Obesity And Fertility

Overweight patients face discrimination in the  fertility world.

Obesity affects over 35% of the American public. It’s associated with many health problems such as heart disease, diabetes, and other conditions. Obesity is also associated with infertility most often because of  PCOS-polycystic ovarian syndrome. As infertility affects one in seven couples, many obese women find themselves requiring fertility treatments and the door is slammed in their face.

Fertility  programs limit access to fertility care for women who are overweight.  Very often I meet with patients who are in tears because they have been literally asked to leave clinics because of their weight.  Why does this happen? One reason is the technical difficulties associated with taking care of obese patients. There are increased anesthesia risks and greater technical difficulties during procedures and ultrasound exams.   The more unjust explanation is that fertility treatments such as in-vitro fertilization/IVF are not as successful in the obese population and clinics like to protect their success rates so as to make themselves more attractive to prospective patients.  That doesn’t happen at Fertility Partnership.

While past studies have pointed to a 7% decrease in success rate in IVF in very obese patients, other studies show no difference in pregnancy success rates.   Either way, I believe we cannot deny these patients access to the modern technologies at our disposal.

Here is another way to look at this issue. It is a reported and generally accepted fact that in the USA (for reasons that are not fully understood) Asian women are also statistically 7% less likely than Caucasian women to conceive from In vitro fertilization. Can you imagine the uproar if you denied Asian women access to fertility treatments based on race? It just couldn’t happen. In my opinion, obese women often face discrimination in the fertility world.  As healthcare professionals this is just wrong.

It is important to note that very obese women who are pregnant have more difficult pregnancies and require more high-risk obstetrical care. They are at higher risk for diabetes in pregnancy, hypertension, premature delivery, and cesarian sections. There is data to say that the babies born are at somewhat higher risks as well. This, of course, raises ethical issues, and so it is important to help every woman do their best to lose as much weight as possible before trying to get pregnant.  At Fertility Partnership we will often use weight loss pills such as phentermine to help patients lose weight.  Several years ago I reported this at a national meeting and was criticized because “everyone knows that patients just put the weight right back on when they stop the pills“. My response was “Isn’t that the point? Let’s have them lose the weight, stop the pills when they get pregnant and then they put some back on”.

I believe that the patients who are overweight should meet with their doctors, perhaps a High-Risk obstetrician so that they truly understand the risks of a pregnancy. We do this for patients with other medical conditions such as a  kidney transplant.

Medical ethics begin with “autonomy”, that is that once given the medical facts, generally the patient has a right to make an informed decision.  The risk to the fetus must be discussed. Perhaps a meeting like this may motivate them to  try something different to lose the weight.  The reality is that weight loss is so hard for so many and how can we deny them the right to be parents?

People who are very overweight face many challenges in everyday life; especially with their health. Guilt and frustration is often involved. I don’t believe we should discriminate against them when it comes to fulfilling their dream to have a family.