Monday, July 12, 2010

Limiting Fertility Treatment Access for Fat Women

Finally, a breath of fresh air reply from the research journals to the many folks advocating that fat women not be allowed access to fertility treatment (as they are not in Britain).

Should access to fertility treatment be determined by female body mass index?


Hum Reprod. 2010 Apr;25(4):815-20. Epub 2010 Feb 3.
Pandey S, Maheshwari A, Bhattacharya S.
Assisted Reproduction Unit, University of Aberdeen, Aberdeen Maternity Hospital, Forresterhill Road, Aberdeen AB25 2ZL, UK.

Abstract

Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy.

Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women.

With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.

PMID: 20129994

13 comments:

Heather said...

They don't limit access to women who are well past middle age. They don't limit it to women who cannot afford it. They do not limit the number of embryos implanted. I say, don't limit my right to have a healthy child just because of my extra pounds. It is unethical and proves our societies disdain for overweight individuals. My rights are the same as anyone elses, regardless of my size.

Meghan said...

Glad to see reproductive rights moving in the right direction. I needed some good news after hearing Polanski was freed - as a woman who was sexually assaulted as a teenager I am beyond livid...

Anyway, with the way reproductive rights were heading for larger women I was starting to think that more "eugenic" type restrictions might be placed. It's not that far to say that certain ethnicies/demographics/etc. "should" be limited if one group is already limited for "health" reasons.

ELizabeth said...

I was denied help at a fertility clinic because of my weight, and it was one of the most painful, de-humanizing things that ever happened to me. Just crushing. I did eventually go to another clinic, but I had lost three years, and I'll never know if I might have been successful if I hadn't lost that time.

BB Allen said...

I live in the UK and have a friend who has been refuse IVF due to being overweight. My friend is in recovert from bulimia and faces putting her recovery at risk in order to diet herself eligable. It's extremely sad that she's unable to conceive naturally; it's even more sad to see her forced to choose between the prospective child she so desperately craves and the recovery she has worked so hard to achieve.

jmdandona said...

Thank you thank you thank you for posting info about this article. I was told last summer that I would be refused infertility treatment because of my BMI by a reproductive endocrinologist at the UNC hospital in Chapel Hill. The same doctor recommended stomach stapling if I was 'serious' about getting pregnant, and told me that obese mothers were a threat to themselves and their babies, as obesity was linked to higher mortality rates for both. I was absolutely crushed by this encounter, as I'm sure other women before me have also been. To me, it seemed to boil down to "fat women don't deserve to have babies". I ended up getting pregnant naturally about 4 months later but am still bitter & angry about my experience with this doctor. I hope that other women don't have to go through this!!

Jennifer said...

Thank you for sharing this! In the Seattle area all but one clinic (as far as I know - I think I have contacted them all to check) has BMI limits wherein they will refuse to work with you AT ALL if you are over a certian BMI. I am horrified that they do this... it really feels like they just don't want fat people to reproduce.

two bits said...

Last week my doctor told me the next few steps we could take to find out why I am not pregnant yet. I was fine with everything she said until the last one: "I could refer you to a fertility specialist, but they won't treat you until you lose weight." I thought she would be fat positive enough to keep going to her, but to not even bother with a referral? It's not like my insurance wouldn't cover it, and I'm sure I can find another specialist who will at least see me for a diagnosis! Sheesh, I haven't even had blood work done yet and she's telling me not to even bother trying to find out what the problem might be.

Kristi, WA Australia said...

It's the same here in Australia. I've seen 3 specialists, 2 specifically fertility specialists, and one was a endocrinologist. I have been sent packing all 3 times with the words, "Lose the weight and you will get pregnant." or "Lose the weight and we'll help you get pregnant." None of these doctors have done anything in the way of finding exactly what the problem is, although it's generally agreed that I don't ovulate due to my weight. You know what the kicker is? The last one told me that technically i was still within the weight range for IVF, albeit at the top end, yet I was still sent away to "try to lose some weight and then we'll see what we can do in a few months." the result? I have dieted myself up to a slightly higher weight, and now feel there is no need to go back, as I'm sure I'm out of the range. Considering the turmoil I have gone through the past 7 years from infertility and being treated like garbage because I'm fat, I've now given up and have begun to plan a life without children. Such a waste because I know I'd have made a great mom.....

LaLa said...

I am a fat woman that is seeing a Reproductive Endocrinologist (RE) and I asked her flat out if my weight was a problem with her. She told me that she had no problems with it as it did not seem to be a factor on why we weren't able to conceive. She went on to say that it might cause discomfort due to the added weight increase that comes with pregnancy, but that would be the only problem she could foresee.

A previous RE also said my weight wasn't a problem with proceeding with any treatments.

Both PCOS and high estrogen (among other things) can cause infertility and are caused sometimes by obesity, but if the infertility is NOT related to weight, then the docs should move forward with treatment without harping on a patient's weight.

Orodemniades said...

I was on a UK waiting list for 4 years for IVF before they kicked me off because the "guidelines" had changed. They told me all along that my weight was not an issue. In fact, they told me that right up to the day my doctor called me - at work - to tell me it was all over for me.

My husband and I ended up moving to the US where I was denied by 3 clinics before finding one - in my home state! - that took me on quite happily. At the time (2007) they said that weight was of no issue. And I've got the miracle to prove it. Transfer occurred on the summer solstice, 6 days after my 39th birthday on my one and only treatment, IVF #1, on the bog standard protocol. We're hoping to try for #2 if we can scrounge up the money.

Orodemniades said...

Oh, I have PCOS, making weight loss pretty impossible, anyway.

Niki said...

I just went to a gynecologist this past week to figure out why I've been bleeding for 7 months straight (I have PCOS) and to start addressing fertility issues. I was told, quite directly, that she would not and nor would any doctor in my HMO take me on since my BMI would make the pregnancy too high risk to myself and a fetus. NO mention that I'm 35 or that PCOS leads to higher rates of miscarriage, just that I was too damn fat! Thank you for this article--I feel like I now have a leg to stand on in filing a complaint against the gynecologist since it points me to some studies that give some credence to my point of view.

Fetamy John said...

More cureable, less expensive and accurate care solution is ivf rather than ICSI. Its IVF cost which really make it different, but not just the cost. One of my friend Malissa recently use this treatment, we usedd Benenden Fertility Centre as recomended by an other friend. The treatment was well enough as a secure process with least harms.