High Infertility Rates and Pregnancy Complications in Female Physicians Indicates a Need for Culture Change
Gwen M. Grimsby, MD.
Phoenix Children's Hospital, Phoenix, AZ, USA.
Background: Physicians are subject to intense training programs, long working hours, high stress work environments, and exposure to radiation and potentially harmful chemicals. While some literature indicates an increased risk of infertility and pregnancy complications in small samples of female surgeons, the true prevalence of these problems in all female physicians is unknown. The goal of this study was to identify the prevalence of infertility, miscarriage, pregnancy complications, and delayed pregnancy in a wide sample of female physicians and to compare these rates to the general population as well as between medical and surgical sub-specialties.
Methods: After IRB approval, an anonymous, voluntary survey was distributed to female physicians via private female physician social media groups. The survey queried information regarding timing of pregnancy, age at first pregnancy, infertility diagnosis and treatment, miscarriage rate, pregnancy complications, pre-term birth, specialty, hours worked, workplace support of pregnancy, and education regarding these topics while in training. The survey results were compared to general population data from the CDC and medical literature and between medical and surgical sub-specialties with t tests and Fisher’s Exact Tests.
Results: A total of 1,039 female physicians completed the survey. Mean age at first pregnancy, infertility evaluation and treatment, miscarriage rate, recurrent pregnancy loss, pregnancy complications, and pre-term births were all statistically significantly higher in female physicians compared to the general population CDC and medical literature data, Table 1. Only 8% of physicians surveyed reported being educated during their training on the risks of infertility and pregnancy complications secondary to delaying pregnancy. Over half of providers indicated they experienced negative workplace attitudes regarding pregnancy. Surgeons had significantly less children (p=0.0069), were less likely to have ever been pregnant (p=<0.0001), work longer hours (p=<0.0001), had shorter maternity leave (p=<0.0001), and were more likely to be discouraged from starting a family during training or practice compared with non-surgeons (p=<0.0001). There was no significant difference between surgeons and non-surgeons with regards to age at first pregnancy, infertility evaluation or treatment, miscarriage rate, pregnancy complications, or preterm births. Providers who worked ≥60 hours per week were significantly more likely to have preterm births compared with providers who worked <60 hours per week (p=0.0248).
Conclusions: The prevalence of infertility, miscarriage, pregnancy complications, and preterm birth is staggering in female physicians compared with the general population. While some of these factors may be attributed to the older age at first pregnancy in female physicians, it is very concerning that only 8% of providers surveyed were educated regarding the potential risks of delaying pregnancy. These factors appear to be consistent across all specialties. The culture of medicine and surgery must adapt to support women with family planning during their training and careers.
Table 1 - Comparison of Pregnancy Demographics in Female Physicians and the General Population
| Female Physicians | General Population | P value | |
| Age at first pregnancy (years); mean (SEM) | 32.1 (0.11) | 23.6 (0.18) | <0.0001 |
| Number of live births mean(SEM) | 1.9 (0.03) | 1.2 (0.02) | 0.0144 |
| Had a miscarriage | 38.8% | 19.7% | <0.0001 |
| Recurrent pregnancy loss | 14.2% | 2.0% | <0.0001 |
| Underwent infertility evaluation | 36.6% | 8.8% | <0.0001 |
| Underwent infertility treatment | 30.2% | 12.7% | <0.0001 |
| Pregnancy complications | 53.0% | 19.6% | <0.0001 |
| HTN/pre-eclampsia/HELLP | 16.1% | 6.5% | <0.0001 |
| IUGR | 4.2% | 5.1% | 0.6093 |
| Gestational diabetes | 8.4% | 7.6% | 0.3505 |
| Preterm birth | 19.7% | 9.5% | <0.0001 |
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