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Original Investigation
July 28, 2021

Incidence of Infertility and Pregnancy Complications in US Female Surgeons

Author Affiliations
  • 1Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
  • 5Department of Surgery, University of Tennessee Health Science Center, Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis
  • 6Division of Pediatric Surgery, Ann & Robert Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 7Division of Pediatric Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Surg. 2021;156(10):905-915. doi:10.1001/jamasurg.2021.3301
Key Points

Question  Are female surgeons at increased risk of infertility and pregnancy complications?

Findings  In this national survey study of 850 US surgeons, female surgeons were more likely to delay pregnancy because of training, use assisted reproductive technology, and experience pregnancy complications compared with the female partners of their nonchildbearing colleagues. Surgeons operating more than 12 hours per week during pregnancy also had increased risk of pregnancy complications.

Meaning  Female surgeons may be at increased risk of infertility and pregnancy complications; changing surgical culture and enacting policies that support pregnancy may reduce risk of adverse obstetric outcomes.

Abstract

Importance  While surgeons often delay pregnancy and childbearing because of training and establishing early careers, little is known about risks of infertility and pregnancy complications among female surgeons.

Objective  To describe the incidence of infertility and pregnancy complications among female surgeons in the US and to identify workplace factors associated with increased risk compared with a sociodemographically similar nonsurgeon population.

Design, Setting, and Participants  This self-administered survey questionnaire was electronically distributed and collected from November 2020 to January 2021 through multiple surgical societies in the US and social media among male and female attending and resident surgeons with children. Nonchildbearing surgeons were asked to answer questions regarding the pregnancies of their nonsurgeon partners as applicable.

Exposures  Surgical profession; work, operative, and overnight call schedules.

Main Outcomes and Measures  Descriptive data on pregnancy loss were collected for female surgeons. Use of assisted reproductive technology was compared between male and female surgeons. Pregnancy and neonatal complications were compared between female surgeons and female nonsurgeon partners of surgeons.

Results  A total of 850 surgeons (692 women and 158 men) were included in this survey study. Female surgeons with female partners were excluded because of lack of clarity about who carried the pregnancy. Because the included nonchildbearing population was therefore made up of male individuals with female partners, this group is referred to throughout the study as male surgeons. The median (IQR) age was 40 (36-45) years. Of 692 female surgeons surveyed, 290 (42.0%) had a pregnancy loss, more than twice the rate of the general population. Compared with male surgeons, female surgeons had fewer children (mean [SD], 1.8 [0.8] vs 2.3 [1.1]; P < .001), were more likely to delay having children because of surgical training (450 of 692 [65.0%] vs 69 of 158 [43.7%]; P < .001), and were more likely to use assisted reproductive technology (172 of 692 [24.9%] vs 27 of 158 [17.1%]; P = .04). Compared with female nonsurgeon partners, female surgeons were more likely to have major pregnancy complications (311 of 692 [48.3%] vs 43 of 158 [27.2%]; P < .001), which was significant after controlling for age, work hours, in vitro fertilization use, and multiple gestation (odds ratio [OR], 1.72; 95% CI, 1.11-2.66). Female surgeons operating 12 or more hours per week during the last trimester of pregnancy were at higher risk of major pregnancy complications compared with those operating less than 12 hours per week (OR, 1.57; 95% CI, 1.08-2.26). Compared with female nonsurgeon partners, female surgeons were more likely to have musculoskeletal disorders (255 of 692 [36.9%] vs 29 of 158 [18.4%]; P < .001), nonelective cesarean delivery (170 of 692 [25.5%] vs 24 of 158 [15.3%]; P = .01), and postpartum depression (77 of 692 [11.1%] vs 9 of 158 [5.7%]; P = .04).

Conclusions and Relevance  This national survey study highlighted increased medical risks of infertility and pregnancy complications among female surgeons. With an increasing percentage of women representing the surgical workforce, changing surgical culture to support pregnancy is paramount to reducing the risk of major pregnancy complications, use of fertility interventions, or involuntary childlessness because of delayed attempts at childbearing.

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    1 Comment for this article
    It’s about time someone studied this
    Karen Milliorn, MD | Retired
    Having had one postmature child with a diaphragmatic hernia while I was in surgery residency, as well having as a 35-36 week premie & two ectopic pregnancies while in private practice, I have often wondered if any of my complications were connected to my work. It’ll be interesting to see how this research develops.
    CONFLICT OF INTEREST: None Reported
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