I hadn’t intended to disclose my pregnancy that day in surgery. But as I was scrubbing in, the nurse asked, “We’re using fluoroscopy in this case, so there’s no chance you’re pregnant, right?” Fluoroscopy is an imaging technique that uses X-rays, and the radiation exposure is thought to be harmful to developing fetuses. Momentarily befuddled, I mumbled, “Uh, yeah...” It was clearly not the answer he’d anticipated. “Well, how pregnant are you?!” I told him 12 weeks.

Sanitation measures were ceased, and the scrub nurse proceeded to shuttle me between operating rooms, each time stating, “Anna, here, is with child. Are you using X-rays?” Finally we settled on the cholecystectomy — a gallbladder removal — which was deemed to be a procedure appropriate for my delicate condition.

I proceeded through as many of the core clerkships — internal medicine, family medicine, surgery, emergency, obstetrics, pediatrics, psychiatry, neurology — as I could before my due date. Each one confirmed my decision. When I arrived at morning rounds, hoping I didn’t smell like my own vomit, I was thankful I wasn’t the intern or resident, responsible for more than twice my number of patients. During pediatrics, while gaining some perspective on how much energy these adorable germ-bags consume, I considered that the sleep deprivation I experienced in med school had perhaps prepared me for something other than the sleep deprivation in residency. And during obstetrics, when the effects of age on fertility were drilled into us, I was relieved I wasn’t putting off pregnancy until I had completed residency in my mid-to-late 30s.

EVERY woman is different, but we know that fecundability (the probability of achieving pregnancy in one menstrual cycle) usually declines in the mid-20s, drops more significantly in the early 30s and plummets a few years later, at about age 37. In the United States, around 6 percent of married women 44 and younger are infertile, and age is by far the most common underlying cause. That’s a problem, considering that more than a third of college-educated women today have their first child at 30 or older.

There’s no solution for the fact that these childbearing years are also prime working years. But whether they have children at 20 or 40, most women today don’t have a choice about working. I am fortunate enough to have a spouse who can temporarily support us, but we also have hundreds of thousands of dollars of medical student loans to pay off between the two of us. As one doctor told me, “I encourage my fellows to have children immediately if they want them. It doesn’t get any easier later, we just get older.”