Fertility Preservation Option Accommodations and Education in Orthopaedic Surgery Training

Employers across a wide variety of workplace settings are striving to create appropriate work-life balance, particularly related to reproductive issues, for their employees. Chen et al. focus on oocyte cryopreservation among female orthopaedic surgery residents or fellows and attending physicians. Their survey evaluated child-bearing plans, experiences regarding oocyte cryopreservation, and knowledge related to fertility and cryopreservation. From their 169 respondents, Chen et al. conclude that, despite a high level of interest in oocyte cryopreservation as a method of fertility preservation, multiple barriers exist to its use in the surveyed population. Their sample, approximately 10% of the female practicing orthopaedic surgery population, comprised 54% attending physicians and 46% residents or fellows. Forty-three percent of respondents reported having children, and 63% reported having delayed, or planning to intentionally delay, childbearing, with consideration of oocyte cryopreservation being reported by 54%. Although the concerns related to the timing of pregnancy and its impact on women and their careers are pervasive across many workplaces, pregnancy and orthopaedic surgical residency training raise some unique conflicts. There are workplace safety concerns such as radiation exposure and anesthetic gases, as well as workplace scheduling involving rotation schedules created far in advance to comply with 80-hour work week requirements that impact others, all of which may impact the timing of a decision to become pregnant. As the inclusion of women in orthopaedic surgery residencies continues to grow1, knowledge of fertility-preserving methods is an important educational objective for everyone involved in orthopaedic surgery; however, this education may be better placed in medical school, as this knowledge should not be limited just to women in this career pathway. Knowledge of fertility-preserving methods is important not only for women as they make their own life choices but also for men, who may be in leadership roles that influence decisions related to programmatic or departmental support, such as accommodating work schedules or partners to these women. This article raises the question of what the role of residency programs should be in personal decision matters of residents and staff. The conclusion of the authors is that residency programs should play a key role in removing barriers for women that make the choice of oocyte cryopreservation difficult. As orthopaedic surgery programs, like many other workplace settings, strive to achieve a work-life balance for all personnel, oocyte cryopreservation as a fertility-preserving method is an option for women that allows for planned delayed childbearing. It is a costly procedure not always covered by health insurance and requires roughly 2 weeks of time to complete the treatments and retrieval for successful freezing. There are orthopaedic residency training regulations that limit how much time off is allowed, while still graduating on schedule, to 6 weeks per year averaged over the entire residency, equaling 30 weeks2, so, theoretically, a 2-week absence is manageable, although few trainees take more than 1 week at a time. Limitations of this study, as with all survey studies, are the low response rate and the potential that only women interested in childbearing-related factors responded. The inclusion of only female respondents also limited the strength of the responses related to the impact of oocyte cryopreservation in the orthopaedic workplace. Chen et al. raise a topic that should feed into a larger discussion in programs and departments everywhere about work-life balance. Fertility preservation should be just 1 topic under family life, including discussions about pregnancy, postpartum time off, and impacts. Focusing on expanding this knowledge base beyond female orthopaedic surgeons to include everyone involved in the training and leadership of orthopaedic surgeons will go further to achieving workable solutions that allow for a work-life balance for everyone in the field. There are other physical and mental health conditions that may require flexible or extended time off for treatment, such as cancer diagnoses or illness of family members. This article can be used to encourage routine evaluations of multiple life factors, including physical and mental health, that impact the workplaces of trainees and staff. Additionally, these factors should be part of ongoing discussions with local and national leadership, as well as hospital administration, related to achieving a work-life balance and reviewing all existing policies and procedures that involve the need for deviations from routine work.