Infertility and pregnancy complications in US female surgeons
Myron Yaster MD
Erika L Rangel, Manuel Castillo-Angeles, Sarah Rae Easter, Rachel B Atkinson, Ankush Gosain, Yue-Yung Hu, Zara Cooper, Tanujit Dey, Eugene Kim. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021 Jul 28. PMID: 34319353
Rick (Humphrey Bogart): “How can you close me up? On what grounds”?
Renault (Claude Rains): I'm shocked, shocked to find that gambling is going on in here! (A croupier then hands Renault a pile of money from his gambling winnings…) From the movie Casablanca
When I started on the faculty of Hopkins in 1981, there was a doctor’s locker/changing room and a women’s locker room. The idea that women could be doctors, let alone surgeons, was, well, inconceivable. Today, women make up 50+% of medical school graduates, 38% of surgical residents, and 21% of practicing surgeons. We know that surgeons often postpone starting a family and take little time off for childbearing. Long, irregular work hours, prolonged training with little financial compensation during residency, and a professional identity that traditionally minimizes personal life responsibilities may contribute to differences in family planning compared with other educated groups. “The goal of this study was to assess the risk of infertility and pregnancy complications in US female surgeons compared with socio-demographically similar female non-surgeons, to identify workplace factors that may contribute to increased risk of complications, and to identify areas with the greatest potential for improvement”.
Of 692 female surgeons who responded to the survey, “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 non-surgeon 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 non-surgeon 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).
Are any of you surprised by these findings? I know I’m not, or in the immortal words from Casablanca, “I'm shocked, shocked to find that gambling is going on in here”! Although never previously studied, the findings that female surgeons have infertility and pregnancy problems should have been obvious or at least was obvious to me. Historically women surgeons have delayed pregnancy until completion of training and given the duration and brutal hours of their training and the need “to man up” to protect their professional reputations results in infertility and the need for assisted fertility treatments, pregnancy loss, premature births, low birth weight, the use of elective C sections, post-partum depression, etc.
How about us? At this moment in time there is no data. And I would not limit this lack of data to women and fertility. We simply do know how working as anesthesiologists, or better said as pediatric anesthesiologists, affects our physical and mental health. Drs. Rebecca Margolis and Norah Janosy (the SPA wellness SIG), Nathalia Jimenez (SPA DEI subcommittee), Nina Deutsch (SPA president), and I (doctor without portfolio) are working with the SPA board to build a health and diversity survey of all SPA members, men and women, to discover this information. It is currently undergoing internal review and testing and will probably be distributed sometime around the SPA winter meeting. When you see it PLEASE fill it out….we really need this information. Finally, for most of you know me, I’ve always urged my pregnant colleagues do their best to limit their hours and to take it easy, particularly after 20 weeks of gestation…take breaks, drink lots of water, get off your feet and so much more… Myron Yaster MD
PS: Today is the first day of Rosh Hashana, the Jewish New Year. A Happy and healthy New Year to you all!