Characterizing Fertility Concerns among Women in Academic Medicine and Evaluating the Economic Impact of Fertility Preservation for Deferred Reproduct

In the past few decades, the number of women in medicine has steadily increased such that women now account for approximately half of all US medical school graduates and 40% of US medical school faculty. However, women tend to leave academic medicine at disproportionately higher rates than men. Although the stress of academic medicine can be demanding and challenging for any physician, concerns about fertility may be a factor that uniquely affects female physicians’ career decisions and attrition. The timing of women’s peak reproductive years often coincides with their peak career-building years and many female physicians experience conflict balancing decisions about fertility with their career. Since the advent of oocyte vitrification (“egg freezing”) in 2007, and the lifting of the experimental label on oocyte vitrification by the American Society for Reproductive Medicine (ASRM) Practice Committee Guidelines in 2013, fertility preservation through oocyte vitrification has become a viable reproductive option for women interested in delaying childbearing for personal or professional reasons. A growing body of evidence highlights the importance of age in influencing both the efficiency and the success of oocyte vitrification. Women who undergo oocyte vitrification before the age of 35 years old tend to require fewer oocyte retrieval cycles and fewer IVF cycles for a successful live birth. Even though most female physicians report high levels of interest in fertility preservation and assisted reproduction technology (ART) options, most women seeking consultation for fertility preservation present themselves too late, with an the average age of presentation between 37 to 38. Two primary factors that may prevent women in academic medicine from undergoing oocyte vitrification at younger ages include: a lack of awareness regarding the importance of age on the efficiency and success of fertility preservation, and the high costs of fertility preservation without insurance coverage. The aims of the present investigation are to characterize the unique needs of women in academic medicine surrounding their fertility and develop a survey instrument to assess these needs in a national sample (Aim 1), and model the cost-effectiveness of oocyte vitrification for deferred reproduction as a function of age (Aim 2). Ultimately, this research will allow us to develop a statistical tool for academic stakeholders and policymakers to use to evaluate the potential financial return of investment of adding expanded fertility coverage to faculty health insurance plans. We hope that the current research will advance the discourse on understanding fertility concerns among women in academic medicine, and the economic impact of expanding faculty insurance plans to include fertility preservation coverage.