AMH Levels in Female Physicians: Why Infertility Rates Are Higher Than You Think

In today’s episode, we’re diving into a deeply important and often overlooked topic: AMH levels, diminished ovarian reserve, and infertility in female physicians.

While infertility affects about one in six couples in the general population, female physicians face significantly higher rates, with studies suggesting up to one in four experiencing infertility and even higher rates among surgeons.

In this conversation, we explore why.

From delayed childbearing and demanding training schedules to financial barriers and the emotional weight of building a family alongside a medical career, the reality for female physicians is complex. We also discuss what I see clinically, including higher rates of low AMH, diminished ovarian reserve, and patterns like lean PCOS.

We also touch on

• The difference between quantitative and qualitative fertility markers

• The possible role of stress on egg quality and reproductive outcomes

• Secondary infertility and the emotional toll it carries

• Increased risks of miscarriage and pregnancy complications in physicians

• Why the data still leaves us with more questions than answers

This episode is both a clinical discussion and an invitation to look deeper at how we support women in high-demand careers who are trying to build families.

Also, be sure to check out our website: loveandsciencefertility.com

Follow us on social media:

IG: www.instagram.com/loveandsciencefertility

FB: www.facebook.com/profile.php?id=61553692167183

Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,

Dr. Erica Bove

Transcript:

Hello, my loves, and welcome back to the Love and Science podcast. Today, we're going to talk about a really important topic, which is AMH ranges and infertility in physicians specifically. Now, what I will say is when I was a medical student, I was taught that infertility was one in eight couples, and that was maybe 20 years ago. Then about 15 years ago, it was like, oh no, it's one in six couples. But more recently, I've learned that female physicians have a one in four chance of having infertility, right? So one in four female physicians has infertility and one in three female surgeons has infertility. And the question I often get asked is, well, how much of this is related to diminished ovarian reserve and how much is related to other causes? Interestingly, female physicians do seem to have, at least based on some data, an increased rate of unexplained infertility compared to non-physicians, which I find really interesting because why is that? Is that endometriosis? Is it Stress, is there something else going on that we just haven't identified? Perhaps. But I will say anecdotally, when I see a female physician on my schedule, invariably we find really high rates of low AMH, really high rates of diminished ovarian reserve. I combed the literature to see if there was some study I could quote that would back this up. And sadly, I could not find anything like that. But I do think that, you know, if you look at it, we know that female physicians do have delayed childbearing. That is a fact. Female physicians have their first baby if they are lucky enough to have a baby on average five years later than non-physicians. And so you have to ask the question, okay, what is this about? We understand there's this constellation of biology and also these social and societal pressures. And so, you know, thinking about it, I finished my training when I was 33 years old, right? And if you're a cardiothoracic surgeon, or maybe you took some time before you went to medical school, you might be starting to try for your first kid in your mid to late 30s or sometimes even later. Also, we know that female physicians do tend to remain single for longer than their non-physician counterparts. And so it's really interesting to think about, okay, so some people take that information and say, this is important to me. I'm choosing single parent procreation. And other people say, you know what?
That's not my vision for family life. And I'm going to wait and... on these dating apps and I'm going to give it everything I've got to find a partner first and then start to build my family.
There's no right or wrong here. There's many beautiful ways to build a family, but you could see how life gets busy, years pass, and if somebody's meeting the love of their life at 39, they may have a harder time conceiving than somebody who maybe met their partner 10 or 15 years earlier, right? And we also know there's the LGBTQ community as well.
And we need to honor that as well. And we can find donor sperm that's readily available,
but it's so incredibly expensive. And I mean, I remember when I was a resident,
I remember staring for about 20 minutes to see if I could make a $20 purchase because I wasn't sure if I could because things were so tight. And to say, okay, well, donor sperm is $2,000 a pop. for somebody who's even a resident, that can be a real stretch. So the point is that there's these social societal pressures on female physicians that may not exist for people in other fields.
Now, my own sister went through law school. I watched her go through that. That was horrible.
Wouldn't watch it on anybody. So if you're listening to this and you're a lawyer, I see you, right?
If you're an engineer like my other sister, we know that engineers have high infertility rates as
well. We know that women in these high demanding professions do have high rates of infertility.
So this is not to say female physicians are the only ones with these difficulties, but I do think
we need to look and see what is going on in the female physician population. And sometimes it's
these uncontrollable schedules, right? If you're a surgeon and you're like, well, I work 100 hours
a week, I'm not sure where I'd find the time to go to a fertility office and even get an evaluation
and start to figure things out. That all has its own ramifications. not to mention our huge
childcare issues in our country. I'm based in the US. It is nearly impossible to find a daycare
that is open at hours that work for a physician family. Maybe a nanny is astronomically expensive.
Most people who have their children as trainees or new attendings are gonna need more than one
person because you can only work a person so many hours, right? before you need to get another
person involved. And so I think there's many, many factors that delay childbearing for,
you know, female physicians. And there's, so when I see somebody on my schedule, who's a female
physician, sometimes it is somebody who's 30 years old and they have diminished to bear and
reserve, or maybe they have polycystic ovarian syndrome. For some reason, I seen a lot, I see a lot
of lean PCOS, you know, in my female physician population. I have ideas about that as well,
but anecdotally, it does seem that. My female physicians have lower MH rates and that large amount
of that is probably due to age, but I don't think the age tells the full story alone. We do know
there are some emerging data that the stress of IVF, right? The stress of the IVF stimulation has a
negative impact on egg quality. And I know that AMH is quantitative, not qualitative, but I do
think that there is a connection to the stress we have in our bodies and the egg number,
the egg quality, all those things that Hopefully we'll have a lot more data on in the next five to
10 years. I also wanted to offer that if female physicians are having their first children five
years on average later than non-physician counterparts, what does that mean for secondary
infertility? I don't think we talk enough about secondary infertility at all. And it is incredibly
painful when you have a three-year-old, a four-year-old who's asking for a sibling. And you are
trying, you're going to the fertility office. Maybe you're on your third IVF cycle. You're not sure
if you're going to be able to build your family. And that is its own stress, right? It's like, what
am I doing wrong? My body did this before. Why can't people figure it out? That can be really,
really awful. And so I, again, comb literature as I always do to see if there were any data for
female physicians with an increased rate of secondary infertility. I could not find that
information. However, I did find that. Female physicians do have increased risk,
increased rates, excuse me, of miscarriage, which, you know, that's, that's horrible in and of
itself and also worse pregnancy outcomes as well. So in terms of having pregnancy complications,
there's lots of data, you know, especially in women surgeons, but also in women physicians in
general, who are non-physicians, non-surgeons as well. that there's an increased risk for
pregnancy complications. And I think we really need to be looking at that because just like female
physicians die earlier than non-physicians, which is terrible, we also need to be making sure that
we're supporting our female physicians as we are all trying to build families alongside a demanding
clinical career and serving other people. There's also data to suggest that female physicians have
smaller family sizes. compared to non-physicians. Is that intentional? Is it not intentional?
How much is related to infertility? It's like kind of like the data with childlessness. It's really
hard to understand like where that's coming from and whether it's a choice or whether it's by
circumstance. So what I wanted to say is we know that female physicians have higher rates of
infertility compared to the general population. We have only started to skim the surface of what
this is about. We do need to look at AMH ranges for physicians and non-physicians and look at the
data and see what's going on and also have better understanding of the role of stress.
all women in high achieving careers as it pertains to AMH and diminished ovarian reserve values.
So this is a relatively short podcast. I wish there was more to say about that, but stay tuned
because we're going to explain FSH values and timing in the next episode. And there's also some
really interesting data that's about to come out as well. So you know how much I love you until the
next time. Bye.