Difficulties with Conception/Fertility Treatment

Female surgeons tend to have their families later.

Fertility decreases with age and therefore if you are over the age of 35 NICE recommends referral to a fertility service earlier than the usual one year of trying to conceive.

If you undergo fertility treatment while training you will need to consider issues of notification, time off for appointments and risk assessments.

Giving information

  • Who you tell, when and how is up to you, but some people will need to know. It is a difficult balance but the earlier the notification you can give can really help with identifying and managing any risks within your workplace and ensuring adjustments can be made.
  • As a minimum you will need to tell:
    • The Rota Coordinator.
    • Your educational and clinical supervisors.
    • Any parties affected by your absence.
  • Some choose to keep within this circle, but others have felt that is was easier to be open with colleagues as they felt that was less stressful than trying to make excuses/ justify absences/ worrying about others perceptions.
  • If you choose to keep things private you may want to notify affected parties yourself so you control what information is shared about you.
  • You will need to be open and realistic about what appointments are coming up and how much notice you’ll be able to give.
  • If you can, let your CS/ AES and Rota Coordinator know when a cycle starts so they know appointments are on the way and give them a copy of your clinics protocol so they know roughly what to expect.

Treatment

  • You may need to take your drugs with you and identify a fridge to use.
  • You may need 2-4 weeks off work following a treatment cycle.
  • Explore alternative pathways to streamline the process a little.
    • Seeing hospital rather than community based teams.
    • Phlebotomy services in the hospital for samples.

Work

  • Try to be flexible and helpful when not in a cycle so your colleagues don’t mind covering for you at short notice even when they don’t know why.
  • Don’t underestimate the emotional effect of receiving disappointing news during an appointment and try to avoid significant commitments on the day of such an appointment. You might want to ensure you allow decompression time with your other half after appointments before going back to work for example.
  • More widely this will undoubtedly be times of high emotion, so you should be honest with your AES, CS and TPD about how it’s affecting you.
  • Try to minimise additional risk factors such as; stress, long periods of standing, on-call and shift working – discuss this early with your TPD/ AES/ CS and Occupational Health.
  • Avoid anaesthetic gases (particularly relevant in paeds anaesthetic rooms and recovery).
  • It is normal at this time to become very risk averse, despite best evidence and therefore it is reasonable to avoid all cement and radiation exposure (see Risk Exposure). 
Real-life stories
An honest account of the emotional impact of fertility issues: 

‘I think that my experience had a very detrimental impact on my training. I think a lot of it was self-imposed but I had my first miscarriage whilst on night shift in 2012. I then had four further miscarriages and it wasn’t until I was whisked off for emergency surgery for my ruptured ectopic in 2015 that I took any time off or told anyone about it.
 
A combination of all of this lead to me having a bit of a breakdown and needing quite a substantial amount of time off. Whilst it was going on I was clearly not at my best and so the middle portion of my training really suffered. I think a culture of increased openness would have helped me but I’m not quite sure how to achieve this. I certainly felt pressure not to let on that I was in anyway different or lesser as a result of being female. And I think if I had been having, say, recurrent flares of Crohn’s I would have been more likely to have let my supervisors know and maybe take some time off which might have helped. Certainly for me the fear of never having children and my career being 'everything' piled even more pressure on at a time when I felt I was underperforming and lead to me making some bad decisions about taking on research projects etc.’
 

If you have a story you think would be helpful or inspirational then let us know at [email protected].

Further resources at Human Fertilisation & Embryology Authority.