Table 4:

Free response (optional): “Do you have any other thoughts you’d like to share with us about your plans to build a family?”

Theme	Example quote
Age/Timing	“As a premedical student, I am planning to have children when my partner and I feel ready rather than trying to wait for the best time during or after training. This may be naive, but I am very worried about waiting too long and having age-related fertility issues.”
	“I know due to my age I will need to have children during medical school and residency and I am very nervous that I will face limited opportunities or backlash due to this.”
	“I would probably choose to try to have children in 2 years if I wasn’t in medicine, instead I’m planning to wait until the end of residency in 4 years and hoping I don’t encounter difficulty when we start trying.”
	“As an LGBTQ+ person, I always thought that family planning would be pushed off until later in life when I had the stability, finances, support, etc to go about building my family. Being a LGBTQ+ in medicine has only pushed that process further back and has put more barriers in front of that process.”
Support	“Family leave is not widely discussed and I do not know what policies are around to support me if I choose to become a parent. I do not know where I will be for residency and this has impacted my relationship as my recent partners have been opposed to long-distance relationships.”
	“I think that it is difficult to think about having kids when the infrastructure is stacked against you. While some institutions are looking to change, there is not a large enough movement to enact large changes nationwide.”
	“If the system was more supportive I would be looking more into having a family earlier, but at this stage feel pressure to not conceive which makes me worry for my future. I worry that by the time I am out of my medical training I will have a short span to create a family which makes me stressed I won't conceive.”
	“I'm currently pregnant with my second child in my second year of medical school and have been faced with a lot of difficulty working with my school for accommodating me and presenting options.”
Cost	“I think if residency programs were required to cover egg freezing in our insurance plans, that would alleviate a lot of my stress. I’m sure that most female physicians or soon-to-be physicians would agree.”
	“I find it ironic that in a career about medicine there’s hardly any support for fertility treatments or cost support. It is incredibly disappointing and almost discriminatory to limit women that way.”
	“As a gay man, I have only 2 very expensive and time consuming options: adoption (vs) IVF & surrogacy. I’m not sure when I’ll be financially stable enough or have enough time to devote to having a child.”
	“Student loan debt payments are an extremely influential component in this decision, especially for those coming from backgrounds that required a high number of loans to afford education and training. Residents are not paid very highly and also have to repay loans, so if the partner finds it necessary to stay home and take care of a child, an income is lost which could greatly negatively impact the odds of planning to have another child.”
Stigma	“I’ve had 2 children during medical school, and it has been very challenging. The worst part was having no postpartum leave and returning 1 week postpartum each time. The second worst part was dealing with judgment from attendings, residents, and peers and lack of support for breastfeeding.”
	“I hoped to have a child third year but decided not to do so because of the stigma in residency and how I will be perceived during audition rotations fourth year if I'm pregnant. I wish it wasn't this hard.”
Reproductive decision making	“I believe that my indecision about whether or not to have children at all is in large part impacted by my decision to pursue medicine. Had I gone into a field that was less demanding, I think I would want to have children.”
	“The more I have decided to pursue medicine the more I feel inclined to put off kids or not have them at all.”

IVF, in vitro fertilization.