Withholding IVF

Time and time again, the correlation between weight and fertility has been a topic of discussion amongst health professionals and patients hoping to become parents. The importance of meeting a healthy BMI (Body Mass Index) when trying to conceive can’t be more stressed.

In light of this controversy, doctors in Canada are starting to take a stand, and are considering implementing a new policy that would withhold in vitro fertilization from obese candidates. While they realize that this can be considered discriminatory, doctors such as Dr. Leader, co-founder of the Ottawa Fertility Centre, have stated that “[While we] respect that people have the right to make their own choices, [we] have a duty of care to do no harm.”

Leader says that the risks and potential medical complications for obese women undergoing in vitro fertilization are far too high. Obese women are more likely to miscarry, suffer from pre-eclampsia, deliver prematurely and have underweight babies. It has also been suggested that, while pregnant, overweight women should consume more folic acid as their babies are at higher risks of brain and heart defects.

One theory that explains the increased risk of miscarriage for obese women after undergoing IVF is that obesity may affect the lining of the womb and the implantation of the egg. Another risk is the egg retrieval process, which is more difficult in obese women due to the heightened difficulty of accessing the ovaries in overweight women. Sedation can be risky for obese patients, and keeping an obese woman under sedation longer than usual to locate her ovaries increases that risk.

Dr. Leader explains that the BMI classifies obesity much higher in the Index when compared to the clinical definition of obesity. He explains that a 5’ 6” woman weighing 220 lbs with a BMI over 35 would be considered obese by clinical standards since the clinical BMI measurement is 30. Dr. Leader expresses that he understands the impatience of obese women wanting to get pregnant, as the longer they wait and the more they age, their risk of infertility rises. However, with all of the combined risks, doctors such as Leader can’t “justify subjecting these women to IVF.” Leader’s primary concern must be the health of his patients and their future children.

When trying to conceive, obese women should consider losing weight if their weight is of concern and is posing a possible impediment to successful pregnancy. Losing weight could heighten the chance of conceiving naturally, and would be much less expensive and much less risky when compared to undergoing treatments such as IVF.