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Women surgeons are more likely to use assisted reproductive technology, have fewer children

Publish date: October 24, 2013
By
Michele G. Sullivan

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Women physicians reflect on work/life choices

Dr. Phillips and colleagues have identified yet another issue that may add to the complexity of surgical training, i.e., pregnancy. Both surgical training and having children are time-sensitive priorities that may conflict with one another and add extra stress to the decision matrix. There is no perfect answer here. So, even after the decision is made to have a child, there will still be many other conflicts coming down the pike.

Dr. Rozycki

The key to managing such issues is to realize the following: Be flexible. You can "do it all" but not all at once. You have a whole lifetime to accomplish goals and from time to time, adjustments in plans have to be made: You lead life, it does not lead you. There is no "yellow brick road." This is where surgeons excel. They exhibit strength and courage when facing such conflicts and recognize that they have the skills and stamina to move their lives forward even in the face of complex challenges.

Grace Rozycki, M.D., FACS, is the Willis D. Gatch Professor of Surgery and executive vice chair of the department of surgery, Indiana University Schoolof Medicine, Indianapolis.

Being pregnant at 40 is miserable but being pregnant at 40 is also incredibly lucky. I just returned from maternity leave after my third child and promise you this is true. As this study demonstrates, despite what we may tell ourselves, we are biologically engineered to procreate in our 20s, not in our 40s. The problem is that in our 20s and early 30s, we are so focused on our career that we all too often neglect our personal life.

We talk about the "choice" of many women surgeons to not have children as an active one, which simplifies a very complex issue. There are many reasons why women surgeons have fewer children than the general population and often it does not represent an active choice.



Dr. Greenberg

Infertility is an intensely personal and emotional issue that is rarely discussed. As such, we often don't realize how many of our colleagues are facing this challenge and can feel isolated when discussions of work/life balance are overly focused on the challenges of raising children.Our discipline is changing in many positive ways that may improve these statistics so that more women surgeons can have a fulfilling career and enjoy motherhood if they so choose. Research such as this will hopefully help the younger generation to start thinking about these issues earlier and motivate the older generation to provide an environment that is conducive to having children at any stage of a surgical career.

Caprice Greenberg, M.D., FACS, is associate professor of surgery, University of Wisconsin, Madison, and director of the Wisconsin Surgical Outcomes Research Program.

As a medical student applying into a surgical subspecialty, I am sobered but certainly not surprised by these findings. I approach my career and desire for a family with wary readiness to face a lifetime of setting tough priorities that at times may feel isolating. Is a career as a surgeon incompatible with pregnancy, lasting marriage, and well -behavedcared for children? I would say no, though it depends on who your partner is, where you work, and careful timing. With increasing numbers of women entering surgery who refuse to compromise mothering their own children, the work environment will have to change.



Ms. Gamble

Part of this changing landscape may mean that female surgeons will undergo assisted reproductive technologies at higher rates than their nonsurgeon counterparts. It may mean that shift work becomes more acceptable. The changes we create as a medical community should affect both men and women; we should be wary of designing special tracks or programs that can lend to further isolation and hand-waving of leadership. To ensure gender equity in surgery, we are asking for institutional change - something for which there is never a perfect or easy time. Surgeons simply have to make it a priority.

Charlotte R. Gamble is a fourth-year medical student at the University of Michigan, Ann Arbor.


 

AT THE ACS CLINICAL CONGRESS

WASHINGTON – Women surgeons have significantly fewer children, bear them later, and are three times more likely to use assisted reproductive techniques to achieve pregnancy, compared with the general U.S. population.

The findings probably speak to the time it takes to launch a surgical career, leading to delayed childbearing and the physiologic problems that accompany advanced maternal age, Dr. Elizabeth A. Phillips said in a poster at the annual clinical congress of the American College of Surgeons.

Dr. Elizabeth Phillips

"Our survey found that 32% of women surgeons had difficulty with fertility at some point in their childbearing career, compared with 11% of women in the general population," said Dr. Phillips of Boston Medical Center. "When we compared the rates of fertility services to [national] data, we saw that 15% of women surgeons used assisted reproduction, compared to just 5% of the U.S. population."

She conducted an anonymous, 199-question survey on reproductive health, which was distributed to female surgeon interest groups in the areas of general surgery, gynecology, neurosurgery, ophthalmology, orthopedics, otolaryngology, plastic surgery, podiatry, and urology. She received 1,021 replies, which she compared with data from the CDC National Survey for Family Growth from 2006-2010, and the National Institutes of Health.

Of the total responses, 784 women had attempted to become pregnant. Of these, 251 (32%) reported fertility problems. Most of these (210; 84%) underwent a fertility work-up; 76% then attempted pregnancy using some form of assisted reproductive technology (ART). These women bore 185 children.

Most surgeons reported unexplained infertility (70%). Other causes were anovulation (23%); advanced maternal age or premature ovarian failure (22%); polycystic ovarian disease (19%); endometriosis (13%); and recurrent miscarriage (12%). Male factor infertility contributed to 19% of the cases.

Specialties with the highest rates of infertility were otolaryngology (29%), general surgery (22%), and orthopedics (18%).

Surgeons conceived at a significantly older age than the general population (33 vs. 23 years) did and had significantly fewer children (1.4 vs. 2.6 national average). Among those who used ART, the average maternal age at birth was even older – 35 years.

There may be several reasons why women surgeons may turn to ART so much more frequently than do nonsurgeons, Dr. Phillips said in an interview. "One theory is that female surgeons have different relationships with fertility specialists, where they are receiving treatment that would not be offered for another 45-year-old who walked into the office. They also may have the financial means to pay for this treatment."

The survey brings up the question of how women surgeons should factor childbearing into their already busy, stressful lives, she said.

"With so many more women going into surgical subspecialties, should we have family planning tracks? Is there some way to encourage women who want to become pregnant to do so during training, or shortly thereafter?"

"I’ve talked to surgeons who have been pregnant during training, residency, and practice, and by far, the best time to have a child seemed to be during residency, when there were more people to absorb the absence. But most women will say, ‘There’s never a perfect time.’ It’s something that, if it’s a goal in life, you simply have to make it a priority."

Dr. Phillips won the ACS Award for Best Scientific Poster presentation by Junior Investigator. She had no financial disclosures.

msullivan@frontlinemedcom.com

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