Navigating Infertility in Medicine – PediaCast CME 116
Podcast: Download
Subscribe: RSS
Show Notes
Description
This episode of PediaCast CME is proudly co-sponsored by Nationwide Children’s Hospital and Widening Impact in Medicine and Science (WIMS) at The Ohio State University College of Medicine.
Dr Cristiane Ueno visits the studio as we consider fertility issues in medicine. Trainees face delayed childbearing, restrictive leave policies, financial pressure, and demanding schedules… all of which drive up infertility risk. We consider solutions that support medical professionals now — and their families in the future. We hope you can join us!
Instructions to obtain CME/CE Credit:
- Read this information page.
- Listen to the podcast.
- Complete the post-test at Nationwide Children’s CloudCME.
- CME credit expires 3 years from this episode’s release date.
- You can view your transcript and print a certificate of completion at Cloud CME.
- Need help creating a Cloud CME account? Click Here.
- Still have questions? Contact CMEOffice@nationwidechildrens.org
Topic
Infertility among Medical Professionals
Presenters
Dr Mike Patrick
PediaCast and PediaCast CME
Nationwide Children’s Hospital
Dr Cristiane Ueno
Associate Professor of Surgery
Indiana University School of Medicine
Learning Objectives
At the end of this activity, participants should be able to:
- Identify risk factors that increase infertility among medical professionals.
- Evaluate and overcome barriers that prevent medical trainees from obtaining support for infertility treatment.
- Develop patient-safe coverage strategies for medical trainees seeking infertility treatment.
- Model stigma-free cultural norms that support infertility treatment during clinical training programs.
Links
Childbearing, Infertility, and Career Trajectories Among Women in Medicine (JAMA)
Family Planning, Fertility, and Medical School: A Survey of Students’ Plans and Perceptions of Institutional Support (The Permanente Journal)
Fertility Preservation and Infertility Treatment in Medical Training: An Assessment of Residency and Fellowship Program Directors’ Attitudes (Women’s Health Reports)
Infertility and Fertility Resources (NIH)
Disclosure Statement
No one in a position to control content has any relationships with ACCME-defined ineligible companies.
Commercial Support
Nationwide Children’s has not received any commercial support for this activity.
CME/CE Accreditation Statement
In support of improving patient care, Nationwide Children's Hospital is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the American Nurses Credentialing Center (ANCC), and the Accreditation Council for Pharmacy Education (ACPE), to provide continuing medical education for the healthcare team.
AMA Statement
The Nationwide Children's Hospital designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA Statement
Nationwide Children's Hospital has been authorized by the American Academy of Physician Associates (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. PAs should only claim credit commensurate with the extent of their participation.
APA Statement
Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs. Nationwide Children's Hospital designates this activity for 1.0 continuing education credits.
ASWB Statement
As a Jointly Accredited Organization, Nationwide Children's Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. Regulatory boards are the final authority on courses accepted for continuing education credit. Social workers completing this course receive 1.0 general continuing education credits.
ADA CERP Statement
Nationwide Children’s Hospital is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at CCEPR.ADA.org. Nationwide Children’s Hospital designates this activity for 1.0 continuing education credit.
Contact Us
CMEOffice@nationwidechildrens.org
Episode Transcript
[Dr Mike Patrick]
This episode of PediaCast CME is brought to you by Nationwide Children's Hospital and Widening Impact in Medicine and Science, also known as WIMS, at the Ohio State University College of Medicine.
[MUSIC]
[Dr Mike Patrick]
Hello, everyone, and welcome to another episode of PediaCast CME. We are a pediatric podcast for health care providers.
This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 116.
We're calling this one Navigating Fertility Issues in Medicine. I want to welcome all of you to the program. We are so happy to have you with us.
Fertility challenges are a common but rarely discussed issue for medical professionals, much higher, in fact, than the general population. And I was not aware of this, and I think that many of you out there may also not be aware of the frequency with which infertility occurs among medical professionals. And we want to raise awareness about that.
Those of us in health care play a key role in supporting folks through difficult times. Many of us do that every day. But in addition to providing support, sometimes we need support.
And one of those areas of needing support is infertility treatment. Medical trainees often face delayed childbearing, restrictive leave policies, financial pressure, and demanding training schedules, all of which drive up the risk of infertility. Today, we'll explore how infertility impacts those of us in medicine, and we hope to spark conversations and solutions that support medical professionals now and their families later.
Of course, in our usual PediaCast CME fashion, we have a terrific guest joining us in the studio to discuss the topic. Dr. Cristiane Ueno is a plastic surgeon and associate professor of surgery at Indiana University. Don't forget, after listening to this episode, you can claim your free Category 1 continuing medical education credit.
It's really easy to do. Simply head over to the show notes for this episode at pediacastcme.org. You'll find a link to the post-test in the show notes.
Click that link to Cloud CME, and then click on the Materials tab after that. Take and pass the post-test, and the Category 1 credit is yours. We offer credit to many pediatric professionals, including doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.
And it's because Nationwide Children's is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of this episode matches your scope of practice, which this is another one of those really pertains to everyone as we think about increasing awareness about the ways in which infertility impacts medical professionals. Complete details about the CME are available over at pediacastcme.org.
Also, I want to remind you the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. Also, your use of this audio program is subject to the PediaCast CME Terms of Use Agreement, which you can find at pediacastcme.org.
So, let's take a quick break. We'll get Dr. Cristiane Ueno settled into the studio, and then we will be back to talk about infertility challenges faced by medical professionals. It's coming up right after this.
[MUSIC]
[Dr Mike Patrick]
Dr. Cristiane Ueno is a plastic surgeon and associate professor of surgery at Indiana University. She has a passion for raising awareness and providing support for medical trainees and her colleagues and peers with regard to fertility challenges during medical training and a subsequent career in the health sciences. As we will discover, health learners and practitioners face an increased risk of fertility challenges, which can be quite stressful as we balance work and family.
That is what she is here to talk about, navigating fertility issues in medicine. Before we dive in, let's offer a warm PediaCast CME welcome to our guest, Dr. Cristiane Ueno. Thank you so much for joining us on the podcast today.
[Dr Cristiane Ueno]
Thank you. Thank you so much, Mike. Thank you very much for this opportunity.
I think this is a very important topic that has a special place in my heart because I suffered a lot of what we will discuss, including fertility issues and ultimately decide for the adoption route. So, I hope we bring awareness, and more people will not have to go through what I went through.
[Dr Mike Patrick]
Yeah, yeah, absolutely. Definitely something important to consider. Can you lay the groundwork for why thinking about fertility is a critical topic for medical trainees and in the case of our audience, pediatric providers, and not only from the woman's perspective, but also from the family, from societal perspectives too.
[Dr Cristiane Ueno]
Yeah, thank you, Mike. I think we are doing a phenomenal job in background work in terms of recruiting more female to the workforce in medicine in general. So, we have an increased representation of female in medical schools, medical students, residents, and physicians working.
However, one thing that sometimes we forget to look into is that the medical training actually happens during the peak of reproductive years for a female that is between the age of 20 and 35 years old. And that can create a strain on childbearing abilities. So, medicine, it's a giver's work and has a professional environment that can be demanding long hours sometimes and high stress levels.
So, we might not know going into the field or into the field, but physicians have a higher rate of infertility. So, one in every four physicians will experience infertility, whereas in the general population, this number is between 9 and 18 percent. So, I think that knowledge of low fertility rate among physicians, medical students, trainees, it's very important.
So, I appreciate this opportunity.
[Dr Mike Patrick]
Yeah, yeah, absolutely. I was going to ask about, you know, current research in infertility risk in medicine. As you mentioned, there is an increased risk.
What kind of research has been done to show that there really is increased risk that's statistically significant among healthcare workers and trainees?
[Dr Cristiane Ueno]
I am a surgeon, so I am involved in our society in terms of some numbers within our society, but it's all across the board. So, in 2023, JAMA Open published, and this is actually referenced in this podcast, the U.S. general population for infertility is about 6 to 19 percent, where we discussed. And then they surveyed female physicians, not only surgeons, and they noted a 36.8 percent infertility rate. So, in that survey, there were over a thousand women that were surveyed, but not only trainees. On the survey, 26.8 percent were fellows or residents, but 7.6 percent were faculty and 60 percent in non-surgical specialties with 45.2 percent in academics. So, 78 percent of those surveyed were able to identify the correct age of fertility decline, and three quarters of the surveyed physicians, they delayed their family building because of their career.
And out of those 36.8 percent that represented with infertility, more than half went through IVF. So, and what is really shocking is that in that study, 45.7 percent, which is almost half of the surveyed female, said that they have family building regrets, and which is very unfortunate. There's also in the podcast a study that was done in 2025, so it's a recent study by the American Society of Reproductive Medicine, and then the prevalence of delaying childbearing for your first child in, for physicians, it's about the age of 32 years old, that's the average, whereas non-physicians are 27 years old.
So that obviously decreased the chance of fertility, and I think those are shocking numbers, but very important to understand.
[Dr Mike Patrick]
Yeah, yeah, absolutely. And so let me just kind of sum up, just kind of get it straight in my head here a little bit. So, if we look at fertility rates across a large group, you know, the entire population, we get a number, and then when we look at infertility rates among women physicians, we see a much higher number that's statistically significant that's been published.
Do we think that that is happening because of the delay, and then the increased risk of infertility because you're starting to try to have a family later, or is there something intrinsic about medical training that, you know, increases your risk of infertility beyond just it being an age issue? Does that make my question make sense?
[Dr Cristiane Ueno]
Yeah, absolutely, absolutely. I think it's both. The answer is really both.
So according to the American Society of Reproductive Medicine, there has been an overall, in the population, an increase in birth rate for women that are older since 2021, which is not just for the physicians but the overall population. But still, again, the number, the mean age of a first child for a physician is 32 years old as compared to 27 for the non-physicians. So, the majority of the times in all surveys, the numbers are very similar.
So, in general, the peak of your training coincides with the peak of your childbearing age. So that is one factor. There is definitely a delay in family planning because of career choices, and some physicians will, you know, choose, there's a difficulty with trying to identify practices that will support reduced working hours or, you know, extended leave in medicine.
So those are kind of extrinsic factors. But also, there's the risk of the long hours, the stress of the job, burnout. Those unfortunately lead to decrease in fertility.
I personally was not aware of that when I tried my fertility journey. I was 35 years old, and I was not aware that, you know, I was going to have problems with fertility. We have these numbers in our head that when you become 40, that's when you are higher risk of complications for pregnancy.
However, the age is actually 35. And so, I was like, well, I'm 35, I'm five years from 40, so I'll be okay. And that was not true.
And then when I checked, my ovary reserve was very low. And when I asked my mother, my mother had a completely different experience. I asked my sister, my sister had children at age of 33 and 36.
So, she had no problems as compared to me. And I think that, again, it relates to the long hours, the stress of her jobs, and that corroborates for this difference, like in my family, for example. So, this is something that we should be aware of.
[Dr Mike Patrick]
Yeah, yeah. And I would say not only be aware of, but also to maybe do something about. And it's, you know, it's one thing to say, okay, we're going to make everyone aware before you apply to medical school that this is going to increase your risk of infertility moving forward.
And I think we can clearly say that with the numbers. And so, I would say that with anything that's a risk factor, you can either just avoid the risk factor, or you can try to decrease that risk in some other way. And I think we have to choose the second of those options because otherwise we would be discounting a whole group of folks who would make excellent, compassionate physicians and help other people.
And if we just turn them away from medicine, because of that risk of infertility, we would really be doing a disservice to patients and families down the road in the future. So, if we sort of establish that this is something that we need to not be quiet about and to try to do something to improve those risks. First, I guess, why is it that this is not something that folks talk about?
[Dr Cristiane Ueno]
I think it's lack of knowledge, honestly. And not only lack of knowledge from the trainees and physicians, faculty, but also in our leaders. There was a publication of a survey that was done in the Women's Health Report Journal in 2021 that surveyed program directors, for example, and then over 50% of them had no idea about insurance coverage for fertility treatment.
70% of them had no idea of coverage for fertility preservation treatment. And a lot of them, the vast majority of the program directors, were not aware of their residents going through fertility issues. And I would say not only female trainees, but also male.
During my time at Ohio State, I had male trainees that were going through fertility issues. So don't think that it's just a female. Obviously, the childbearing age, the peak for female, it's in the 25, 29 years old.
But men at age of 45, they start to have decline. So essentially, the male trainees, they have a later peak. However, they also go through decline.
And I think this is important to understand as well, because it's something that is not just cis female, cis male, but also transgender population. So, it's something important.
[Dr Mike Patrick]
Yeah, for sure. So, lack of awareness is one. I would think another reason that folks, when you said a lot of program directors don't even know their trainees are going through any sort of infertility treatment, you know, in that sense, it would seem like, for one, it's personal, but also you may have fear of the consequences of you sort of rocking the boat when you need to take time away from your training program to undergo infertility treatment.
[Dr Cristiane Ueno]
Yeah, unfortunately, this is correct, right? There are really no established policies in terms of time off for treatment. There are really no established, very well-established policies for even grief if you suffer a loss, for example.
And during this, in preparation for this videocast, I was looking into some data. And what I found shocking too, Mike, is that paid parental leave is not federally mandated in the U.S. So, you know, during this research, I also found, which I found very interesting, is that 42 percent of the medical schools don't have paid parental leave. And there's 44 percent that don't even have birth parental leave, paid parental leave for faculty that, for example, go my route, that is the adoption route as a non-birth child, which happened to me as well.
My husband works for an organization, company that is not related to medicine and had 10 weeks of parental leave, whereas I did not have because there was a child that we adopted. So, this is important.
[Dr Mike Patrick]
Are there things that can be done? So, obviously, decreasing the stress is helpful. And, you know, there have been movements toward that.
You know, when I think back to my own training, you know, we had every third night call, and you could sometimes work 100 hours a week. And that kind of situation obviously needed to be corrected for many reasons and has been. But, you know, but it's still very stressful on the body for sure.
So, we can try to decrease that stress as much as we can within individual programs, but still meeting the needs of, you know, of individual hospitals and patients and all that gets very complicated. Are there also some things that folks can do to increase the likelihood that they'll be able to have a family later on? I'm thinking things like egg preservation and that.
Can you talk a little bit about what that entails? And then we'll also think about the cost of that and how does that get covered?
[Dr Cristiane Ueno]
Yeah, that's a very good question. I think, you know, we are 100% making progress, right? And again, having this opportunity, like if you imagine when you and I went through training, probably there were not, you know, there was nothing about this.
So, I think those are great. And we see more and are family friendly, which is very, very important. So, I think, and then the other thing that is important to you is that in 2013, the American Society of Reproductive Medicine changed the technique of egg preservation from experimental, so took the name away, which actually helps with insurance coverage and also helps with awareness.
So, there's opportunity to have egg preservation, which means that you may not be able to have a child during your peak of fertility. However, what you can do, you can actually save those eggs and then to use them in a later date. There's an option to do the egg preservation, but also the embryo preservation, which means you basically inject the sperm and the egg and then save the embryo for a later date.
So, those are ways that we as female or even male or even, like I said, transgender populations, we can also preserve the ability to have a child in a later age.
[Dr Mike Patrick]
Yeah, yeah. This is, okay, so this is completely out of the ballpark for me in terms of thinking about as a pediatrician and as a man, both, it's a little more difficult to wrap my head around this. I had no idea they did frozen embryos.
I've heard of, you know, frozen eggs, but a frozen embryo, is there any side effects of being frozen as an early embryo, like later in life?
[Dr Cristiane Ueno]
Yeah, no, absolutely, absolutely, absolutely true. I think there are things that are important. So, if you have the age of the egg, it's extremely important, right?
And then there are probably risks related to the frozen embryo that, you know, we cannot predict. Keep in mind that I'm a plastic surgeon. I am not an OBGYN, so I can't really say the chances per se, but those are opportunities, right?
For example, one of my previous partner, they were a gay couple, and they wanted to have a child, so they did the embryo freezing, and then later in life, when he was established and was a faculty, and they had a better, let's say, economic situation as well, they opted for a surrogate, and the embryo that they had frozen in the past. So, those are options, and not only for female, but also for male.
[Dr Mike Patrick]
Yeah, yeah. So, the bottom line is, talk to your fertility specialist about these things, and we certainly, on this podcast, are advising every female who starts medical training to have a frozen embryo set aside, but it's something to think about, as you said, and the first step of that is raising awareness about possibilities that we may not even have brought up with our own medical professionals because we didn't know about this risk factor. And so, just, you know, getting the word out so folks start thinking about it critically, not only on a personal level, but also on a program level, because if the program is a known risk factor for fertility issues down the road, is there a way that programs can be more friendly to making sure that the insurance that they have covers that sort of, that's one thing, another would be if you need time off to do these things.
So, I do wonder, like, that makes it more difficult and challenging to talk about, but I really don't have any idea of how much time is needed for those kinds of treatments.
[Dr Cristiane Ueno]
I think I went through IVF during my training and I don't, I did the wrong way, and I, you know, by not letting people know that I was going through that, so I don't even know if I would have had a chance to have time off or not because I was scared of disclosing that I was going through that. And, but it's really the time to go get blood drawn, which we can cover for each other or, you know, you don't need a day, you know, or two, you just really need a couple of hours. So, I would say probably a little more flexibility in terms of timing, maybe be instead of being, for me, I was in surgery, so instead of being surgery, being the clinic, for example, where you have more support for that period of time.
So, I would say having this conversation with your program director or with your, you know, if you are junior faculty, with your chief, with your chair, you know, and try to make, you know, and make them also aware that you're going through this because there's also an emotional toll, but it's, you just need a few hours, right, to go get a blood drawn, an ultrasound, and things like that.
[Dr Mike Patrick]
Yeah, yeah, yeah. And having those open conversations ahead of time is going to make it much easier and hopefully folks have empathy and understanding and realize the importance of this. And again, I think the more we talk about it, the more awareness that we have, and then that will, you know, help, hopefully help those who are having this issue down the road.
[Dr Cristiane Ueno]
Yes, 100%. I think so. Don't go through that alone.
There's support, even though, for example, on the research about program directors not being so much aware of the resources, you know, the majority of them, almost 100% of the program directors said that they were supportive, they could offer emotional support, they could make adjustments, and I think that is true for everybody.
[Dr Mike Patrick]
Yeah, yeah. You know, when you go through something like this, it really does become passion for you to get the word out about this so that others can feel support and sort of know where to go and how to, you know, what path to follow based on maybe the mistakes that you feel like you made and could have done in a better way. And one of those is to talk about it openly and seek that support.
Some programs, though, may not have a champion like yourself, and it would be nice to have some conversations about this before it becomes an issue so that you have a unit so that you can provide that support that folks need and to have understanding of, you know, the kind of time commitment that's required and how you can find that time and cover for each other, as you said. For those programs, would you recommend, you know, if someone's hearing this now and thinking, oh, we have never talked about this, really anyone can be a champion for it, male or female, right?
[Dr Cristiane Ueno]
100%, absolutely. You know, when I was at Ohio State, the program director with me actually is a physician at Nationwide Children's, and he was fantastic about it. So, I think that the more we talk about it, please don't feel that I never went through this, I don't know what it is, I'm not, I don't know how to talk about it, right?
I think this PediaCast offers an opportunity, maybe you can play that around. There's data that we are putting out there for people that are joining us today or will join us later, that they can actually look into those numbers and offer that as resource. I think it's a matter of offering a safe space, and then you'll be surprised how people will come to you and they will actually disclose.
During my journey of speaking up, because again, you know, the choices that I made, I would totally have made differently if I had an opportunity. So, I had many, I had medical students coming to me and say, Amory, what is egg preservation? Or should I have a family now?
I had residents in this journey; I had junior faculty coming to me and talk about it. So, I think the more you talk about it, you will be surprised and people will come and see you as a resource, and that is fantastic, right? That's what we're aiming for, to have more and more resources and be able to create a safe space for everybody.
[Dr Mike Patrick]
Yeah, so very important. I also want to point out, there is a little bit of a difference, I think, and please correct me if you think I'm wrong about this, but there is a difference between the kind of support you might need if you are going through a short residency program, like a general pediatric program or a practice program, you know, if it's three years, and then you're going to have, you're going to be younger when you start to think about having a family. And so, but in the surgical specialties, and as you had mentioned, those were the highest risk, they're also the longest training programs often. So, you know, you do a general surgery and then you do your fellowship, and the next thing you know, you know, you're eight years out of medical school before you really feel like you have the time and opportunity to start a family, and you may want to start a family sooner than that as you get into those longer training programs.
And so, you know, before, I feel like I had, was speaking a little nonchalantly, like, oh, it's, you know, we can't just wait until after the program, which you may be able to do if it's a three-year program, but the longer surgical residencies and fellowships, this does become more of an issue, and probably more so than we know, because folks don't talk about it.
[Dr Cristiane Ueno]
Yeah, no, I agree. And I think, you know, having the opportunity of the egg preservation, embryo preservation, understanding IVF, for example, for me, as I was going through the, I started with intrauterine insemination, which for me was a very low yield that I was going to end up with a pregnancy, and, but I was not aware of other possibilities, so when I started to become aware, then I asked my GYN at that time, and I said, why can't I just jump into IVF? And that's when I figured out that I had a low egg reserve, but there's also, you know, an opportunity for an egg donor, surrogates, and things like that, but more so, let's say you get to the pregnancy, right? As you said, because of the longer training, most likely you're going to be an older parent, your eggs are going to be older, you're going to have a, you'll be like, almost like a geriatric pregnancy, right, after the age of 35, so then your risks related to the pregnancy are much higher, so your chance of having problems with preeclampsia, right, your chances of having a child of, you know, low weight at birth or having to go to a premature labor are much higher, so there are studies in there, actually, for female surgery, surgeons, which is kind of shocking too, because the, in the survey, and the surveys that I'm talking about, so 42% of the female surgeons suffered a pregnancy loss, and then 84.4% were in the first, you know, 10 weeks, however, 3.8% were still birthed, and that's something that unfortunately is extremely sad, takes in a huge emotional toll, and we need to be aware and understand. A few months ago, I had one of my colleagues, plastic surgeon, that actually suffered a pregnancy loss, and she basically said, I was barely aware that I was pregnant, you know, so this can be quite traumatic as well, and like you and I, we don't want to dissuade anybody from any career, I absolutely love what I do, but again, having the knowledge and the opportunity to make that decision, it's extremely important.
[Dr Mike Patrick]
What are some concrete things that programs can do that can make a measurable difference in this?
[Dr Cristiane Ueno]
I think it starts with education from both ends, right? Education to your trainees and your faculty, but also education to the leadership, because if the leadership education will lead to change at the institutional level, change in the policies, and change in the culture, and then you are educating your trainees, educating your faculty, will actually bring awareness of their options. So, this definitely, it's one of the most important things that we can do.
I think that, you know, having a strong institutional support to combat infertility is extremely important. Other is considered, you know, flexibility in hours. Of course, it's a, you know, an ask from all ends is childcare support, support in terms of insurance for fertility treatment coverage, and also for fertility preservation.
So not only support for the IVF treatments, but IUI treatments, but also for egg preservation. So, insurance coverage, definitely. Some better policies in terms of parental leave, or in having some maybe policies for people that are going through those treatments as well.
There are lots of things that we can do, Mike. I can't go on and on and on.
[Dr Mike Patrick]
Yeah, yeah, yeah. And the first step is raising awareness. And then from a program director standpoint, like to think about this as an issue before it becomes an issue.
So sort of, you know, lay the groundwork for this, you know, someone wanting to do egg preservation or go through IVF treatments, you know, to have the groundwork laid before the person arrives so that we can provide support, you know, and help them have a family later after their training or during their training. How can we use going through something like infertility challenges to help us be a better physician in terms of how we engage with patients based upon that experience?
[Dr Cristiane Ueno]
I don't want to say that makes you more human, because that's not true. But definitely from the start makes you a little more empathetic. And I think not only, but again, you don't have to go through this, right?
Just having the awareness will definitely help you with that. And you may identify even in your patients, right? You may have a family that is going through this.
And by you showing your vulnerability, you may open the door for them to explain to you. And for example, when I take my daughter to the pediatrician, she is adopted. And I'm always a little worried.
It's like, oh my gosh, they're going to ask about family, you know, medical history and things like that. And as she grows up and she's with me, you know, I'm always a little worried. How do I say that?
How, you know, how do I explain that I have no idea of those things? I think, you know, going through this or like, as we are aware, there's higher risks of having other physical complications or even organic complications related to late pregnancy. So having that awareness definitely helps you support the parent as well that are coming, you know, are coming to the visit, not only the child, and maybe understand them a little better.
[Dr Mike Patrick]
Yeah. Yeah. Yeah.
It definitely increases empathy. But as you said, just raising awareness about the, we would rather have a positive experience for trainees than to say, well, it was negative. What can you get out of it?
Like, let's make it positive right from the get-go. But certainly, you have taken your experience into your practice in terms of empathy for patients and families. And that is a real thing.
But, you know, not to the degree that, well, then it's OK to let folks go through the stress and issues that accompany infertility treatment during training programs. Right.
[Dr Cristiane Ueno]
Yeah. And I think, you know, the good part is that as you are aware, maybe someone is going through this next to you and maybe it will be easier for you to catch up on that and kind of like, you know, help your colleagues and offer a hand, offer a shoulder, you know, give a hug. And I think that the most important thing is create this family friendly environment and decrease the stigma that because you want to have a family or because you want to get pregnant, that doesn't mean that you want to be a less of a physician or you're less committed to your professional life or your specialty.
By all means, that's not true. And I think the more we do that and the more we support others, the more of us will be out there. Right.
And then less of my stories or less of other sad stories will be out there. And that's the ultimate goal for everybody.
[Dr Mike Patrick]
Yeah. Yeah. And you could say that same thing about so many issues that oftentimes we have good causes, but advancing those causes is going to rock the boat.
And so, if we don't say anything, that that is certainly one option. But, you know, not only are you doing this for yourself, like if you're in the situation where you do have to advocate for yourself and say, this is important to me and I want to be able to do it and, you know, openly talk about it, that's going to be an important thing for folks, not only for yourself, but then also for those coming behind you, that you really are paving the way for it to be easier for subsequent trainees. And that's a really important thing and can make the discomfort of rocking the boat maybe worth it a little bit more.
[Dr Cristiane Ueno]
Yes, I think so. One hundred percent. Right.
We already seen those chains. Right. You know, when I started my journey, I could not get any fertility coverage through the insurance provided by my trainee.
However, I was lucky enough that my husband could get through his work. So, we got some coverage. So, and now we see that more and more there's coverage.
Right. Same with, you know, lactation rules. In the past, you will not see that.
And now we see more. There are some societies that have meetings that are very family friendly. They are half a day and then the other half is your family or there's childcare into the meeting.
So, I think there's more and more. The more we bring awareness, the best, the better it gets. And we're making progress.
I agree with you. We're making progress and make making things better and better. And hopefully one day this podcast is going to be, oh, my gosh, this is old age for the dinosaurs.
And this problem doesn't even exist anymore, which is the ultimate goal.
[Dr Mike Patrick]
Yes. Yeah, absolutely. One hundred percent.
You know, we can talk about norms and how norms are contagious. And so, you know, the norm has been to just wait till after your training to start a family. The norm has been, oh, no, we have to do all these long hours.
The norm is that we can't do those things. But, you know, as we've seen when things do improve, it is because someone bucked the norm. And the more that we do that and push back against norms, the more that we can create norms that make a lot more sense.
[Dr Cristiane Ueno]
Yeah, I agree with you. If you think about simple things right in the past, you would not think that, you know, wearing a seatbelt would become a norm. Right?
Or wearing a helmet or even recycle. Right. Will become a norm.
And now it's a norm. So, I think that we have this idea that things change are impossible and big changes such as that are impossible. But it's not.
Just look around us. You know, like I said, recycling. A few years ago, if you talk about recycling, people would be like, oh, how are you going to convince all this, you know, group of people, which is essentially everybody to recycle?
And now everybody does it and we do it without even thinking. So, one hundred percent we can totally rock this boat, make this change. And I so hope that this conversation will be for the dinosaurs pretty soon.
[Dr Mike Patrick]
Yes, yes, absolutely. Well, this has been a great conversation. I'll be honest.
This is probably the most difficult PediaCast CME that I have recorded in recent memory. And that's why I feel like I've been sort of all over the place with asking questions a little bit and certainly not in the order that we had discussed previous to the to the podcast. But I think it's these, you know, sensitive issues that sort of take us off guard because we didn't have awareness about the about the issue.
And so anyway, I and to the audience and to you, I apologize that I have not been 100 percent with this with this topic. But it is not as black and white as many scientific topics that we that we discuss. When you inject that element of humanism, it becomes more difficult, but also very worthwhile to talk about, for sure.
[Dr Cristiane Ueno]
Yes, yes. And honestly, I can only I don't have words to thank you for this opportunity. And, you know, thank you, Maya Albrey, for this great opportunity, because it's something that is a little bit of taboo.
There is some stigma around. So, this will involve, you know, some culture change. But it starts with us.
And as you said, I hope this is something that will be so contagious that will disappear. And maybe, you know, one day is going to be so simple as talking about recycling or, you know, seatbelt.
[Dr Mike Patrick]
Yes, yes. We are going to have some terrific resources in the show notes for folks. So, if you head over to PediaCastCME.org, episode 116, look for the show notes for episode 116, and you'll find these links. And they really do go into lots more detail about the situation and with thinking about infertility during training and what we can do about it. The first one is from JAMA, Child-Bearing Infertility and Career Trajectories Among Women in Medicine. We also have one from the Permanente Journal, Family Planning, Fertility and Medical School, a survey of students' plans and perceptions of institutional support.
Again, right on, right in line with what we've been talking about. Also from Women's Health Reports, Fertility Preservation and Infertility Treatment in Medical Training, an assessment of residency and fellowship program directors' attitudes. NIH has a resource page on infertility and fertility resources.
And then Isolation, Discrimination, and Feeling Constant Guilt, a mixed methods analysis of female physicians' experience with fertility, family planning, and oncology careers. And that is in the journal, Cancer. So, we'll have all of those links.
And I'm sure that if you did a Google Scholar search or a PubMed search, you would find lots more on this topic. And we're just, again, trying to create much more awareness here so folks understand the situation and what a lot of the trainees do face. That's not as infrequent as you would think because people don't talk about it, but we want to start talking about it.
And then I think you'll discover that it is way more frequent than you otherwise would have thought. And hopefully that's the message that we were able to get out today. So once again, Dr. Cristiane Ueno from Indiana University, Associate Professor of Surgery, Plastic Surgeon there. Thank you so much for stopping by and chatting with us today.
[Dr Cristiane Ueno]
Thank you so much for this opportunity. This was great. I appreciate it.
[MUSIC]
[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast CME a part of it. We really do appreciate your support. Also, thanks again to our guest this week, Dr. Cristiane Ueno, Associate Professor of Surgery at Indiana University. Also, thanks to our co-sponsor this week, Widening Impact in Medicine and Science, also known as WIMS at The Ohio State University College of Medicine. So, this is our last episode of 2025. We do have a full schedule for you, though, planned for 2026.
So, we will be back. But I did want to take time out again just to say thanks for all your support. We really do appreciate that.
It means so much. And, you know, I have folks, you know, reaching out through the contact page, on social media, in the halls of the hospital, just saying, hey, we love the podcast and appreciate you taking time to do it. And I just want to say thank you all for taking time to listen.
It's really much appreciated. And I hope that you have a really great, fantastic holiday with family, friends, and loved ones. And, you know, those of us in medicine often work over the holidays when other folks are off.
Please, please try to take some time out for yourself and take some getaway time if you're able to do that. It's just so important to recharge and refresh. And the holidays are a great time.
I do want to remind you; you can listen to this podcast wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube, and most other podcast apps for iOS and Android. Our landing site is PediaCastCME.org.
You'll find our entire archive of past programs there, along with show notes for each of the episodes, our CME information, our terms of use agreement, and that handy contact page if you want to reach out and say hello or suggest a future topic for the program. But just saying hi is a fine as well. Reviews are also helpful wherever you get your podcasts.
We always appreciate when you share your thoughts about the show. And we love connecting with you on social media. You'll find us on Facebook, Instagram, Threads, LinkedIn, X, and Blue Sky.
Simply search for PediaCast. So, you have listened to the podcast. Now be sure to claim your free Category 1 Continuing Medical Education credit.
Really easy to do. So, head over to the show notes for this episode at PediaCastCME.org. It's episode 116.
You'll find a link to the post-test in the show notes. Follow that link to Cloud CME. Click on the materials tab, take and pass the post-test, and the Category 1 credit is yours.
It is super easy. And again, we do offer credit and it's free credit to many pediatric professionals, including physicians, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. Complete details are available at PediaCastCME.org.
Thanks again for stopping by. And until next time, this is Dr. Mike saying stay informed, keep it evidence-based, and take care of those kids. So long, everybody.
[MUSIC]
