Over break, I was watching an episode of, “This is Us” and in this episode, Kate and her partner, Toby, were going to the doctor's office for a consultation for in vitro fertilization (IVF). Kate was struggling to get pregnant again and despite many treatments and losing a bunch of weight, nothing seemed to be working. Oh, and I forgot to mention: Kate and Toby are obese, and Kate has polycystic ovary syndrome (PCOS), a condition in which the ovaries produce higher than normal levels of androgens thereby causing a widespread effect on a woman’s body, most notably, fertility. Additionally, Toby is on antidepressants which the doctor mentioned could be causing a reduction in sperm count. Due to the high failure rate and risks associated with PCOS and obesity, the doctor initially declines to take Kate on as a patient. The doctor eventually has a change in heart and is willing to take Kate on as a patient so long as she understands the risks involved, including a 90% failure rate in women her size. Desperate to get pregnant, Kate chooses to look at the 10% and agrees to the risks of the procedure
A physician’s ability to refuse to provide IVF treatment in obese women is rather controversial as some physicians are advocating against a BMI cut-off for this treatment. However, evidence has shown that obese women have decreased fertility treatment sucess and are at a greater risk for complications such as from being put under anesthesia for egg retrieval. Additionally, obese women tend to require a greater number of gonadotrophins which are administered in IVF treatment to help stimulate ovulation which raises their risk of developing ovarian hyperstimulation syndrome. Advocates for IVF treatment on obese women argue that the risk is actually small and that patients should receive proper education about the risks and allow the patient to make their own decision. Furthermore, they argue that although livebirth rates in obese women is reduced by 30%, this is still a better success rate than livebirths in older women who are allowed access to IVF (Tremellen, Wilkinson, & Savulescu, 2017) The possibility of a successful pregnancy, even if it’s only 10%, may be enough reassurance for a woman that is desperate to get pregnant and patients should understand their risks and be allowed to make an informed decision about their right to become a parent.
Tremellen, K., Wilkinson, D., & Savulescu, J. (2017). Should obese womens access to assisted fertility treatment be limited? A scientific and ethical analysis. Australian and New Zealand Journal of Obstetrics and Gynaecology,57(5), 569-574. doi:10.1111/ajo.12600
Interesting read! My inital reaction was, no, patients should definitely not be refused this treatment based on BMI. After further research, I’ve come to the conclusion that the costs may outweigh the benefits. According to this review (see citation below), obesity during pregnancy increased the risk of pre-ecclampsia, gestational diabetes, venous thromboembolism, emergency cesarean sections, miscarriages, and DOUBLED the rate of stillbirth. Even if the mother is well informed and willing to take these risks, it is important to consider the risk to the child. This same review reported that obesity during pregnancy tripled the risk of spina bifida, omphalocele, and heart defects. In this case, both parents are obese which means that their child will likely adopt similar lifestyle choices, leading to possible future healthcare related financial burdens. Not saying that IVF should never be an option for these patients! However, there are multiple factors that should be taken into careful consideration, and I could understand a physician’s hesitation to proceed with the IVF.
ReplyDeleteFitzsimons, K. J., Modder, J., & Greer, I. A. (2009). Obesity in pregnancy: risks and management. Obstetric medicine, 2(2), 52-62.