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Does a Surgical Career Affect a Woman's Childbearing and Fertility? A Report on Pregnancy and Fertility Trends Amongst Female Surgeons
Elizabeth A. Phillips, MD1, David Petullo, MS2, Julie Braga, MD3, Lori B. Lerner, MD4.
1Boston Medical Center, Boston, MA, USA, 2Private Practice, Silver Spring, MD, USA, 3Dartmouth Hitchcock, Lebanon, NH, USA, 4VA Boston Healtcare System, Boston, MA, USA.
BACKGROUND: The number of females pursuing surgical careers is rising. Previously published studies reveal an increase in pregnancy complication rates amongst female urologists and orthopedic surgeons as compared to the general US population. An increase in the use of assisted reproduction technology (ART) has also been noted among female urologists. However, whether this trend is consistent among surgeons of all specialties is unclear. We launched a survey open to female surgeons in all fields and compare the prevalence of infertility between the groups, as well as to the national averages.
METHODS: An anonymous, voluntary, 199-item online survey was distributed to female surgeons via individual female surgeon interest groups and word of mouth in nine specialties: general surgery; gynecology; neurosurgery; ophthalmology; orthopedics; otolaryngology; plastic surgery; podiatry; and urology. A total of 1021 responses were received and compared to the Centers for Disease Control and Prevention National Survey for Family Growth and National Institute of Health data, as well as between surgical specialties, to discern any differences between populations.
RESULTS: Of those who attempted to achieve pregnancy, 32% reported difficulty with fertility and 84% of these women went on to have a work-up for the same. In comparison, 10.9% of women 15-44 report impaired fecundity in the general US population and 11% have sought infertility services to achieve or maintain pregnancy, compared to 6.5%, on average, for US women. Seventy-six percent of female surgeons reporting fertility difficulty used ART to attempt pregnancy. The national percentage of children born via use of ART is 1.4%. The most commonly employed methods of ART were clomiphene (25%) and in vitro fertilization (IVF) (19.4%). In addition, three of the nine surgical specialties reported rates of difficulty with fertility over 15%, these were general surgery (22%), otolaryngology (29%), and orthopedics (18%). The surgeons reported 1.4 biological children on average, compared to the national average of 2.6 children, and the age with first pregnancy was 33, in comparison to a national average of 23 years. The average age of the surgeons at the birth of their first child was increased to 35.4 if ART was implemented.
CONCLUSIONS: Female surgeons have first pregnancies later in life, on average, have fewer children, and report more issues with infertility. ART is implemented more often by female surgeons than the national average. Specialties reporting most difficulty with infertility were general surgery, orthopedics and otolaryngology.
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