A recent review paper reveals that infertility rates among surgeons can be up to 32%—nearly three times that of the general population—with pregnancy complications affecting up to a third of those who conceive. These statistics are at the heart of Occupational Hazards and Pregnancy in Orthopaedics, a review by Dr. Elizabeth “Lily” Garcia, a pediatric orthopaedic fellow with UBC’s Department of Orthopaedics.
The review, published in the ANZ Journal of Surgery (April 2024), was conducted at the request of the Orthopaedic Women’s Link (OWL), a group within the Australian Orthopaedic Association, and culminated in the release of new guidelines last week.
Drawing on her own experience of two pregnancies during residency in Perth, Australia, Garcia set out to understand how the operating room and the exposure to the operating room environment can affect fertility and pregnancy outcomes. Her findings point to a reality that extends beyond orthopaedics, raising questions for surgical teams across medicine about safety, support, and the need for change.
The review looks at risks in the operating room that could affect pregnancy, including radiation, bone cement, surgical smoke, long hours, and night shifts. It also includes risks outside the OR, such as exposure to certain gases and cleaning chemicals. While many doctors already take steps to protect themselves—like wearing lead aprons or using proper surgical masks—Garcia says there’s room to improve how work schedules and duties are managed during pregnancy.
“The risks we looked at are specific to orthopaedics,” she explained. “But many of them apply to other types of surgery too.”
The Spark Behind the Study
Garcia began researching the topic in 2020, during her training in Western Australia. She completed her orthopaedic surgery training in 2024 and is currently doing a paediatric fellowship at BC Children’s Hospital in Vancouver.
“I had two children during training,” she said. “My personal experience made this a bit of a passion project.”
OWL encouraged Garcia and her co-authors to investigate whether sufficient research existed to develop guidelines for surgeons who are pregnant. What she found was a large amount of information—much of it scattered across different specialties.
“I was surprised by how much was out there,” she said, “but no one had taken it and put it into a single source.”
Looking forward
Garcia hopes the guidelines will help in three key ways:
- For individuals: A resource for those undergoing fertility treatment, pregnancy, or early parenting.
- For departments: To assist hospitals and supervisors in better understanding what someone may be experiencing and facilitating open support conversations.
- For future learning: “It would be wonderful to circle back and learn from the people who are using the guidelines—what’s missing, what’s been useful, and how the guidelines have had an impact.”
“Having information about how to work safely in orthopaedics during pregnancy, infertility treatments, and those early years of parenting,” said Garcia. “That’s what helps people manage their lives in a way that works for them.”
The guidelines are a step toward making surgery safer and more accommodating for people starting or growing their families. By sharing clear, practical information, Garcia hopes to help others feel more confident in managing their health and careers—and to start conversations that have long been overdue.