Although work-family balance impacts specialty selection for medical students of both sexes, pregnancy and childbearing experiences are unique to women. Cardiothoracic surgery, with low female representation, must prioritize these issues to support women entering the field. This study compared family planning experiences between male and female cardiothoracic surgeons. An anonymous, self-administered questionnaire was distributed to cardiothoracic trainees and surgeons from January to June 2023. Descriptive data were collected on family planning perceptions, assisted reproductive technology use, number of children, and pregnancy characteristics (maternal age, complications, miscarriage). Male surgeons reported pregnancy outcomes of their childbearing partners. Of 378 participants, 45.77% were women, and mean age was 44.40 ± 11.59 years. Compared with male surgeons, female surgeons were more often deterred from pursuing cardiothoracic surgery due to a desire to have children (41.62% vs 22.93%, P = .004), more often used assisted reproductive technology (32.37% vs 15.12%, P < .001), had fewer children (1.92 vs 2.48, P < .001), and had fewer children than desired (40.81% vs 25.14%, P < .001). Compared with partners of male surgeons, female surgeons were older at first live birth (34 vs 32 years, P < .001). Among female surgeons, 73 (42.40%) experienced 155 miscarriages, and 54 (74%) reported taking 0 days off from work after miscarriage. The path to parenthood varies significantly by sex for cardiothoracic surgeons, with women more likely to be deterred from the profession by perceived challenges. Policies that promote work-family integration, support maternal-fetal health, and provide support following fetal loss are needed. Display omitted