was the norm.” Crooke said that they discussed children when they started dating. “I told him that I was more than open to having children if that was what he wanted, but I was clear that he would have to be the driver of the decision.”

The couple married and Crooke attended medical school and residency. “We enjoyed our young lives traveling and in leisure activities,” said Crooke. “We certainly were not ready for a commitment larger than our marriage and two dogs.” As time went on, friends and family began to have children, but the timing never seemed quite right for the couple. In addition, Crooke said that she was struggling with fear of the unknown: “Would I even be able to conceive? Could I have a healthy child? Would I be a good mother if I never felt the ‘maternal instinct?’ How could I imagine leaving children to a world I think is headed in the wrong direction socially, financially, and environmentally?”

Ultimately the couple decided to embrace being childfree, which has freed up more time for work and personal life. “It has allowed me to be more involved in organized medicine and volunteering,” said Crooke, who also noted the significant financial savings involved in not having children.“We may be able to retire at an earlier age and enjoy more traveling while we are young.”

Crooke does wonder if people who know that she made the decision not to have children think that she is selfish. “I remember people telling us things like we'd ‘be stupid not to have kids and pass along our great genetics’ or that we'd ‘make such great parents,’” she said. “No one will ever be able to know and understand all of the nuances of our decision.”

She also worries about what will happen to the other if she or her husband were to get sick or die. “We won't have children to help us, so we certainly need to make sure we have good friends and other loved ones in our lives to help with loneliness as a widower.” Crooke said the couple is planning to move closer to her husband’s family to spend more time with his siblings and their kids (10 and counting). “As we age, we’d like to be closer to them in location and connection.”

Focus on career

Susan Liberski, MD, a retired gastroenterologist in Naples, Florida, said that she was focused on career from an early age. “I grew up in a very misogynistic family and when I expressed my goal to become a doctor, I was always discouraged.” For example, family members told Liberski, “You’re only going to quit when you have babies,” or “Your (male) cousin didn’t get into medical school, what makes you think you can do it?”

Liberski was determined to prove them wrong. She entered into medical training at a time when only 10% of gastroenterologists were women and continued to face adversity after graduation due to her gender. “It was hard to find a practice willing to hire me. They would say, ‘What if you quit to have babies? We need a REAL gastroenterologist for our practice.’”

It wasn’t until her mid-30s that Liberski met her perfect partner, and she assumed children would come shortly after marriage. “When that did not happen the old-fashioned way, we had to make some decisions,” she said. “I did not think I could put myself through in vitro fertilization (IVF), as I saw way too many of my friends become overwhelmed by the entire process. I really did not need to be a parent that badly.” Liberski said that she and her husband considered surrogacy and adoption but decided not to proceed. Her decision was validated by seeing her godmother’s experience: “She never had children, and yet she was loved by everyone and had a very fulfilling life.”

Now retired, Liberski said that she is satisfied with her life choices. “Overall, I had the career I wanted, an excellent relationship, and really have no regrets about not having children.” Her only advice for her younger self: “I should have had a bit more fun and spoken up more for myself.”

Know thyself

Elizabeth Shandor, DO, an internist in Wyoming, said that she never felt a strong desire to experience pregnancy, in part due to witnessing her mother’s struggles raising a family. “Being a lesbian meant that an unexpected pregnancy was not a concern, and I found comfort in knowing that my sisters were continuing our family lineage,” said Shandor. Instead, she chose to focus on her professional goals and personal fulfillment.

“I have deep admiration for those who manage the dual roles of being a physician and a parent, especially given the additional challenges women often face in balancing these responsibilities,” said Shandor. “Occasionally, I reflect on my own choices and feel a sense of contentment knowing they align with my values and lifestyle.”

Now past childbearing years, Shandor said she doesn’t regret her choice. “While I sometimes wonder what parenthood might have been like, I feel confident and happy with the path I have chosen. If I could advise my younger self, I would encourage her to stay true to her values and desires and not be swayed by societal expectations. It's important to be self-aware and courageous enough to make decisions that support your own happiness and fulfillment.”

Acceptance of biological limitations

Kristina Kise, MD, said she knew from a young age that she wanted kids—in fact, her love of children led her to become a child psychiatrist. “I love spending time with my nieces and nephews and watching them grow up,” she said. “It would give me such warm feelings when friends would watch me with their kids and tell me what a good mom I would be one day.”

Kise met her husband in her mid-30s, and the two married when she was 37. “We both really wanted kids, so we started trying right away,” she said. After six months, Kise began fertility treatments. “We did IVF for two years and I had three miscarriages,” she said. “It was so stressful; just one disappointment after another. Every period was devastating.”After using their embryos, the couple decided to stop treatment. “I just could not do it anymore,” said Kise, who felt particular regret about not freezing her eggs when she was younger. “When I was around 32 I asked my OB/GYN about it and she dissuaded me, saying it wasn't necessary.”

Kise said that one of the hardest parts of her fertility journey was feeling like a failure. “I knew it didn't make sense and wasn’t true, but it’s what I felt.” Kise said that part of that hurt came from only hearing the positives about fertility treatments. “You only ever hear about the success stories of IVF and not the ones that didn't work out, so I felt very alone. I also felt like IVF doctors gave false hope. I really loved my IVF doctor but I think they try to give too much optimism, and not enough realism.”

Adding to her sense of isolation, Kise felt left out of women physician spaces because she didn’t have children. “I often felt hurt by being excluded from activities and vacations that involved kids,” she said. She also notes a lack of social media spaces for physician non-moms. “It wouldn’t take much to change the name from physician mom groups to physician women’s groups,” she said.

Kise said that she and her husband have reconciled themselves to not having children. “I sought out therapy, which made a big difference,” she said. “While I’m sad I couldn’t have kids, I am happy in my life. I can see that there are pros and cons—the nights that I come home exhausted from work, I am grateful I don't have energetic kids that I have to try to take care of and thus I can just relax.” Kise also noted that not having children allows more personal and financial freedom. “We were able to save more money, have more freedom to pursue hobbies and travel, and dedicate quality time together.” Kise said that because she is not torn between work and family, she is able to focus on her career. “I have accepted that this is my life and am at peace with that. I know that a life without kids is still a good life.”

'It just never happened'

“I was an only child, surrounded by a lot of adoring adults as the child star of the show,” said Robin Rose, MD, a retired family physician who lives in Hawaii. Rose said that she determined from an early age to have eight children, but babies never came along. “I did some exploratory procedures with a good gynecologist friend to see why she was having one baby after the other while I only grew fibroids,” said Rose. “Circumstances just didn’t happen.”

Over the years, Rose developed a thriving small town primary care practice and found herself in the position to act as a godmother to many children. “When I lived in India, I cared for the new baby of the head fisherwoman because the momma was so depleted—this was her fifth baby in a village where many babies died.”Later, Rose took over stewardship for children from her friend circle who needed respite and “adopted” young adults who needed help.

Not having her own children allowed Rose the opportunity to follow her passions, including time in nature and retreats in isolated places. “I’m at peace with the life I’ve gotten to live—so much of it might not have happened had I had children and the prolonged nature of that responsibility,” said Rose. “I was able to be spontaneous—which was great considering my work as a physician was so demanding.”

As she reflects on a life without children, Rose acknowledged that she sometimes questions her place in the world. “As I get older, it’s more about not having grandchildren, and sometimes I grieve the loss of the original vision I had.” In addition, she wonders about aging without support from a child. “I am concerned about how it will go when I’m much older or frail and needy,” she said. “I cared for my mom as she dwindled and died—tender loving care. I just wonder and have faith.”

Overall, Rose said that she is happy and grateful for how her life has turned out. “I am still surprised to have no kids—it seems almost funny but I don’t know what the joke is,” she said. “Mostly I am living happily ever after. I am grateful for the aloha, the peace, the ability to focus on creativity in the garden, the kitchen, the marriage, the incredible place we live.”

Overcoming societal expectations

Adria Carney, MD, an adult and child/adolescent psychiatrist in California, had little exposure to children because she was raised by her grandparents in a household without siblings. “When asked, I would reflexively say I wanted children because of societal expectations,” she said. “To say otherwise would lead to a discussion on a woman’s ‘purpose’ and the ‘joys’ motherhood. Worse yet, how terribly selfish of me to desire a medical doctorate which would limit, if not prohibit, motherhood.”

Carney said that as the years passed, her automatic response evolved into a “wishful lie.” “I felt this need to be perceived as a ‘good woman,’ which meant a woman who wanted children,” she said. “I would say that I always thought I would have children, but it just didn’t happen.” Meanwhile, Carney was taking precautions to avoid pregnancy. “It wasn’t until uterine cancer took my fertility that I was emboldened with gratitude for a child free life and felt free of the societal obligation to have children,” she said. “Now I had a selfless reason for being childless: cancer.”

Carney said that she has come to accept that having children isn’t what makes you a “good” woman. “Now I know that good wasn’t the goal, but instead, greatness,” she said. “How great it was to have the freedom and financial ability to put myself through college and medical school.”

Choosing service to others

Amy Swift, MD, a physician in Washington state, said that not having children was an easy decision for her, based on her mother’s experiences raising five children on her own. “Don’t get me wrong—we were always clean, fed and for the most part happy,” said Swift. “I can’t say the same for my mother. Her fear was palpable. Was she going to make ends meet, afford groceries, and put gas in the car with small wages she made as a secretary at a TV repair shop?” Swift noted that as a child, she had no real understanding of the challenges her mother was facing. “I just knew my mom cried a lot.”

When Swift was 6 years old, her mother remarried. “My stepfather was a saint of a man who rescued the family and moved us out of poverty to a comfortable middle-class life in a house on a tree-lined street,” Swift said. But while life was better, Swift said that her mother continued to carry guilt about the hardships her children endured. “As I got older, my mother and I would have conversations about her life and experiences. She often told me, ‘I’m surprised any of you kids still talk to me.’” Swift said that she found this heartbreaking. “My mom did the best she could. She had made so many sacrifices for us. Often she would go hungry while making sure we were always fed. She would lay her own dreams to rest while constantly encouraging us to pursue ours.”

Swift said that while her choice not to have children was based on her mother’s experiences, it was not due to fear of facing the same issues. “The decision was based solely on the life I wanted to live. I wanted to pursue my dreams. I wanted to be fully present in my own life and, for me, that involved choosing not to have children.”

Swift said that she is often asked if she regrets not having children. “That answer is no. I love children, and I am very close with the children of my friends. Having said that, I believe we all have a purpose. My purpose is to be of service to the many. For me, that has been more rewarding than motherhood.”

No regrets

Returning to my story, this year I turned 50. It was a bit of a landmark, since my own mother died at age 49. I always had a bit of a superstitious black cloud over my head that I wouldn’t make it past that age—and perhaps this contributed to my decision not to have children: I never wanted a child to experience the pain that I felt at losing a mother.

But once I hit 50, I felt a lifting of anxiety, almost a new lease on life. Yes, I’m too old to bear children, but my life is so full and so happy. I’ve graduated medical school, opened a practice, written books—and I have been lucky enough to experience true love.

Children are a wonderful blessing, and I’m so happy for those who are called to bring them into the world. But take it from those of us who were not called to that purpose: There is nothing to fear about being childfree.

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