Decreased Fertility Awareness Amongst Surgeons and Surgical Trainees and Potential Role of Formal Fertility Education

Hayden Hartman; Nazanin Kermanshahi; Elizabeth Matzkin; Erin A Keyser; Arianna L Gianakos

doi:10.1016/j.jsurg.2024.03.011

Decreased Fertility Awareness Amongst Surgeons and Surgical Trainees and Potential Role of Formal Fertility Education

J Surg Educ. 2024 May 14:S1931-7204(24)00157-0. doi: 10.1016/j.jsurg.2024.03.011. Online ahead of print.

Authors

Hayden Hartman¹, Nazanin Kermanshahi², Elizabeth Matzkin³, Erin A Keyser⁴, Arianna L Gianakos⁵

Affiliations

¹ DeBusk College of Osteopathic Medicine; Lincoln Memorial University; Knoxville; TN 37932. Electronic address: Hayden.hartman@lmunet.edu.
² Arizona College of Osteopathic Medicine; Midwestsern University; Glendale; AZ 85308.
³ Department of Orthopaedic Surgery; Brigham and Women's Hospital; Boston; MA 02115.
⁴ Gynecologic Surgery & Obstetrics; Brooke Army Medical Center; Houston; TX 78234.
⁵ Yale Medicine, Orthopedics & Rehabilitation; Yale School of Medicine; New Haven; CT 06519.

PMID: 38749812
DOI: 10.1016/j.jsurg.2024.03.011

Abstract

Objective: Compared to the general population, physicians tend to have children later in life, increasing rates of infertility, obstetrical complications, and the need for assisted reproductive technology (ART). The aim of this study is to systematically review the literature to determine the level of fertility and ART knowledge amongst United States surgeons and surgical trainees, and analyze the impact of the medical career on family planning goals and outcomes.

Design: A systematic literature search of articles published between 2014 to 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to, Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary outcome measures included fertility and ART knowledge, childbearing decision-making factors, and current education. Secondary outcomes included evaluation of institutional support, postpartum, and infertility.

Participants: Sixteen studies with a total of 6983 partici- pants (908 men and 5162 women) were included in this systematic review.

Results: Sixteen studies with a total of 6983 participants (908 men and 5162 women) were included in this systematic review. Though most participants were aware of the presence of age-related fertility decline, most were lacking in fertility and ART knowledge, and most likely did not receive formal education in these topics. The vast majority elected to delay childbearing due to career aspirations, with many facing subsequent pregnancy complications, infertility challenges, and a lack of institutional support in the postpartum period.

Conclusions: Our study demonstrates that medical students, trainees, and physicians overall are lacking in knowledge and awareness regarding age-related fertility decline and ART, indicating the necessity for a formal educational curriculum. Additionally, female physicians opt to delay childbearing longer than their male counterparts, while also experiencing increased complications and institutional challenges. This study clearly demonstrates a need for parental leave policy expansion, transparency of the policies in place, and financial and time allowance support for elective oocyte cryopreservation in the medical community.

Keywords: ART; cryopreservation; education; fertility; infertility.