The association between pregnancy and otosclerosis is controversial. If pregnancy physiologically increases the likelihood of otosclerosis progression, then one would expect that there would be a difference between male and female patients with regards to whether having children affects how soon they experience significant hearing loss and consequently undergo stapedectomy. Females who undergo pregnancy and bear children would be expected to undergo stapedectomy earlier compared to childless females and males. The authors performed a retrospective analysis of insurance claims data documented by the Optum Clinformatics Data Mart (Eden Prairie, Minnesota) from 31 December 2002, to 30 November 2017. A total of 6025 adults aged 26 years and older who underwent stapedectomy for otosclerosis were included, 59% of which were female. Overall, age at initial stapedectomy was significantly lower in females than males (46.8 vs. 48.1 years; t test, P<0.0001). Females with children had significantly lower age at surgery compared to childless females (39.3 vs. 49.9 years; t test, P<0.0001). Males with children had significantly lower age at surgery compared to childless males (40.5 vs. 51.3 years; t test, P<0.0001). Pearson correlation showed a significant inverse relationship between age at surgery and number of children in both females and males. The results suggest that pregnancy’s perceived effect on otosclerosis is more due to the psychosocial effects of having children as patients with children receive earlier surgery regardless of sex. The authors discuss that it could be due to parenthood being associated with higher health care utilisation.