REPRODUCTIVE ENDOCRINOLOGIST PERSPECTIVES ON PHYSICIAN PREGNANCY (REPPP)

Rachel M. Whynott; Karen M. Summers; Emily A. Capper; Stacey A. Pawlak

doi:10.1016/j.fertnstert.2024.07.087

OBJECTIVE To determine the impact of being pregnant while working as a reproductive endocrinology and infertility (REI) subspecialist. MATERIALS AND METHODS We used criterion-I purposive sampling to recruit REIs across the United States who experienced pregnancy while caring for subfertile patients. Semi-structured interviews took place from March 2021 - January 2022 with 12 participants. We used combined inductive-deductive thematic analysis. A codebook was developed with inductive codes based on open codes from initial transcript readings and deductive codes from the interview guide. Four investigators individually coded transcripts and met to compare coding, resolve discrepancies, and refine the codebook. RESULTS Respondents experienced pregnancies at REI fellow and attending levels while practicing medicine in 11 states. 5 utilized reproductive technologies. Identified themes included the impact of pregnancy on patient care, emotional experience, patient interactions, challenges, and advice for other pregnant REIs. All REIs reported that pregnancy increased their empathy as a physician. A majority (83%) discussed how increased awareness of the fertile window and potential complications impacted them. Most (92%) acknowledged that seeing a pregnant physician could be difficult for a subfertile patient and took steps to protect the patient, including intentionally trying to hide physical manifestations of pregnancy via clothing or scheduling (67%). Emotional experiences discussed included: anxiety about their own pregnancy (83%), self-consciousness of physical manifestations of pregnancy or personal fertility journey (75%), survivor guilt over ability to conceive while their patients struggle (67%), and anxiety over patient interactions (67%). The majority (83%) noted that patients had initiated conversations about physician pregnancy. Generally, REIs (75%) discussed redirecting questions about their personal pregnancy back to the patient or remaining patient-centric during their pregnancy. While the majority (75%) had positive interactions with patients about their pregnancy, many (67%) reported negative interactions. All explored how the specialty that helps others build families is not always supportive of REI physicians doing the same. CONCLUSIONS Personal pregnancy poses unique challenges for REI physicians. They must balance their personal rights (including right to build a family and right to privacy) with their desire to be sensitive to patients. With these competing interests, pregnant physicians may experience survivor guilt, heightened self-consciousness, and anxiety related to patient interactions, leading to efforts to hide pregnancy, avoiding disclosure to patients unless specifically addressed, and changing family-building plans to limit impact on patients. IMPACT STATEMENT Being pregnant while caring for subfertile patients can have a profound impact on the physician and highlights the importance of a culture of support in the workplace.

REPRODUCTIVE ENDOCRINOLOGIST PERSPECTIVES ON PHYSICIAN PREGNANCY (REPPP)

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