Fertility Preservation and Family Planning in Surgical Training: Highlights from a Much-Needed Discussion

Authors: Nensi M. Ruzgar, Camila R. Guetter, Natalia Correa, Jessica Millar, Jessica Means, Kelsey Romatoski, Brooke Golisch, Pietro Bortoletto

Affiliations:

1. Nensi M. Ruzgar, MD, MHS – Beth Israel Deaconess Medical Center, Boston, MA; Dana-Farber Cancer Institute, Boston, MA
2. Camila R. Guetter, MD, MPH – Beth Israel Deaconess Medical Center, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA
3. Natalia Correa, MD – University of Miami Holy Cross Hospital, Fort Lauderdale, FL, USA
4. Jessica Millar, MD – University of Michigan, Ann Arbor, MI
5. Jessica Means, MD – Beth Israel Deaconess Medical Center, Boston, MA
6. Kelsey Romatoski, MD – Beth Israel Deaconess Medical Center, Boston, MA
7. Brooke Golisch, MD, MS – Northwestern University Feinberg School of Medicine, Chicago, IL
8. Pietro Bortoletto, MD, MSc – Boston IVF, Waltham, MA; Beth Israel Deaconess Medical Center, Boston, MA

On Nov 12th, the Association of Women Surgeons Resident and Fellow 2024 Webinar Series offered a valuable discussion on fertility preservation and family planning for surgical trainees. Hosted by AWS, the session featured a talk by Dr. Pietro Bortoletto, a Reproductive Medicine Specialist at Boston IVF and Beth Israel Deaconess Medical Center Department of Obstetrics and Gynecology, followed by a Q&A panel of surgical trainees including Drs. Jessica Means, Kelsey Romatoski, and Brooke Golisch. The session aimed to explore the challenges faced by trainees in balancing their demanding careers with reproductive health decisions and resources available.

Dr. Bortoletto discussed various assisted reproduction methods, including egg harvesting, cryopreservation, in vitro fertilization (IVF), and artificial insemination. Egg retrieval involves using a needle under ultrasound guidance to collect eggs, which are then cryopreserved or fertilized in a lab with the resulting embryos cryopreserved or implanted into the uterus. IVF and embryo cryopreservation are proactive ways to potentially preserve future fertility. Preimplantation Genetic Testing (PGT) screens embryos for genetic conditions before implantation. Artificial insemination methods like intrauterine insemination (IUI) offer alternatives for those facing male factor infertility, as well as those with same sex partners or who are not partnered.

During the panel portion of the event, surgical trainees shared their personal experiences with seeking fertility treatment while in training. Their stories highlighted the deeply personal decision to pursue fertility preservation and how it is influenced by both professional and financial considerations. Many panelists turned to co-residents, faculty, and social media for guidance. While not all programs offer fertility preservation, some provide financial assistance or healthcare coverage to help offset the high costs of these treatments, motivating some trainees to pursue these options.

The panel also discussed the challenges of finding time for fertility treatments while maintaining the demanding schedule of surgical training. Daily procedures or tests required for fertility preservation can conflict with call shifts or operating room time. However, several panelists were able to manage by working with their program directors and scheduling treatments during less demanding rotations, such as research blocks. Other systemic factors were also addressed, such as training timelines that lead to delayed childbearing and age-related fertility concerns.

Access to fertility preservation resources varies significantly between programs, with discrepancies in insurance coverage, availability, and institutional support. Trainees often struggle to find clear and transparent information about fertility benefits, which complicates decision-making. To address these issues, the discussion emphasized the need for advocacy from surgical organizations like AWS and ACS. These organizations should push for improved access to fertility preservation resources, more equitable policies, and greater transparency regarding fertility benefits in training programs. Fertility preservation education should be seen as an essential part of surgical residency training, allowing residents to make informed choices about their reproductive health without compromising their career advancement.

In conclusion, the webinar highlighted the importance of supporting surgical trainees in navigating reproductive health decisions. By advocating for systemic change and improved access to fertility preservation resources, surgical training programs would create a more inclusive environment where trainees can make informed decisions about both their professional and personal futures.

Anyone interested in the topic can access the recording of the session on the AWS online webinar library or attend one of our upcoming webinars (link to sign up here).

 

Author Bio:

Nensi Ruzgar is a general surgery resident at Beth Israel Deaconess Medical Center, completing her residency research years at Dana-Farber Cancer Institute. She serves as a Regional Liaison on the AWS Resident and Fellow Committee. She is proud to have worked on this blog post with other members from the Resident and Fellow Committee (Drs. Guetter, Correa, and Millar) as well as our wonderful webinar speakers (Drs. Bortoletto, Means, Romatoski, and Golisch).