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.

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