The Cost of Becoming a Surgeon: Why 1 in 3 Female Surgeons Faces Infertility
One in four female physicians will face infertility. Among female surgeons, it's one in three. And even after controlling for age, surgeons still come out with worse fertility outcomes than their age matched peers.
That gap isn't about age. It's about the job.
This episode is part of my series on why certain specialties make the fertility journey uniquely difficult, and this one is for the surgeon who has spent her whole career proving she can handle anything, and is exhausted by what that has cost her body.
In this episode:
The statistic that is unacceptable, and what the research actually shows about surgeons and fertility
Why age alone doesn't explain the gap, and what else may be going on physiologically
Why a 16 hour day in the OR can register in the body as famine, and what that means for the reproductive axis
What changed for one client the moment she started scrubbing out at regular intervals
Why unprocessed trauma from the job may be part of the story behind conditions like endometriosis
One in three is not a personal failure. It's an epidemic. You don't have to stay stuck in this statistic: authentic hope is possible. 💜
With Love and Science,
💜 Dr. Erica
P.S. If you're a surgeon reading this and recognizing your own schedule, your own body, your own exhaustion, you're not imagining it. If you want to talk through what's actually happening physiologically and what your options are, book a consult here. I'd love to connect.
Also, be sure to check out our website: loveandsciencefertility.com
Follow us on social media:
IG: www.instagram.com/loveandsciencefertility
FB: www.facebook.com/profile.php?id=61553692167183
Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
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Erica Bove, MD (00:01)
Hello my loves and welcome back to the Love and Science Podcast. Today we're continuing this series when we talk about what makes being in a particular branch of medicine especially difficult. And today's topic is female surgeons. Okay, so let's talk about it because I did not know this until a couple years ago, but
We know now that one in four female physicians has infertility, which is higher than the one in six rate in the general population. We also know that one in three female surgeons has infertility. One in three female surgeons, okay? This is like terrible, terrible news. And when I think about this, it makes me angry, it makes me enraged, it makes me sad, it makes me wonder like what is going on with our culture that we allow this. There's actually even some data that wives of male surgeons have.
Worse outcomes when it comes to frighten you know fertility and pregnancy outcomes. So I you know, I I was on the business of surgery podcast a couple years ago, and I did a deep dive into literature to try to understand like why this is, what studies exist. This is consistent through like every branch of surgery, like whether it's trauma surgery, ENT, ortho, like there's so many different studies now that show that female physicians, specifically female surgeons, have worse fertility outcomes. And so
You know, what is contributing?
The obvious thing that most people say in reaction to this is, it's obviously age because, you know, a cardiothoracic program takes a bajillion years and then people emerge when they're 39 and then you know they have problems. But if you actually look at it when you control for age, female surgeons still have worse outcomes than their age-matched counterparts, which I think is is wild to me. And I've helped so many female surgeons at Love in Science, and I've learned that it's multifactorial. So, you know, what do I think is going on for female surgeons specifically?
That makes it harder for treatments to work and also harder to have good pregnancy outcomes. Okay, let's talk about it. So we know that sleep is altered, right? Like there is no surgeon I know who like has a regular schedule nine to five, you know. I do know, I do know one physician coach who has negotiated this, but she works part time and you know, she's also in a surgical subspecialty. But any, any, for the most part, any surgeon I talk with is like taking calls.
Call, they are available for emergencies, they work the next day, you know, it's really stressful work, and sometimes like the hospital's understaffed, usually it is. And the sleep dysregulation, I think, is really important to talk about. So, you know, at Love in Science, we always talk about there's some things we can control and some things we can't control. And so it may be that you can't control exactly what your call schedule is, but maybe there are ways to negotiate this, and we can talk about that in a minute. So I think you know, calling out that surgeons have long hours.
Usually the days start very early with OR starts. oftentimes, you know, even a normal day can end easily at 8 or 9 p.m. And then, you know, if you're on call, especially if you live in a, you know, you have a search surgical specialty where there's like you're like the only one, or say you're in a rural community. I'm from a rural community in Vermont where my father, I you know, watched him be on call 24-7 for probably like 30 years until he got a partner. And I like to think about what he did for his patients and also like
Like to provide for our family, you know, as I was a child and was like a little bit blissfully unaware of what that requirement meant of him. Like it really is quite humbling as I think about trying to be, you know, an REI and a parent and all those roles that I balance right now. Like I have mad props to him. But I also know that, you know, we have rules in residency and fellowship as to how many hours people can work, but those rules all go away once we're attending. And so at some point, it's up to us to look.
Look
at what's being asked of us, look at, you know, if that is actually something not just that we can do, because we're all super resilient and we really can prove ourselves that we can run marathons and run surgical marathons, so to speak, and and take call for several days in a row. But is it serving us? Is it serving our, you know, highest good as the main priority in life right now, trying to become a parent or build a family? I think that question can bring up some difficult sticking points.
Talk about it. So, yes, sleep definitely plays a role. We know that there's circadian rhythm alterations that happen with sleep dysregulation. We know that that increases inflammation, it increases cortisol. Like I have whole other episodes about why sleep, by poor sleep, is involved in the fertility axis not working as well, and also perhaps even why even IVF doesn't work as well. So I think we have to think about that. there's also, you know, the sort of corollary of being a you know a surgeon, a female surgeon. I do not know too.
Many surgeons in general, male or female, who I would say, you know, exhibit excellent self-care. And you know, I think at Love and Science we work on it. Like I remember I had a surgeon client who was a subspecialist, she was doing these like 14-hour-long surgeries, and like a lot of a lot of her psychology was, you know, I have to do this, I have to prove myself, it's a man's world, and like I'll be weak if I scrub out and I can't really feed myself in between clinic patients, and you know, there were
All these things that stemmed from this lifestyle that she was living and all these beliefs that she had about how she needed to be at her job. And I remember like she had a long infertility journey, she had losses, and again, you can't say, well, it's because of that, but it's multifactorial, right? It's like I always say, if we budge the vectors in enough places and then get enough vectors to align, sometimes we can like get across the finished line to fertility. We never know what it was that exactly made the difference, but if we only can embrace the things that are in our control.
a lot of times, like there are things like that in terms of, you know, scrubbing out or feeding ourselves or peeing or, you know, attending to our basic needs that we disregard, but they actually are super important because the body knows, right? Like we think about, you know, I have episodes on stress as well. Like we think about how the body knows when it's a stressful time, when it's a famine, when it's a war, you know, the body knows to shunt the energy to the important places like the heart and the lungs and the brain, the liver and the kidneys, like all those organs
That you all know so well, because you probably operate on them, right? and fertility, you know, the reproductive axis becomes an afterthought. And so it is not uncommon for ovulatory function to cease or pregnant pregnancy rates to go down or pregnancy outcomes to be worse during times of significant stress. And I know we're not living in a famine, but hey, if you are not eating for 16, 18 hours at a time because you're in a long case, the body might perceive that as a famine. You know, truly, at least in this
country right now, like in the US, we are not at war in our soil, and I'm very grateful for that.
But however, how does the body, how does the brainstem, how does the physiology recognize, you know, I I think a lot of surgery residencies and and attending jobs probably do feel like that level of stress sometimes, especially in trauma surgery and some of the other, you know, really high acuity specialties. Like I've talked with numerous surgeons, I've been the coach for numerous surgeons, I'm in a lot of the surgery Facebook groups where I see and witness firsthand, you know, the stress that it is. And, you know, maybe there are
Some physiological signals that the body is giving that, like maybe this is not the best time to become pregnant, to gestate a baby, because there is a significant amount of stress that is associated with this job. And so I think that you know, as we think about what is actually in our control moving forward, it really is important to address the sleep dysregulation and the stress. So then what happens when we are living the life of a surgeon and we're operating with these long cases and we have these intense call schedules? You know, what happens?
is the natural consequence is poor self-care. And this is not a judgment, but it's to say, like, you know, what do we reach for when we're in the hospital? We reach for the graham crackers and the peanut butter. Or maybe the cafeteria is, you know, we're just exhausted. And when we're exhausted, it's harder to make solid choices. And so we reach for the chips instead of the salad bar. Like, or maybe you're in a place that actually has a pretty crappy cafeteria and it's like a lot of effort to bring your food ahead of time and plan those things. Like I think really saying okay, food is medicine. I can nourish myself
I can scrub out of a case like that client I was telling you about. She eventually learned to listen to her body, to scrub out of her cases at regular intervals. And then she ultimately got pregnant, so it was even more important as a pregnant person, right? That she listened to her body and she take good care of herself and now she has a beautiful son. But I think sometimes we think, we can't do that, but we have to rewrite the script. Yes, we can. We are the surgeons, we are the bosses, we take control in so many other ways. And if we say we need XYZ, then that is what has to happen. So I just wanted to say that.
I also have seen a pattern in terms of female surgeons, and I fit this pattern as well of like really taking on challenges in every aspect of life. And so
I know that time is short, but I've seen many surgeons when they're post-call go on like a 10 or 15 mile run to blow off stress. Or people are often training for like a marathon or an Iron Man or an ultramarathon, and like this is considered normal. And I do want to challenge that a little bit because similar to what I said about, you know, why when the body recognizes like a time of stress, like it may not, you know, have the optimal physiology for reproduction. I am so sensitive to this because how I blow off stress is exercise and I like.
Like,
love orange theory and I love lifting weights and all those things, but we've actually even seen through some of the physiological data that we're getting from a device called Auto, which is a company that actually looks at biomarkers that seem to correspond with fertility outcomes. Super interesting topic for another day. But when people, when women are engaging in what's deemed as excessive exercise, their fertility index actually goes down. And that's really interesting. And I, you know, when I look at my orange theory and I want to be in zone four and five, and like I'm like looking at those metrics.
I feel really strong and powerful. But and I hear all this stuff about like zones two and three, and I kind of like poo-poo it, or we talk about yoga as being kind of like something for the weaklings. Again, I don't really believe that, but like some part of me, some part of my like competitive brain thinks that way. I will say I see a lot of surgeons with you know either like really low BMIs because they're like exercising excessively, or maybe even higher BMIs because they've not been able to, you know, really address self-care and they've gained a lot of weight through fertility treatments and otherwise. A lot of
Of people who are engaging in these really intense physical challenges that maybe have become normalized over the years, but may not be serving the ultimate goal of becoming a mom. And so I just wanted to share that because I think that you know there is this like martyr complex that can go along with like being the toughest and being the one who can take the most. And as we unpack that a little bit, I always like think about like be your future self now. Okay, so like like the mom version of you, like is that person you know running ultra.
Marathons and like doing all these things, like sometimes it takes a step back from what we're doing. It feels super uncomfortable. And I might even throw an expletive in there, super ethnic and comfortable, right? To take a step back and to like you know challenge the identity, but to say, okay, like once I'm a parent, am I going to be exercising at this level? Is this BMI, you know, a BMI that's optimal for me as like a you know a parent? to be somebody who's like breastfeeding another person, like all those things, if that's what people choose. Again, if you don't choose that, that's totally cool too. But
But
again, you know, starting to think about okay, what am I doing in my life today that might have beneficial ramifications for my life as a parent? And so all those things really matter.
I also wanted to say that like that comment about my client said it's a man's world, that we can't ignore that, right? I think that there's outc there's data that like female doctors, female surgeons have better outcomes, probably because we're overcompensating, because we feel like we need to prove ourselves. Maybe that's part of it. but there's this coach I have done podcast swaps with, her name is Roseanne Austin. She's actually an attorney. She was a trial attorney, with a super, super successful career, actually like doing
Sexual assault cases, and she had like eight years of unexplained infertility, failed IVF. that was like like again completely unexplained. And one thing that she talks about in her content in her books is that we really do need to embrace a feminine energy and allow that in. And I again suspend your disbelief. I know this sounds super woo, but I have a lot of experience in this regard, and there is a balance of the masculine and feminine energies that we have to address if we're gonna.
Going talk about conception. The notion that conceiving is receiving, I think conceiving is receiving is really important to think about because it really is a receptive act. And if she knows she has this expression like trying to get pregnant like a man, and I know it sounds very out there and maybe even controversial, but what I've seen is that when I can help my people soften, when I can help my people take some of that masculine energy, that in control, that like sort of we all know what.
What I'm talking about, right? That sort of like force it to happen, yeah, you know, sort of take charge that very active energy and transmute it and really allow some of the more feminine energy to come in, which is softer, more creative, more open, more receptive. It is somewhat of like a disarming and it does take a little bit of an identity identity shift. I have seen, like, I have an episode too about how people become more creative, right, when they're about to conceive, which is really interesting. But I do think, and and I
And
I have to think about this in my own life too, because if I'm in the OR, I need to be in charge and I do have to exhibit what we might code as like more masculine energy.
Because we are the captain of the ship in that regard. But when I'm thinking about my fertility journey and my, you know, my physiology and what's necessary for that process, we can shift without being inauthentic, right? We can allow more feminine energy to express itself. We can become softer, we can become more open, we can become more communal and and allow that in. And I have actually seen that that makes a big difference. And so think about your own experience of being in a man's world.
having to prove yourself, having to take on this very strong, maybe even forceful energy, and ask yourself what it would take in other contexts to perhaps allow a different way of being, I promise you it will make a difference for you.
Okay. let's also talk about the things that female surgeons witness on a day-to-day basis. It is unimaginable. Like people, regular people who are not doing this, do not have to experience the traumas, the gunshot wounds, the you know, calls to the ER with unimaginable things, the the children who get lost and who need to be operated on. Like truly it is it is something that takes a special person even to be able to hold
That and then help those people. But then we also hold that trauma in ourselves. And I mean, I, as an OBGYN and a fertility specialist, I have seen also some completely unimaginable things that still haunt me. You know, there's that quote about how each surgeon carries a graveyard within them. I think that is 100% true. And so I think having a way to deal with the trauma, again, to allow that to pass through. One thing we do at Love and Science is we help people.
People
feel their feelings. And again, you know, if you're about to scrub for a tough case, you're not gonna say, okay, now's the time I'm gonna let down my garden and feel my feelings. That's when you're gonna like, you know, really harness that energy and and be that captain of the ship and and do what needs to be done. But I also think it's equally important to carve out space at another time when it is safe to do so, to maybe listen to music and draw yourself into a more vulnerable place or journal or connect with another colleague who will actually get it because it is actually too much to carry that's alone and what I've
What I've experienced is that people who carry trauma within them, whether it's like childhood trauma or ch or sexual abuse trauma or medical trauma from unsuccessful treatment or trauma from the job, which we all have, right? We talked about the second victim, all of that trauma accumulates. And I really do believe it lives in the pelvis. Like I've seen it time and time again that when when when we can release those energetic blocks, like things happen, I think that endometriosis probably has an association with trauma. Like there, and a lot of my clients come to me with, you know, undiag previously undiagnosed endometriosis. We just
Discover it, we treat it, and then they move on with a successful outcome. So I also want to take the link and say, okay, being a female surgeon inherently involves trauma from the job, and then you're a fertility patient, so there's that. And then, you know, many of us also have, you know, history of things in the past. And so really understanding that we're whole human beings, and it's not just like, I'm going to go to the fertility doctor, have this transaction and have it work out. Like we also have to go deeper into the deeper layers and do the work of like what has my body experienced.
What do my cells carry within me? What am I making that mean about myself? You know, maybe maybe at some level I feel like I'm broken or I have to shut out people or men or whatever else it is to be able to exist in this world. And I really do think we there's a lot of really fruitful work that can be done to release those blocks to help us all move forward with the highest chance of success possible. Okay, so what can help, right? So, what can help with being a female surgeon? Because again, there's some things we can
Can
control and some things we can't control. So altered schedules. This is a tricky one, right? So one thing I do a lot is I help people find their voice. I have helped clients who said, okay, I had my embryo transfer. I am not taking call for the nine days after that until I know if I'm pregnant or not, because I know that my body needs that time to, you know, be have the lowest stress possible. Some people have to take a vacation during that time to get that, other people are unable to negotiate call swaps. But I do think
That understanding the level at which we typically function and then saying, like, is that actually good for this process? It takes some creativity sometimes, but really looking at the altered schedules, figuring out the sleep, figuring out the call, figuring out some creative switches. Maybe it's even like dropping effort a little bit to go from full time to point eight. We all know that full time is way more than full time, right? In a physician career. And so let's think about options to make the schedule more doable and not just
for like somebody who's 22 and like bright-eyed and bushy-tailed and like can handle anything, but somebody who maybe is in their mid to late 30s, early to mid-40s and is struggling with fertility to say, how can I be a little bit gentler on my system to take one thing off my plate so that I can help this process forward? embodiment and self-compassion, like I talked about, like there are times for this and times not for this. Like when you're scrubbing about to do a tough case, like that is not necessarily a time to like let down your guard and and and feel all your feelings and
But I do think that self-compassion actually is a thread and it's a muscle that can help us with every aspect of life. I've been talking about this, you know, myself and my own running journey, and how the more self-compassionate I am in so many aspects of my life, you know, the more positive self-talk I have, the more I can turn that inner critic into an inner coach. It works with surgery. Like Mel Facker has a lot of really great stuff on this. It works in in life as well, but I think it also works in the fertility journey. And so when we can remind ourselves like we're doing our best, when we can ourselves,
ourselves like Dr. Kristin Neff says, anybody in my situation would feel this way. When we can find ways to become mindful and use sensory experiences to get into our body, when we can find ways to be, you know, self-kind like kind to ourselves instead of judgmental to ourselves. Those are all the key elements of self-compassion. I have found her mindful self-compassion workbook extremely helpful. I just finished it the other day after a four year journey and I'll probably do it again because it's been so useful. But it's almost like it feels really uncomfortable at first. She talks about the
Backlash of how it feels to be compassionate instead of like super hard and nasty to ourselves all the time. But when we start to work that muscle, there's actually data that our our brain function actually expands, our performance actually improves. We can actually get into our bodies, we can connect with our breath. You know, actually surgical outcomes improve as well because when you have like an embodied surgeon and not like an anxious spinning, you know, during an emergency, fear of a complication, all those things, like it actually becomes better for the process as well. So
Self-compassion is one of those things that helps everything, but I actually think it helps tip the physiology into a direction that is more optimal for fertility. And I've seen that with my patients, I've seen it with my clients. I will not do an embryo transfer until my my patient is regulated emotionally, and my nurses just know this by now. Like I will I will kneel, I will hold the hand, I will take some deep breaths with my patient. Like I know that success that outcomes are just more successful when the physiology is better, but it is something that we need to be taught. It's not something that comes naturally to us. And I think that.
Female surgeons are perhaps among them the least self-compassionate group of female physicians. I mean, not to compare, but just to say that like it takes a certain breed of person to succeed in this field, and in the fertility realm, this actually works against us. Okay, again, I'm gonna reference Malthacro. She talks about preserving the assets. So, what does that mean? That means sleep, that means nutrition, that means true self-care. I'm not talking bubble bass, I'm talking about like what is actually going to help you be restored. We were on a coaching call last night and I had a client.
Who worked like two 24 hour shifts essentially back to back. And she said to her chair, like, I need to sleep in during didactics tomorrow. I know we have our educational conference, but like I've been working so much. She actually happens to be pregnant after a long journey. She's like, I'm taking tomorrow morning and sleeping in. Which, you know, maybe in the past version of herself, she might have said, like, I can't do that. I have to be there. We're dinged if we're not there, et cetera. But she was just like, I know what my body needs and this is a lot of call. And I that is her way of preserving the asset. So she can continue on, refill the well.
keep you know being present for herself, for her unborn child, for her for her other partners and her patients. I think that's just brilliant. We have to give ourselves permission and we have to look for opportunities to do that. We talked about no call during certain windows. It's really hard to ask for these things at first, but it gets easier with time. And I always say like if you were to have an appendicitis, right, you'd be out for two weeks and so we don't blink an eye about that. But when we think about our own fertility journeys, we're like, I can't take time off for my egg retrieval cycle or I
Can't, you know, I'm just, I'm just in the two-week wait. Like, that's not a big deal, but I think we have to think about these things differently. coming home to yourself, something I love to talk about a lot. I learned this from Dr. Kabita's son. And that's really like getting quiet and tuning in and like just asking yourself, like, what does my body need? It could be as simple as, I'm a little chilly. I think I need a sweater. Like maybe we might have blown through that and just been uncomfortable. I have another clinic patient, but I think I really need to pee. So I'm gonna take three minutes, you know, to pee.
And to come back, pee, wash my hands, and then come back to the situation. And like, I would not want a surgeon seeing me in clinic who I knew had like was distracted because she had to pee, right? Like, so why would I not offer the patients what I think they actually deserve? And so again, that's some like a small way to come home to yourself. Maybe you're hungry, maybe you need a snack, maybe you take a pause and address your basic needs. Maybe you even like take a nap. I mean, many of us are like not great at napping or resting the eyes. I don't like waking up more than once in a day, so I tend to like
Like
rest my eyes and not always fall asleep. But that's another way that I come home to myself. I'm like, I'm feeling depleted. What if I take a pause and like just take 10 to 15 minutes, close my eyes, and then re-enter the situation? I mean, there's data about this, people are more productive, but it actually feels really good. It feels scary at first to be like, my gosh, I'm not productive every single moment of every single day. But I think when we do this, it can really make a big difference over time. so it's really about tuning into the body, asking the body what it needs. Maybe, maybe we need a hug. Like, I talk all
The time about how hard it is to ask for a hug, especially from people like we like, you know, don't want to have any needs whatsoever. But there's physical needs, there are emotional needs, there's spiritual needs, there's fertility needs. And so a lot of this work is figuring out like who am I in this moment? What do I actually need? How am I gonna get that need met? And sometimes it means asking for something that maybe doesn't exist within the current structure. And then we talked about embracing the feminine. Again, this is a hard concept to grasp sometimes when we're used to like existing a certain way and our identity is tied up with.
Being a certain way and like this achievement orientation, but I think that and I'm happy to talk with anybody about this who has more questions, but I think disarming ourselves, allowing space for feelings, allowing space for you know, that feminine energy to emerge, I've seen it time and time again that that that energetic space when we are hoping the best for a successful outcome, not blind hope, but hope-grounded in science, and when we can turn that over and surrender to the outcome, the adventure.
Outcome, that surrender is a very like feminine divine notion, not necessarily like a masculine divine notion. And so when we can bot embody that in particular, that is actually when I see the highest chance of success. So we've talked about a lot today. We've talked about the epidemiology of infertility and poor pregnancy outcome in female surgeons. We've talked about why that is in terms of you know stress levels and altered sleep and and you know poor self-care and diet and
you know, sort of dealing with trauma on every level, and also that sort of masculine like being in a man's world and trying to make this all work, like we have not cut up. The world has not cut up to us, so we need to figure out how are we going to change ourselves, how are we going to push back on some structures that aren't built for us because we all deserve to have a successful outcome. And I'm also here, I'm super passionate to help people with this who may not know how to become more self-compassionate, who may
Not know how to find their voice and ask for what they need. again, like thinking about the statistic of one in three female surgeons just makes me just want to punch a wall. Like it makes me so angry. It's not fair, it's not fair that people who are working so hard for people, like my mother just recently had a health experience where you know a surgeon saved her life. Like surgeons are incredible. People save lives, you save lives every single day. And when the science is not working for you, that's not that's not a fair exchange. And so we need
To do the work in this fertility space to make the science work for you. I can't think of anything more worthy to bridge you all to your successful outcomes. So I hope you hear how much I love you. You know it's true. And until the next time, can't wait to talk to you again. Bye.
