Kristen Mancinelli, Director of Partnerships and Education at Extend Fertility
Recently, we wrote about how women’s childbearing choices can be inadvertently curtailed if they don’t learn about age-related fertility decline early enough from a credible voice—such as their OB/GYN. So why don’t most physicians bring it up? This post will explore the barriers to conversation about fertility with women who aren’t ready to have children. Our final post will suggest ways for both patients and physicians to close this communication gap.
Nearly every week, I hear a variation on the following comment from women attending one of our education sessions: “I see my gynecologist/primary care doctor every year and s/he never mentions fertility. They remind me about diabetes and heart disease as potential concerns as I get older, but I’m a healthy weight and I exercise, so I’m not too concerned… But all women face age-related fertility decline, regardless of lifestyle. So why doesn’t anyone bring this up?”
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It’s worth answering the “why don’t we talk about it” question directly. There are both real and perceived barriers to fertility education at “well woman” or annual visits. Understanding these barriers can help us better navigate the experience so that OB/GYNs can become the trusted resource for fertility advice that female patients need.
1. Physicians are prioritizing. Anyone who’s ever visited their gynecologist to get treated for a UTI—while also troubleshooting the side effects of hormonal birth control (breakthrough bleeding and unexplained tantrums, anyone?)—and simultaneously getting a full STI screening because “why not? I’m already here”—knows that our doctors are tasked with a LOT to discuss in the short time they have with us once or twice a year. In an interview with Contemporary OB/GYN on the importance of the “fertility talk,” Dr. Laurie McKenzie says that because there is so much to cover at the annual visit, “fertility often takes a back seat to other discussions.”
This is especially true if the woman being seen isn’t trying to get pregnant; after all, if you’re actively using contraception (and nearly 70% of women ages 25-44 are), that signals to your physician that you’re focused on NOT getting pregnant. They’re trying to use their time to manage the health conditions you currently have—so if you’re not asking about fertility, then it just may not make the doctor’s list of topics to raise.
2. Physicians don’t want to offend or worry their patients. Women are already under enough pressure when it comes to decisions about childbearing—from the question of when, whether, and with whom to have them, to the desire to have a thriving career, a strong network of social support, and significant financial reserves in place before taking the plunge into parenthood—that doctors are hesitant to add another concern to the list for their female patients. In our own research, Extend Fertility found that OB/GYNs recognize how tricky this topic can be, and they address it with care. Doctors have told us: “You have to be very careful about how you approach the issue… it’s very sensitive—everybody has their agenda or plan, and you have to be politically correct.”
This last statement touches another nerve in a conversation already fraught with emotion: doctors told us they worry that suggesting egg freezing implies they believe that a patient can’t or won’t find a partner. Doctors don’t want to jump on the bandwagon with your great aunt who nags you every Thanksgiving about when you’re going to settle down—while in the back of your head you’re wondering whether you should update the photos on your online dating profile. Doctors want to help their patients stay as healthy as possible, and that includes managing stressful life scenarios. They don’t want to add to it by amplifying the sound of the biological clock.
3. OB/GYNs aren’t experts in fertility preservation. Believe it or not, if you’re a regular reader of this blog then it’s very likely that you know more than the average MD does about egg freezing. Medicine is a fast-changing discipline, and physicians have enough of a job to do keeping up with the latest research and evolving practice guidelines in their own specialty. (Reproductive endocrinology is its own specialty, distinct from obstetrics and gynecology, and while all reproductive endocrinologists are also trained as OB/GYNs, most REs are not in the habit of seeing patients for things like Pap smears, birth control, or vaginal health.) It’s a lot to expect of your OB/GYN to know the details about fertility preservation and counsel you knowledgeably about your options.
While these barriers to talking fertility with your OB/GYN are very real, they don’t have to mean that the conversation is a non-starter. There are some practical ways that physicians and patients can move the fertility conversation along. Check out our next post to learn more about what you can do to turn your OB/GYN into an advocate for your fertility health.