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Female surgeons were found to be at increased risk of infertility and pregnancy complications in a national survey study.

The survey showed that female surgeons, compared with male surgeons, had fewer biologic children (mean 1.8 vs 2.3), were more likely to delay childbearing because of surgical training (65.0% vs 43.7%), and were more likely to use assisted reproductive technology (24.9% vs 17.1%), reported Erika Rangel, MD, of Brigham and Women's Hospital in Boston, and colleagues.

In addition, female surgeons were more likely than their nonsurgeon partners to have major pregnancy complications (48.3% vs 27.2%), which remained significant after controlling for age, work hours per week, race and ethnicity, use of in vitro fertilization, and multiple gestation (OR 1.72, 95% CI 1.11-2.66, P=0.02), the authors noted in .

"There is a rather high price for those whose aspirations for childbearing overlap with the time required for surgical training and career," observed Emilia Diego, MD, and Sally Carty, MD, both of the University of Pittsburgh, in an .

While previous studies have reported an increased risk of infertility and adverse pregnancy outcomes among physicians, extrapolating these results to surgeons is difficult because of the duration, intensity, and physical nature of surgical training and practice, Rangel and colleagues said.

The team conducted a self-administered survey that was electronically distributed and collected through multiple surgical societies in the U.S. and social media among male and female attending and resident surgeons who had children. Female surgeons with female partners were excluded because of uncertainty regarding who carried the pregnancy.

The survey, conducted from November 2020 to January 2021, had 1,175 respondents, 850 (median age 40 years) of whom were included in the final analysis (692 women and 158 men).

In other findings, female surgeons were older than their nonsurgeon partners when they had their first child (median age 33 vs 31) and were more likely to work more than 60 hours a week during pregnancy (56.6% vs 10.0%).

Additionally, 42% of female surgeons reported at least one pregnancy loss, which, according to Rangel and colleagues, is more than twice the rate reported in the general population of women ages 30 to 40.

"Studies suggest consistent night shift work and working more than 40 hours a week are associated with higher risks of miscarriage," the authors pointed out. "Although work schedules prior to miscarriage were not specifically evaluated, it is likely that many female surgeons exceeded these parameters, given the substantial duty hours and call obligations that were reported during first pregnancies."

Finally, the team also found that compared with nonsurgeon partners, female surgeons were more likely to have musculoskeletal disorders (36.9% vs 18.4%), nonelective cesarean delivery (25.5% vs 15.3%), and postpartum depression (11.1% vs 5.7%).

"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," Rangel and colleagues argued.

They proposed a number of recommendations for residency programs and surgical departments to follow -- including at least 6 weeks of parental leave for trainees, and up to 12 weeks as recommended by the American Academy of Pediatrics -- to facilitate pregnancy earlier in careers and to reduce pregnancy-related health risks.

Diego and Carty agreed with these recommendations, and suggested that the American Board of Surgery and U.S. surgical institutions must do more to normalize parenthood policy during surgical training.

"Even among surgeons, parenting is a common outcome of adulthood," they wrote. "Yet, unless a change happens at the policy level (i.e., pregnancy at an earlier stage in a surgical career becomes destigmatized to allow routine, flexible reintegration into the workforce), these issues will continue to plague our culture."

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