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Obesity And Fertility

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 and, as infertility affects one in seven couples, many obese women find themselves requiring fertility treatments.

Unfortunately, some fertility programs have limited access to fertility care for women who are extremely or morbidly obese. 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.  Another explanation is that fertility treatments such as in-vitro fertilization/IVF are not as successful in the very obese population and clinics like to protect their success rates so as to make themselves more attractive to prospective patients.

At the meeting of the American Society for Reproductive Medicine in San Diego-2012, a very important position was taken: obese women should not be denied access to advanced reproductive technology. Many studies point to the fact that there is no difference in outcome when we do artificial insemination or IVF.

While past studies have pointed to a 7% decrease success rate in IVF in very obese patients, other studies show no difference in pregnancy success rates.  And so, in the face of conflicting studies 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 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.

On the other hand, it is important to note that once very obese women are pregnant they have more difficult pregnancies and require more high risk obstetrical care. They are at higher risk for diabetes in pregnancy, hypertension, premature delivery, and ceasarian 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. 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 in a pregnancy. We do this for patients with other medical conditions such as a prior difficult pregnancy.

Medical ethics begin with “autonomy”, that is that once given the medical facts, generally the patient has a right to make an informed decision. Perhaps a meeting like this may motivate them to really try harder to shed some of their 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. I don’t believe we should discriminate against them when it comes to fulfilling their dream to have a family.

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