Infertility and the anaesthetist | Association of Anaesthetists

Infertility and the anaesthetist

Box 1.

Podcasts 

  • BFN (Big Fat Negative)
  • Fertility Life raft
  • Infertile AF 

Mindfulness 

  • Mindful IVF 

Support groups 

  • Health Unlocked “Fertility Network UK”
  • Closed Facebook medics IVF group 

Instagram
Instagram: an incredibly supportive community, with a wealth of knowledge and the option to remain anonymous. 
@_mother_of_one_ (www.rainbowrunningclub.co.uk
@thisisalicerose 
@alloureggs

Infertility and the anaesthetist

The decision of if, and when, to start a family can be a difficult one for a medical professional trying to balance training, exams and career progression. Having made such a decision, there is a natural expectation that the pitter-patter of little feet will follow shortly. However, for a not insignificant proportion of couples, infertility and baby loss is a real and unspoken issue.

My motivation for writing this article is twofold: 

  • anaesthetists are involved in many stages of the fertility journey. From anaesthetising for initial investigations to egg collections and surgical management of miscarriage (SMM). By increasing understanding, I hope that this will encourage us to provide supportive and empathic care during these highly anxious and emotional experiences. 
  • with increased focus on wellbeing, I thought that it was time to raise awareness of the issue in order to improve understanding, and support those of us who are struggling.

Fertility statistics

The NHS website reports that while 84% of couples will conceive within a year of having unprotected sex, around one in seven will have problems conceiving [1]. While many may be struggling with infertility, I believe that it is rarely discussed. No doubt, speaking to one’s colleagues about one’s sex life is not usual work chat. The very real feeling of failure inevitably plays a part.

Following a period of trying to conceive naturally, the usual next step is to pursue medical investigations, followed by intervention. There are many treatments options available; one in particular, often perceived as a ‘quick fix’, is in vitro fertilisation (IVF). There are many detailed variations of IVF, but three common themes are:

  • it is a long and trying journey, both physically and emotionally. 
  • NHS funding is limited and hard to obtain (only 35% of cases [2]), and the costs are significant for those paying privately. 
  • success rates are much lower than general perceptions; 29% of under-35s having a life birth after embryo transfer, decreasing to 9% for age 40-42 [2].

While medical professionals have a vague understanding of the concept of IVF, one often overlooked aspect is the significant amount of time required for attending appointments. During ovarian stimulation, daily scans and bloods may be required for a period of up to 14 days. For many professions, especially medics, taking a few hours out of the working day can prove challenging.

Baby loss

Infertility is a very broad topic and doesn’t just encompass not being able to conceive – baby loss is a significant challenge in and of itself, with one in four pregnancies ending in loss during pregnancy or birth [3]. The fact that it is so common should not detract from the physical and emotional effects of losing a pregnancy. It is a sad reality that, as anaesthetists, we far too regularly encounter baby loss in our working lives, with a constant trickle of 'SMMs' booked onto the emergency list. Have we become de-sensitised to this loss? With losses occurring before the pregnancy announcement, many couples will suffer in silence.

The psychological aspect

We must not underestimate the emotional demands that infertility and baby loss have on a person. The physical impact of treatments would normally last for a matter of months. The feeling of loss, failure and inadequacy is much longer lasting. One study suggested that the psychological symptoms of infertility are comparable to those with serious medical conditions such as cancer [4]. Insecurities and self-doubt in one’s personal life can creep into the workplace. It can be difficult to watch colleagues fall pregnant and have babies. Labour ward placements may prove to be particularly difficult. The fact that there is little openness and discussion around this topic compounds the issue.

Being now aware of the prevalence of infertility, let’s turn to the support available: The formal NHS employers leave policy is ‘There is no statutory entitlement to time off for IVF or other fertility treatment’ [5].

Whilst IVF and related treatments are elective, it is somewhat surprising that there is such a lack of formal support available from our employer, after all infertility is a recognised medical condition. This seems somewhat short sighted from the perspective of supporting staff wellbeing.

For late baby loss, leave is in line with the typical employer maternity policy. However, for baby loss up to week 25, only normal sickness provisions apply. This can leave staff feeling pressured to return to work.

Practical advice

Speaking from a trainee perspective, I would strongly encourage you to chat with your College Tutor, or a consultant that you trust, as it is likely that they have supported other trainees through similar circumstances and may well be more knowledgeable than you expect. They may be able to link you to a peer for support. Getting to know the rota co-ordinator can be helpful in maximising training opportunities, whilst balancing treatment demands. It is important to highlight that the departments that I have worked in have been supportive and accommodating, and gone beyond that permitted by the NHS guidelines; for that I am incredibly grateful. My comments here are from a female’s perspective, but I hope that in the future someone is able to provide a male’s (or other denomination’s) perspective.

Advice to supporting colleagues

Be supportive. Be approachable. Be kind. Alice Rose, an infertility commentator, runs a campaign of what not to say to those affected [6]. This includes “you can just adopt/do IVF”, “just relax”, “at least you know you can get pregnant”, “just stop trying and it’ll happen” or “go on holiday”.

All pregnancies are precious, but those after loss or infertility come with a lot more anxiety and apprehension. Not working nights during treatment or pregnancy should not be viewed as laziness.

My story

I am in my higher stage of anaesthesia training in London. I (well, my husband and I – it is a couple’s journey!) were lucky to get pregnant naturally in 2018. I was naturally anxious, but took reassurance from a heartbeat scan at eight and ten weeks. The 13-week scan was less hopeful: a strong heartbeat, but a fetal abnormality was detected. After an excruciating two weeks of waiting and extensive testing, we made the difficult decision to end the pregnancy. Fast forward two years, and after two investigative operations and multiple fertility treatments including IVF, we are no closer to bringing that much wanted baby home.

I have chosen to remain anonymous. We are still working through our fertility journey, and for now we would like it to remain private. For me, my work is my escape; it is an immersive place where I do not have to discuss fertility. However, I am more than happy to chat individually about my experiences, or support anyone struggling with fertility, as I know what a lonely place it can be. My email is [email protected] (Instagram @thelonghardroad), and I promise that anything talked about will be in the strictest confidence.

Resources

There are many support groups and resources available, in particular a confidential support group for medical staff having IVF (Box 1).

A London Higher Anaesthetics Trainee

Figure 1 - see [3]

AN-20-321 ANON Fig 1

References 

  1. NHS. Overview: infertility, 2020. https://www.nhs.uk/conditions/infertility/ (accessed 2/7/2020). 
  2. Human Fertilisation & Embryology Authority. Choose a fertility clinic, 2019. https://www.hfea.gov.uk/choose-a-clinic/ (accessed 2/7/2020). 
  3. Tommy’s. Pregnancy loss statistics, 2020. https://www.tommys.org/ourorganisation/ our-research/pregnancy-loss-statistics (accessed 2/7/2020). 
  4. Domar AD, Zuttermeister PC, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynaecology 1993; 14: S45-52. 
  5. NHS Employers. Guidance on dealing with requests for time off, 2014. https://www.nhsemployers.org/-/media/Employers/Documents/Pay-andreward/ Guidance-on-time-off-requests-28-Jan.pdf (accessed 2/7/2020). 
  6. Alice Rose. Think! What not to say: to fertility patients, 2020. https://www.thisisalicerose.com/what-not-to-say (accessed 2/7/2020)

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