By Dr. Dawn Baker, Guest Writer

Picture this scenario: You just completed your residency and landed your dream attending job. You’re starting to generate real income for the first time in your life, which feels great since you need to start paying off those student loans. Now that you aren’t killing yourself in residency, you’ve got so much living to do! You finally want to start the family you and your spouse have dreamed of. Or maybe your residency baby is a toddler now, and you finally feel the time and space needed to expand your family.

Then, you get hit with the perfect storm.

An infertility diagnosis is a complicated, time-sucking, mind-consuming cyclone, and it often happens at the worst time of a doctor’s career—during the transition from trainee to seasoned attending. It’s inevitable; the prime years to build or expand a family occur right around this same time. Most doctors do not enter medical school with a complete family, but by the time they’re finished with training, in control of their student debt, and on secure footing, it might be too late.

I’m a second-career physician, and I didn’t even start medical school until age 28. With my athletic background and healthy lifestyle, I mistakenly thought I had tons of time to worry about starting a family.

I was wrong.

The average age women become mothers in the US has increased from 21 to 26 over the past 50 years. That’s the typical age most of us entered medical school. When you narrow the pool to women who also happen to be doctors, the average age jumps to 31. Furthermore, women physicians have an incidence of infertility more than twice the general population.

There are lots of factors contributing to the current epidemic of infertility, but one is an indisputable truth: a woman’s eggs degrade in quality over time—increasingly after age 30 and precipitously after age 35, contributing to lower pregnancy rates and increased pregnancy losses. This phenomenon happens regardless of health status. The possibility of being diagnosed with health problems that contribute to infertility increases with age, as well.

When I finally got around to starting a family, I was already 35 years old. I knew my fertile window was getting smaller, but it was the tail end of my anesthesiology residency and I was still in the thick of a low-energy haze that I thought was burnout. I hadn’t had a period in more than a year—something I innocently attributed to high-stress levels and crazy work hours. A subsequent fertility workup led to a diagnostic odyssey, lengthened by my own busyness and lack of ability to show up for clinic appointments and lab testing.

Finally, on an Easter Sunday at an MRI scan that I begrudgingly squeezed in between call shifts, I got the answer to my struggles: a large pituitary adenoma was compressing my optic nerve. Suddenly, I had two reasons for my infertility.

With the surgical removal of my pituitary gland and my older age, it took years before I had the child of my dreams at age 41. I spent tens of thousands of dollars and lots of vacation time doing infertility treatments along the way. And afterward, I became an infertility advocate by providing thousands of anesthetics to patients undergoing egg retrievals and spreading infertility awareness among physicians.

Despite the cause, navigating an infertility journey is sure to challenge a physician’s work-life balance and finances. Why? Infertility treatment cycles are expensive, unpredictable, and invasive.

Imagine needing to undergo a surgical procedure with an indefinite date. In preparation for the procedure, you must take multiple medications on a strict time course. You must also be seen daily in the clinic for preoperative blood draws and ultrasounds. The date of your impending procedure is a moving target hinging on the cascading results of these studies. Does this sound compatible with a typical physician’s schedule in any practice setting?

It's no wonder when I conducted an anonymous survey of more than 150 women physicians with infertility in preparation for my talk on infertility at WCICON22, 68% of respondents had difficulty scheduling their treatments around their work. Thirty percent of respondents had chosen to change jobs or decrease their clinical workload due to their infertility experiences.

What can you do if you, your partner, or a loved one is facing an infertility diagnosis? Here are five steps you can take to weather the storm.


Examine Your Finances

The cost of an infertility journey is highly variable. A typical round of intrauterine insemination (IUI) costs in the low thousands. In contrast, the average cycle of in vitro fertilization (IVF) costs $10,000-$15,000. Most patients end up requiring multiple rounds of at least one of these procedures to get pregnant.

Have a frank discussion with your reproductive endocrinologist about your age, medical risk factors, and family goals. In your clinician’s experience, what would your typical journey entail? What are the chances of success and the possible risks with each associated procedure? How much does the clinic charge for each type of treatment?

I wish I had taken this advice. In my circumstance, there was very little chance I would get pregnant using less invasive procedures like IUI, but I didn’t pay attention to the numbers because I was in denial about my health status. Once I graduated to IVF, I again failed to look properly at the statistics of how many genetically normal embryos I was likely to produce at my age. If I had done so and had asked more directly (and had listened to the explanations), I would have paid the extra money and spent the slightly longer cycle time to have my embryos tested. It was only after a miscarriage and lots of time lost that I realized doing the higher level of testing and procedures would have saved me time, money, and heartache in the end.

Next, evaluate the out-of-pocket costs you might soon be faced with. Do you live in one of the states that mandate insurance coverage for infertility treatments? Do either you or your partner have access to health insurance that offers infertility coverage? If neither of these applies, you will most likely be paying out of pocket for all your infertility-related services.

Look at your emergency fund. If you don’t have one, start one now. How can you reprioritize your finances to allocate more toward this immediate healthcare need? It might mean minimizing retirement contributions for a short period. If you are unable to reallocate funds right now, consider your options for loans—either public or private.

More information here:

Infertility Among Doctors

Finding Balance in Your Life


Figure Out Your Values


Learning. Adventure. Connectedness. Family. Accomplishment. Excellence. Integrity. Which concepts resonate most with you? Which ones excite you, and which ones upset you when you see someone exhibiting the opposite? Perform the internet search “List of Values” to find many more.

Bear with me; you might be wondering what this has to do with infertility. Your core values represent a north star governing your behaviors and relationships.

Being in tune with your values helps you in many ways. They define your priorities and your boundaries. They serve as a “why” behind your decisions, and there will be a lot of decisions ahead: treatment-related, work-related, money-related, and relationship-related decisions.


Discuss Your Boundaries

Even among physicians, infertility is a deeply personal issue. As much as I’d like to see this change, many people choose to keep their journeys a secret out of guilt, shame, or cultural reasons. Maybe you simply don’t want to talk about it with everyone. In any case, have an honest discussion with your partner about where both your boundaries lie.

Being that I write a blog about how the wakeup call of my health crisis shaped my ideas of work-life balance, professionalism, and what is enough, I was very forthcoming about my infertility with everyone at work and on the internet. Luckily, this openness didn’t bother my husband. But just recently, a physician approached me for advice on how to talk to her husband about what she perceived as his oversharing about their journey to family members. Everyone has a different level of comfort with this.

One person I recommend keeping in the loop is the person at your workplace in charge of scheduling shifts or clinic hours. Infertility treatments inevitably involve last-minute schedule changes and time off. Keeping the reason behind your scheduling needs to yourself is likely to cause confusion and strife. I have heard multiple stories from physicians who received negative work evaluations due to “unplanned absences.” However unfair this may be, some of them were likely due to a misunderstanding between them and their workplace scheduling team.

More information here:

Growing the Family After Residency


Get Support

It’s estimated that 25%-60% of people with infertility suffer psychiatric symptoms of depression, anxiety, or both. However, infertility literature indicates that stress-lowering psychiatric interventions and support in the form of cognitive behavioral therapy groups decrease dropout rates for infertility treatment, indirectly increasing pregnancy rates. Thus, it’s important to have a support system beyond your immediate family.

There are multiple Facebook groups for women physicians with infertility. Some are searchable, and some are not; if you have trouble finding or joining a group, contact me through my website and I will help you. Even if you want to keep your journey private, consider telling a trusted colleague who can be part of your support system. Because of the high prevalence of infertility among physicians, you likely have at least one colleague who’s gone through the process already.

Coaching in groups or one-on-one can be a great way to get support. If you are feeling symptoms of depression, anxiety, or both, also consider finding a therapist. Most hospital systems or groups have access to some type of employee assistance program offering free or discounted counseling during the evenings and weekends.

More information here:

12 Financial Considerations of Pregnancy


Adopt a ‘Journey' Mindset

Infertility can be a long and arduous path, not unlike the process of becoming a doctor. There will be wins and losses, but one thing is clear: there will be uncertainty. To save your sanity, focus on the present moment and the immediate next step in front of you.

When you have a setback on the journey, think, “What can I learn from this?” Lastly, accept that you will be fine regardless of the outcome. Just like anything you envision for your future, there are no guarantees, but going through this process is worth your time, energy, and money investment.


Although infertility was a difficult experience, it helped me in many ways. It helped me find my values and priorities. I found new ways I could exercise self-care during trying times. And I clarified the type of work-life balance I need to sustain a career in medicine while honoring the other parts of me that make me human.

[Founder's Note from Dr. Jim Dahle: Fertility treatments are one of the few reasonable uses of a personal loan in my book. While I'm a big fan of saving up for expensive things, the problem with fertility is that you may completely lose the ability to have a baby while you're saving. Fertility treatments are so expensive, they're out of reach of many students, residents, and fellows. Unless it is their No. 1 financial priority, even attendings may take years to save up enough money to pay for expensive fertility treatments. While a HELOC may be a better option for those with home equity, here is a list of personal loan companies that can help with a fertility loan. As always, if you must borrow, take out as little as you need and pay it back as soon as possible.]

[Editor's Note: Dawn Baker (MD, MS) is a physician, coach, speaker, and author of the book Lean Out: A Professional Woman’s Guide to Finding Authentic Work-Life Balance. She can be found at This article was submitted and approved according to our Guest Post Policy.]