The Long Road to Parenthood

Abstract

Objective: We sought to characterize demographics, costs, and workplace support for surgeons using assisted reproductive technology (ART), adoption, and surrogacy to build their families. Summary Background Data: As the surgical workforce diversifies, the needs of surgeons building a family are changing. ART, adoption, and surrogacy may be used with greater frequency among female surgeons who delay childbearing and surgeons in same-sex relationships. Little is known about costs and workplace support for these endeavors. Methods: An electronic survey was distributed to surgeons through surgical societies and social media. Rates of ART use were compared between partners of male surgeons and female surgeons and multivariate analysis used to assess risk factors. Surgeons using ART, adoption, or surrogacy were asked to describe costs and time off work to pursue these options. Results: Eight hundred and fifty-nine surgeons participated. Compared to male surgeons, female surgeons were more likely to report delaying children due to surgical training (64.9% vs. 43.5%, P < 0.001), have fewer children (1.9 vs. 2.4, p < 0.001), and use ART (25.2% vs. 17.4%, P = 0.035). Compared to non-surgeon partners of male surgeons, female surgeons were older at first pregnancy (33 vs 31 years, P < 0.001) with age > 35 years associated with greater odds of ART use (odds ratio 3.90; 95% confidence interval 2.74–5.55, P < 0.001). One-third of surgeons using ART spent >$40,000; most took minimal time off work for treatments. Forty-five percent of same-sex couples used adoption or surrogacy. 60% of surgeons using adoption or surrogacy spent >$40,000 and most took minimal paid parental leave. Conclusions: ART, adoption, or surrogacy is costly and lacks strong workplace support in surgery, disproportionately impacting women and same-sex couples. Equitable and inclusive environments supporting all routes to parenthood ensure recruitment and retention of a diverse workforce. Surgical leaders must enact policies and practices to normalize childbearing as part of an early surgical career, including financial support and equitable parental leave for a growing group of surgeons pursuing ART, surrogacy, or adoption to become parents.

Association of Women Surgeons’ Comprehensive Initiative for Healthy Surgical Families During Residency and Fellowship Training

“…Those using surrogacy to build their families may wish to attend prenatal visits or require scheduling flexibility for other appointments, such as legal meetings prior to the birth of the children. There are substantial financial costs associated with adoption and surrogacy, 8 which may be prohibitive for trainees. As nearly half of surgeons in same-sex couples use adoption or surrogacy, these individuals may face disproportionately greater challenges in balancing parenthood with surgical training.…”

“…There are substantial financial costs associated with adoption and surrogacy, 8 which may be prohibitive for trainees. As nearly half of surgeons in same-sex couples use adoption or surrogacy, these individuals may face disproportionately greater challenges in balancing parenthood with surgical training.…”

Fertility and Pregnancy: How Do These Affect Family Planning and Surgeon Health?

“…4 Compared with the general population, women surgeons had their first child approximately 7 years later (30-34 vs 25 years) and fewer children overall (0.6-2.1 vs 2.7). 2,3,5 These trends also persist when comparing women surgeons to women nonsurgeons married to surgeons and therefore women with similar sociodemographics, with an average age of first birth of 33 versus 31 years. 6 Women surgeons have fewer biologic children than nonsurgeons and are more likely to delay having children until training was complete.…”

More Than a Pause—Reply

“…This may lead to delays in having children and unintended repercussions, including infertility. Compared with their male colleagues, female surgeons are more likely to delay pregnancy, to require assisted reproductive technology to have a child, to have fewer children, and are less likely to have the number of children they desire . Early education about oocyte cryopreservation and fecundity should occur before the peak of training and fertility to empower medical students, interns, residents, and fellows to make evidence-based decisions on family planning.…”