There is a debate going on in the infertility medical circles about whether doctors should have a weight limit on women seeking IVF. Although weight limits for fertility treatment are controversial, they are already the reality in several countries. In New Zealand, obese woman are barred from fertility treatment; in British Columbia, obese woman are not allowed to have egg retrieval under sedation; and Body Mass Index (BMI) limits are in place in some regions in England. Note that these countries have nationalized health care that covers at least part of the cost of fertility treatment. Certain clinics in the US have their own BMI cutoff, even with self paying patients. I’ve summarized the main arguments pro and against below. What do you think?
Argument for Banning Obese Women from IVF
Obesity is a major causal factor of female infertility primarily due to hormonal imbalances, and it also affects the success rate of treatment, with overweight women having lower pregnancy rates. Egg retrieval is often more complicated because it is more difficult to get good ultrasound images of the ovaries, and often do not respond as well to the ovulation stimulating medications. And then there is the cost. Dr. Arya Sharma, Professor of Medicine and Chair in Obesity Research at the University of Alberta I Edmonton says, “cost associated with assisted reproductive technologies are not a little bit more expensive—they’re far more expensive as the BMI goes up” because of technical difficulties, significantly more days of gonadotropin stimulation, higher cycle cancellation rates, and lower success rate. Obesity is also linked to more complications in pregnancy such as hypertension, gestational diabetes, preeclampsia, prolonged labor, increased blood loss, higher rate of caesarean deliveries and unexplained still births. Infants of obese mothers are more likely to be admitted to the neonatal care unit.
Argument for Allowing Obese Women to be Treated with IVF
Those who argue against a ban point out that the evidence limking obesity to poorer fertility treatment outcomes are not conclusive. They argue that the common presence of Type 2 diabetes in obese women might be skewing the results—in other words the fertility treatment problems might be caused by the diabetes not the obesity. They point out that some obese women are active and as healthy as thinner women. Furthermore, weight gain and difficulty losing weight are symptoms of polycystic ovarian syndrome, and it is basically unfair to use one symptom of a disease to prevent treatment for another symptom. In fact, they argue, it is unfair to prevent women from accessing treatment for a disease, regardless of the cause of the disease. Banning access to fertility treatment further stigmatizes women who are already suffering. If these women could lose weight, they would have already done so since wanting a child is a huge motivator.
OK, time for you to weigh in (pardon the pun) with your opinion. Are there arguments I’ve missed? We did a great Creating a Family show on weight and fertility, available to listen or download, and a video on Weight, PCOS, and Infertility.
Image credit: Perfect Woman
Dawn,
Not having any stake in this fight I would like to suggest that it is a very important medical concern.
I do not think it has anything to do with Canada being a universal health care system – it has to do with Canada having it’s own health care protocals – some that will be identical to the US – others that are based on their own research and policies created from that research.
I am of course biased as I have Canadian universal health care and I am thankful for it every single day. NO medically “necessary” treatment/test/proceedure has ever been refused to me in a timely manner – as in received based on current risk status.
I have also been told that for an “elective” or even some medically “suggested” proceedures that quite likely no doctor would perform one on me. “I” am to high risk to undergo proceedures I can live without. It isn’t about their stats – it is about me staying alive and maintaining my current quality of life…
You have to trust someone and even though every single doctor will make one or more mistakes in his/her career – their primary goal and focus is on ensuring the patient recieves the very best possible care they can provide. I will also confirm my bias in this because dad was a doctor and working on obsesity through a very healthy diet comebined with daily excerise was his continual advice to his patients – if they wanted to live a long, healthy life. He also made sure we practiced what he preached and I can tell you I thought I was hard done by many, many, times over the years growing up while all my friends got to eat what they wanted and sit in front of the TV for hours on end…
Any doctor with ethics would not do Ivf treatment on an obese woman. Its a waste of time and resources. If they cared so much about kids and wanting to be a mom then they wouldnt be obese in the first place. Children need healthy mothers, not lazy people who are gong to die early.
Erica, I think you’re falling for a common misconception that people who are obese are “lazy”. There are probably many reasons for obesity, but laziness is seldom one of them.
I still question how BMI can adequately be applied across all people as accurate. A corn fed Iowan should be measured on the same BMI as a Vietnamese woman? Really? Is it becuase of the range that its ok?
Michelle, it is based on height measured against weight. I guess the main thing it doesn’t take into account is build–big boned people compared to small boned. I assume that’s why there is such a weight range for each height.
All they care about is their success numbers. If fat women have a harder time and go through more cycles to get pregnant, it screws up th clinic’s percentage. The higher their success rate the more they can charge for being a “better” clinic.
I think this is what feels like part of a larger war on people who are fat, the subject upsets me so much it’s hard to be articulate about it. I’ve lived with a lot of fat shaming in my life. The arguments for allowing this ban are basically what I would say so I won’t rehash it except to say bigotry, assumptions and bad science all go into this suggestion. I won’t say it’s the last accepted form of prejudice (cause racism is certainly still in my life), but I will say that much of this fat panic is as much about bigotry as it is about ‘health concerns’.
Tara, I’ve been thinking a lot lately about different types of prejudices with the Fox News statement about the mental health of adopted persons. There seem to be a lot of accepted forms of bigotry that still exist, including as you say against the overweight. {Sigh.}
I think this is one area that our privatized healthcare beats out blanket policies of socialized medicine. If both the doctor and the patient are willing to assume the cost and take on the risk of fertility treatment in these situations, I don’t see an issue.
Anon, the doctor’s I’ve spoken with who do have BMI limits say it is because of the risks to the mother and fetus during pregnancy. Not sure if that is what all would say, though. I don’t know the percentage of clinics in the US that have BMI limits, but I would guess that it is fairly low for the reasons you mention.