When patients realize they may be having trouble with their fertility, it is common for them to seek out specialists to aid them. While OB-GYNs tend to assist people early on in their fertility journeys, family medicine (FM) physicians still see about 20% of patients with fertility issues. OB-GYNs and family medicine physicians usually provide a gateway for patients by identifying problems and anomalies that can be addressed by other fertility providers.
Through assessing practices and knowledge of OB-GYNs and FM physicians, the quality of training regarding fertility becomes evident. Are our primary providers prepared to talk about fertility? If they are not, countless women could be out of touch with their fertility and the services that could help them.
- How was physicians’ fertility knowledge assessed?
- Are physicians having effective conversations with patients?
- What does this mean for physician training and the questions patients should be asking?
Residency programs are sources of crucial training for our future physicians.
A survey was sent out to residency programs to assess how comfortable physicians-in-training felt about their education regarding fertility and elective oocyte preservation (EOC).
EOC is an option for people who want to delay their childbearing. Newer trends in childbearing means that women are having children later than they used to. The average age of conception has increased from 21 in 1972 to 26 in 2018. In places like San Francisco and New York City, the average age of childbearing is over 31 years old.
While having children earlier reduces the risk of fertility issues, women still have a high chance of conceiving later in their lives. Due to this, EOC has become an attractive option for women, especially since some studies have shown that cryopreserved oocytes have similar implantation and live birth rates as fresh oocytes.
Since fertility does decrease with age and more women are electing to conceive later, it is important that physicians are prepared to breach conversations about fertility and EOC with their patients.
To assess this, the survey included questions about:
- Knowledge of age and fertility
- Education regarding reproductive potential and EOC
- Satisfaction with training
Are Doctors Being Trained Effectively?
How do doctors in their OB-GYN and FM residencies feel about fertility knowledge?
The study showed that OB-GYNs were more comfortable talking about how age affects fertility, with 93.5 percent claiming they were comfortable versus 76.5 percent of FM residents. OB-GYN residents were also more confident in their knowledge of fertility potential, although at a lower rate: 64.5 percent of OB-GYNs versus 30.8 percent of FM residents.
OB-GYNs and FM physicians both acknowledged a lack of satisfactory training led to their discomfort with certain topics. While both groups knew these conversations were important, 46.5 percent of conversations with OB-GYNs and 65.2 percent of interactions with FM physicians were initiated by the patients rather than the physician. There was a similar trend in referrals for EOC being initiated by the patient first.
This shows that while residents are aware of fertility and EOC, they are not always comfortable initiating conversations. While OB-GYNs had higher rates of physician-motivated fertility talks, more FM physicians tend to see people in underserved areas. For people with access to OB-GYNs, the chance of confronting fertility and EOC is higher. In underserved areas that may not have as many OB-GYNs, FM physicians must fill that role, but this study indicates they may not feel prepared to.
What Needs to Change?
If physicians are not fully equipped to deal with fertility and EOC, it can affect countless women. What can be implemented early in training to ensure fertility does not go unchecked? What can patients do in the meantime to increase the chance of getting sufficient care?
The most obvious way to fill gaps in physician knowledge regarding age, fertility, and EOC, would be through increased focus on these issues during residency. This would make sure physicians are more comfortable with their knowledge and therefore willing to initiate conversations before any issues get out of hand. For physicians who have completed their residencies, implementing workshops in hospitals could be beneficial.
This is not an easy endeavor, however. In order to ensure you are getting the care you need, you may have to keep initiating conversations regarding fertility and EOC with your providers.
If you are anticipating that you will have children later or you have other questions regarding your fertility, asking your provider is the first step to addressing your concerns. At the very least, they can refer you to another provider who may be more comfortable with the subject.