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They Say – Should Obesity Be a Factor in IVF?

By bethanysanders |

676878_88902670When considering whether or not a woman is a good candidate for IVF, should obesity be a factor?

In a new position statement, The European Society of Human Reproduction and Embryology suggests that obesity could be a factor in decided whether a woman was healthy enough for IVF, alongside other lifestyle factors like excessive drinking and smoking.

The paper, which is published in this month’s Human Reproduction made five recommendations regarding women and IVF, including outright refusal to treat women who don’t reduce their alcohol consumption below moderate levels.

But they also recommended further research into the effects of obesity on fertility, suggesting that morbidly and severely obese women may eventually be asked to lose weight before attempting treatment. Obesity can affect ovulation, and obese women are also at special risk of complications during pregnancy.

Whenever science and social matters meet, it’s a touchy subject. Asking women to quit drinking excessively — a habit that clearly puts the fetus in danger — is clear enough. But asking a woman to lower her BMI feels more like a gray area. Larger women who exercise and eat well can be very healthy reproductively, and plenty of overweight women go on to have healthy pregnancies and babies.

Smoking is a third lifestyle factor the group touched upon, but like weight loss, they made no direct recommendation. What do you think: How big of a role should lifestyle factors play in IVF?

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36 thoughts on “They Say – Should Obesity Be a Factor in IVF?

  1. Laure68 says:

    It is less about what we think and more about the data. If data clearly shows that being obese leads to higher risk and poorer outcomes, it is reasonable to ask women to lose weight. (They are not talking about women who are just overweight, but obese.)

    Also, remember that most European countries have state-sponsored medicine. IVF is an expensive procedure. If there is a factor that will make the chance of a positive outcome less likely, they have to take that into account. The only real way to lower health care costs is to identify what procedure/situation are effective and what are not, and to eliminate those that are not effective. People in this country complain about high healthcare costs, but then are mortified if something is taken away from them, even if that something is ineffective.

  2. Angela says:

    There’s a big (no pun intended) difference between being a little overweight and morbidly obese. While there are plenty of people who struggle with weight despite regular exercise and good eating habits they are generally not morbidly obese. A really severe obesity problem truly can put mom and baby at a lot higher risk and I don’t think it’s unreasonable to look at whether those risks are a little too high to justify IVF. It’s no more discrimination than my friend who is a brittle diabetic being turned away by fertility doctors because her condition would make treatment too risky. At least weight is something that can be lost with hard work and dedication.

  3. jenny tries too hard says:

    a better question would be, why WOULDN’T obesity be a factor in IVF?

  4. Larissa says:

    Bravo Jenny, you are right about that. Obesity (not being chunky, husky or heavy) is a serious state of unbalanced health, effecting one’s endocrine system. This is fact. Pregnancy is a hormonal experience. This is also a fact. This isn’t about judging women or saying that their obesity is a danger to their baby, it is about the ability for the systems in their body to function in a way that is necessary for a pregnancy to succeed.

  5. Allie says:

    If the logic for denying obese patients IVF is because of their pregnancies being riskier, doesn’t that same logic then deny older women IVF as well? In an industry where 50-year-old women can have twins and Nadia Suleman exists, I think its interesting that fat is where they draw the line.

  6. Lalalala says:

    Wow. Firstly, the BMI is an outdated measurement.

    Secondly, the only reason that this should even be considered is if during the infertility testing, absolute evidence showed that the obesity was a factor – such as excessive estrogen storage that sometimes occurs in fat. This does not occur in ALL obese women, however.

    I am basing this off of personal experience. I am considered obese, but I’m healthy according to every test out there including the incredibly extensive testing for fertility. In fact, my reproductive endocrinologist stated without any doubts that there were no issues whatsoever with me and would not have a problem with IVF in my case.

    You can technically be fat and heathy – the medical community doesn’t like to admit it, but it’s true. ;) I’m very active, exercise, and have no difficulties keeping up with “normal” weight folks at all. Great blood pressure, great cholesterol levels, etc… just genetically meant to be fat.

    Being fat doesn’t mean you can’t have a healthy pregnancy either.
    http://www.plus-size-pregnancy.org/

  7. Beth says:

    Obesity has been studied and IVF has been shown to be less effective for obese women. It is an RE’s job to get women pregnant, and if your body size is going to work against that, I think it is completely reasonable for an RE to refuse to treat a woman until she loses weight.

    Insurance companies should also be able to deny treatment until a reasonable weight is reached, as they also have a stake in making sure the treatment is effective.

  8. jenny tries too hard says:

    lalala, I do tend to agree about BMI, but other markers of obesity can still be used. Of course, no one is saying you can’t be fat and healthy, can’t be obese and have a healthy pregnancy—they’re saying if you’re obese, you’re much less likely to have those outcomes. It’s not impossible to smoke a pack a day for 50 years and live to 100; it’s just a lot less likely. Medicine, even emotionally complex forms like IVF, work on likely outcomes, not outliers.

  9. Laure68 says:

    I actually do think that there should be an age limit for IVF also, for what insurance will cover. (Again, I know in some European countries there is an age limit for what the state will pay for.) Is “infertility” in a 50-year-old woman really an anomaly?

  10. Moo says:

    I don’t think it’s wrong to have obese women lose weight before the procedure – first off, it may be why they can’t get pregnant in the first place, and second, even if they do not have any problems at the moment, problems can develop later in the pregnancy. I had a friend who is obese, and not only did it take her a very long time to become pregnant, once she did become pregnant the pregnancy was uneventful until about 7 months – that was when she developed preeclampsia (which became dangerously close to eclampsia) and diabetes and the baby had to to be delivered right away. Furthermore, the birth was extremely difficult for her because the pressure her weight put on the vaginal canal, and a C-section would have been just as difficult because of her size and body composition. The diabetes and high blood pressure that appeared during her pregnancy did not resolve itself – she is now on treatment for both. The person that I have speaking weighed over 400 lbs. Now let’s talk about the life span of obese mothers at a higher risk of heart attack, stroke, poorly treated diabetes (because it’s difficult to calculate dosage at a certain size).

  11. Wow. This is a fascinating discussion, everyone. Great points made. Moo, I think you take it too far when you talk about life expectancy, though. Studies, in general, say that obesity takes an average of 3 to 10 years off lifespan. Significant, yes, but hardly a barrier to motherhood.

    Keep it up, everyone. Great discussion!

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  16. leahsmom says:

    Lots of people support IVF or pregnancy for women who have cancer, MS, and other conditions – so I think that claims that obese women shouldn’t be permitted assisted reproduction because obesity is a health risk are not only unsupported by the science, they don’t hold up to women with real health risks who are encouraged to have a baby no matter what.

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  20. mystic_eye says:

    I’m sure there is a weight that everyone would agree is “too much”. Clearly if you are soo obese you can’t get out of bed without assistance that doesn’t bode well for pregnancy or your ability.

    However, in general, I agree with Lalala. Weight alone is a very poor indicator of health. I’d rather see things like blood pressure, cholesterol, insulin resistence, and fitness level used as guides. Of course there are always going to be exceptions. I wouldn’t tell someone with a physical handicap that just because they didn’t pass some rudimentary fitness test that they couldn’t have IVF.

    But I think what people are losing sight of is that these guidelines, are just guidelines. They are recommendations for what fertility doctors might consider. Really it is absolutely up to the individual doctor; all this does is make is a little easier for doctors to say “no”. Some doctors get sick of taking abuse from patients and like to be able to point at the guidelines and say “see someone else made this rule up”. Of course giving a patient IVF isn’t quite the same as writing a prescription just to “get them out the door”. However all doctors have the absolute right to decide who they will and won’t treat as long as 1) Its not an emergency 2) If the procedure is necessary (but not an emergency) there is a doctor that is available and willing to do it.

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  23. Sarah Kline says:

    I had IVF complications that landed me in the hospital for days. If I would have been obese it would have been worse. I then ended up pregnant with triplets… something that commonly happens with IVF. Being obese puts you at high risk for gestational diabetes, along with multiple births, having both could be LIFE THREATENING to the mother and babies. So yes there is a point to where IVF should not be offered to IVF women.

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