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Surgeons face higher infertility rates. UC may make it even harder to have babies

For women who train as surgeons, infertility is a known occupational risk. A fight over who pays for it is coming to a head at UC hospitals.

Eva Gillis-Buck, right, and her husband Ben Berman hold their daughter, Mila, at their family’s Mission District home. | Source: Morgan Ellis/The Standard

By Jennifer Wadsworth Senior News Editor

Published Jul. 9, 2026 at 6:00am

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Dr. Eva Gillis-Buck wanted to work at UCSF in no small part because of the women surgeons — many of them mothers who had figured out how to navigate a profession that was never built for them.

It’s where she attended medical school, graduating in 2020, during the height of the pandemic, working 24-hour shifts in the trauma bay. It’s where she matched as a surgical resident and where she leaned on advice from parent-colleagues when she gave birth to her first child, Isaac, during her second year of training.

But by the time Gillis-Buck and her husband began trying for a second child a couple years later, she experienced firsthand what her colleagues in the profession had long known: their job made them far more vulnerable to infertility, miscarriage, and pregnancy complications.

Getting pregnant again took a year. She was in the research phase of her training, working in a lab, away from the 80-hour weeks of clinical residency. But still her body refused to cooperate. She miscarried.

So she went to a fertility doctor for the full battery of tests and tried intrauterine insemination. Ultimately, because of a benefit her union won between her first pregnancy and her second, she was reimbursed $7,000 the day her positive pregnancy test came back.

She said it felt like “the universe aligning.”

It took a year of trying, and a miscarriage, for Gillis-Buck to conceive her second child. | Source: Morgan Ellis/The Standard

Mila was born during the research phase of Gillis-Buck’s surgical training. | Source: Morgan Ellis/The Standard

But now, the very benefits that allowed her to grow her family with her daughter, Mila, are at risk.

Gillis-Buck and her peers say the $30,000 lifetime fertility provision won four years ago in a landmark labor contract is more than just a wellness perk. It’s compensation for a documented work hazard, with the chemicals and radiation exposure, 12-hour shifts, and sleep deprivation.

“Firefighters are at high risk of cancer,” she said, “and surgeons are at high risk of fertility complications and pregnancy loss.”

It’s only fair, she argues, for their employers to make up for it.

Troubling health disparities

Women surgeons struggle to conceive at a rate of nearly 33% (opens in new tab) , roughly triple that of the general population. The demands of the job also drive them toward treatment: About a quarter use assisted reproductive technology like IVF (opens in new tab) , compared with less than 2% of the general population (opens in new tab) .

A systematic review of nearly 5,000 female physician trainees (opens in new tab) , released in February, the most comprehensive analysis to date, found that between 39% and 56% suffered at least one pregnancy complication during training. Preterm labor affected up to 23%. As many as 28% had miscarriages, more than double the national average.

The cause of these complications is no mystery.

Female surgeons face infertility at three times the rate of the general population

Infertility rates among women, by group

Lai et al., Ann. Surg., 2023

Female physicians broadly

CDC / Rangel et al., 2021

Why surgeons? Surgical training runs through prime childbearing years — most residents start in their mid-20s and don't finish until their mid-30s or later. The operating room itself is a documented reproductive hazard: radiation, anesthetic gases, prolonged standing, and shifts of up to 12 hours without food or water compound the risk.

Sources: Lai et al., Annals of Surgery, 2023 (opens in new tab) ; Rangel et al., JAMA Surgery, 2021 (opens in new tab) ; Vishwanath et al., 2024 review (opens in new tab)

Surgical training runs the course of prime childbearing years: four years of medical school, followed by five to seven years of residency, followed by two to three years of fellowship for those pursuing subspecialties. Most residents start in their mid-20s and finish well into their 30s.

The operating room itself is a documented reproductive hazard: radiation, anesthetic gases, prolonged standing, and frequent 12-hour shifts without food or water. More than half of women surgeons work over 60 hours a week during pregnancy. Nearly 40% of pregnant surgery residents contemplate quitting (opens in new tab) .

“Egg freezing and fertility preservation aren’t luxuries for surgery residents,” UCSF surgical resident Dr. Sophia Hernandez said in early June at a Committee of Interns and Residents union rally outside the UC Health Parnassus Heights campus. “They’re the direct consequence of a training system that occupies the entirety of reproductive years.”

The profession has long demanded that women shoulder the costs, financially and emotionally. But a growing body of research around the health toll has inspired a new generation of surgeons to organize around the issue.

In 2022, UCSF residents successfully negotiated the first family-planning benefit ever written into a UC resident contract — the product of a labor bargaining committee that coalesced specifically around reproductive health. The agreement came at a time when no such support existed for medical trainees anywhere in the UC system. It was then expanded to union chapters throughout the UC network.

In 2022, UCSF residents successfully negotiated the first family-planning benefit ever written into a UC resident contract. | Justin Katigbak for The Standard | Source: Justin Katigbak for The Standard

The benefit, which came in the form of up to $30,000 in reimbursement through a platform called Carrot, covers egg freezing, IVF, adoption, surrogacy, postpartum support, and breast milk shipping. It extended to family members, meaning male residents and same-sex couples could use it too. Now, as UC negotiates a new labor contract for all 6,300 medical residents and fellows, it’s on the chopping block.

Under a proposal floated during negotiations, the $30,000 lifetime Carrot benefit dedicated wholly to family-building would get swapped for a bundled yearly $5,100 that also has to cover meals and education expenses.

‘I was too scared to stay’: Patients are fleeing the UCSF Parnassus ER by the thousands

Critics of the plan argue that procedures residents need most, like egg freezing, are time-sensitive, often not deemed medically necessary by insurance, and amount to far more $5,100 in a given year. A single round of IVF, for example, costs about $12,000. Meals and education expenses can cost a few-thousand a year in their own right, easily depleting the proposed annual allotment.

UC has suggested that residents will retain access to fertility care through their health insurance. Physicians in training say that misses the point: Insurance doesn’t cover other family-planning services, such as surrogacy, night doulas, and adoption fees.

“The issue with insurance too is that there are a lot of hoops to jump through,” Gillis-Buck said. These include getting an infertility diagnosis, which was required before she could get the treatment she needed for her second pregnancy. Standard health insurance involves prior authorizations, unpredictable billing, and coverage uncertainty. “I have no idea what I’m going to get billed or what insurance covers,” she said, “and that makes me very reluctant to seek care.”

Carrot’s model eliminates that uncertainty: Residents submit receipts and get reimbursed. Some of the benefits wouldn’t be covered by insurance at all, like adoption expenses and postpartum night nurses, which Gillis-Buck called “the only employer-paid childcare we ever receive.”

UCSF declined to comment on the contract negotiations, referring all questions to UC. In a statement provided to The Standard, UC spokesperson Heather Hansen said the parties remain in confidential mediation, and “the final benefits for medical residents are to be determined.”

Dr. Tiffany Sinclair knows too well what it costs to juggle family planning with surgical training.

A few years into her residency, Sinclair was in her early 30s, making less than $50,000 a year. She and her husband were each working 60- to 80-hour weeks but still struggled to afford Bay Area rent. Having a kid just wasn’t an option. Daycare centers couldn’t accommodate their schedules or overnight calls, au pairs were prohibitively expensive, and there were no family members nearby to help.

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So she paid out of pocket to freeze her eggs in hopes of having children later. It took a year of moonlighting 24-hour shifts in the cardiac unit at the UCSF Veterans Affairs hospital to save enough to cover the $14,000 bill at the fertility clinic, where she could afford only a single cycle. The medications were expensive too, so she ordered them through online pharmacies based in Europe.

“I did not come from a family of money,” she said. “I paid for all my own schooling. I had hundreds of thousands of dollars in loans. And that just felt like the only time frame that made logistical sense.”

Resident physicians and nurses held several rallies in recent months to demand better working conditions and benefits. | Source: Jennifer Wadsworth/The Standard

It was another five years before she finished her surgical training at Stanford University and a few more before she considered thawing her eggs.

A breast and endocrine surgeon who now works in private practice in Southern California, Sinclair serves on the executive board of the Association of Women Surgeons and the American College of Surgeons task force that writes pregnancy and fertility support guidelines for surgical trainees.

“We shouldn’t be disadvantaging people who are giving up their prime reproductive years to take care of other people,” she said.

It’s why so many women quit the field, she noted.

Women make up 38% of surgical residents but only 21% of practicing surgeons, a gap researchers attribute (opens in new tab) partly to uneven attrition. A systematic review and meta-analysis found that female general surgery residents leave training programs at a rate of 24%, versus 16% for their male counterparts. Research shows (opens in new tab) that the pattern holds true across (opens in new tab) all surgical subspecialties. Women are entering surgical training more than ever yet leaving at disproportionate rates before they finish.

Even though Sinclair said she’s fulfilled by her work and her advocacy for the next generation of surgical trainees, she wonders if she’d have made different choices had she known about the personal toll.

Two years ago, she decided to start trying for a baby in earnest. Now, at 41, the sacrifices she made a decade ago have yet to pay off.

“To be honest,” she said, “I don’t think it’s going to be possible for me to have a baby.”

Forced family planning

Dr. Maria Castro, a 31-year-old rising fifth-year general surgery resident at UCSF, gave birth to her first baby during her research years. It was the optimal window, she and her husband decided, before the clinical demands of her training made pregnancy harder to manage.

“You can be in training for anywhere from three to 11 years,” Castro said. “You’re not making an attending salary. You have very little control over your time.”

Working 80-hour weeks comes to about $44 an hour — less than the median income in San Francisco, and about as much as a nanny makes — with no ability to negotiate pay.

“The ability to have a child when you can — it feels like food or housing,” Castro said. “When you’re thinking that you can’t have a child for seven years of training, and then you might be 40 or 42 and struggling with infertility — you’re between a rock and a hard place.”

Gillis-Buck feeds chickens with her daughter at their residence in the Mission. | Source: Morgan Ellis/The Standard

Castro used her Carrot reimbursements for a postpartum doula who came five nights a week. She returned to the hospital just weeks postpartum, pumping in the operating room and on her feet for half a day or more.

For her next child, she’s already strategizing. Fellowship comes next, which means another stretch of punishing hours. But the benefit she relied on for her first child might be gutted by the time she tries for a second.

The stakes extend well beyond current residents. A survey of incoming UCSF and UCLA residents, conducted this spring by the Committee of Interns and Residents, found that 89% rated the Carrot benefit as important or extremely important to their decision to rank a UC program as part of their residency matching. Several said they would not have chosen UC without it.

Castro learned about the cuts from Gillis-Buck, then rallied fellow members of the Muriel Steele Society — named for the first female surgeon at San Francisco General — to pen a letter to UC contract negotiators.

At least 276 UC residents across various specialties — more than 170 of them at UCSF — had signed the petition as of early this week. UC has not publicly responded to its central argument: that what residents are asking to preserve is not a benefit but a remedy for workplace injury and inequity.

The cuts come as UCSF Health reported a $809 million surplus in fiscal 2025. Castro said the UC system appears to be treating the benefit as an accounting matter rather than an equity issue. “To be honest, it seems like an easy line item to them,” she said.

Hundreds of colleagues agree. “A resident who must choose between her career and her reproductive health is not thriving,” they wrote in the letter to UC negotiators. “A fellow who delays starting a family due to lack of support, only to later confront infertility and subsequent lack of fertility coverage, is being failed at a systemic level.”

For Gillis-Buck, who’s 36 and in her fourth year of surgical residency, the timing worked out for her to have a son and daughter before her career gets even more demanding as she takes on more responsibility by teaching trainees and performing surgeries.

But as she plays with her children, she often thinks about the residents behind her who planned their lives around a benefit that may not be there when they need it.

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