Fertility Treatment and Obesity — The Controversy Escalates
By William Murphy
Published on November 30, 2007
The guidelines recently issued by the British Fertility Society (BFS) regarding fertility treatment and obesity have some fertility specialists cheering and others crying foul. The recommendations, though not enforceable, are expected to be adopted by the National Institute for Health and Clinical Excellence, and they could have considerable influence on fertility treatment policies throughout Europe, and possibly even in the United States.
BFS Fertility Treatment Guidelines
In a nutshell, the BFS recommends that women who are obese should forego fertility treatment if their body mass index (BMI) is above 35, and that women under 37 years of age should strive for a BMI below 30 to optimize their chances for successful treatment. Clinics and clinicians, according to the guidelines, should defer treatment for women who do not meet the recommended standards.
Discretion or Discrimination?
Some fertility specialists say the new guidelines are on the money. They point to the many increased health risks associated with obesity and, in particular, the increased chance of complications for the mother and child during pregnancy. They say governments and caregivers have the right and responsibility to use discretion in providing treatment only to women who have the best chance for a healthy pregnancy.
Other fertility specialists, however, claim that the BFS has gone too far and that its blanket recommendation to deny fertility treatment to all obese women is discriminatory. They say that a woman’s candidacy for fertility treatment should be determined on an individual basis. Some women are healthy at an advanced weight and would most likely benefit from treatment.
Obesity, Fertility Treatment, and Pregnancy: A Dispassionate View
A great deal of controversy has erupted recently over rising obesity rates throughout the world, with health experts and government officials wringing their hands over what to do about the ever-fattening public, and the new BFS guidelines have only amplified the uproar. The generally accepted definition of obesity is a BMI of 30 or above. (BMI is calculated as a function of height and weight.) In Britain, an estimated 25 percent of women are obese; in the United States, the figure hovers around 34 percent.
Obesity has been linked to an array of health problems, and it has been shown to be especially detrimental to women who are attempting to become pregnant or who have achieved pregnancy. Obesity is known to:
- trigger the development of polycystic ovary syndrome.
- lower chances of conceiving (a BMI of 35 or above decreases chances by 50 percent).
- increase risks in administering anesthesia during procedures.
- impede proper viewing of the ovaries and other internal structures on ultrasound scans.
- increase the risk of miscarriage after in vitro fertilization (IVF) treatment and during pregnancy.
- increase the likelihood of diabetes and hypertension developing during pregnancy.
- increase the chances of birth defects, including spina bifida and heart defects.
Controversy in Regulating Fertility Treatment
The BFS guidelines have already aroused controversy in the U.K., and they have the potential to stir up similar hornets' nests elsewhere. Currently, women in Britain with a BMI over 30 are regularly denied treatment at government-affiliated clinics. However, private clinics are widespread, and each has its own standards for treatment. If the BFS guidelines are adopted by the National Institute for Health, even private clinics may feel compelled to turn away women who do not meet the recommended standards.
If the National Institutes of Health or another government agency in the United States adopts similar guidelines, the results here could be even more dramatic. The threat of lawsuits brought by overweight women who fail to become pregnant or who suffer health problems during fertility treatment or pregnancy could lead clinics to close the door to all women at or near the BMI 30 threshold.
Obesity and Individual Freedom
As governments and related entities become more involved in addressing rising rates of obesity, infringement on individual freedoms could increase. State governments throughout America are presently considering legislation targeting obesity. Many U.S. schools have removed snack and soda machines and have changed their lunch menus to reduce fatty foods and include more fruits and vegetables. Next on the slate could well be laws limiting the access of overweight women to fertility treatment.
Should Obese Women Have a Choice?
Should obese women be able to choose whether to undergo fertility treatment? To an extent, their options are already limited. Many fertility clinics will not treat women who are excessively overweight. However, money talks, and with enough persistence, virtually any woman who wants treatment can find it. So, for now, the decision of whether to undergo fertility treatment is left to individuals. Should it be? As word spreads about the new BFS guidelines, the controversy surrounding this issue is likely to grow – and the final outcome is anybody's guess.