Infertility Treatment Discrimination

How many of us have heard it over and over again…..lose some weight and then we will talk about treatment. So many Re around the world limit who they will help based on BMI. I say what a load of crap. I have been to and heard countless stories where someone has gone to see an RE and they said come back after you lose x amount of weight. In my opinion this is lazy and discriminatory way to treat patients. We are individuals and thus each of us should be looked at as such and not as just another woman with PCOS who’s BMI is over 35 (for most places in the UK), 40 (for many places in the U.S.). When I hear this, my thought is these doctors in the U.S. are more concerned about their success rates than they are understanding the individual sitting in front of them. Due to this, when I screen for an RE I asked right off the bat, “Do you have a cut off limit for BMI regarding treatment, if so what is it?” Or I ask “Do you limit who you treat based on BMI, if so what is your limit?” I am tired of wasting my time and money on doctors who do. This type of discrimination is deplorable.

I know there are some of you out there who do not agree with me and have even tore into people in support groups for commenting about how their RE refused to treat them because of their BMI. Recently, in one of the many support groups I belong to on Facebook I read a rather nasty thread where a number of people were judging those who wanted treatment from an RE but were refused based on their BMI. Their reason for doing so was to inform them of the risk of getting pregnant while obese…..

Hello I think most of us know obese pregnant individuals are high risk…..does this than give you the right to say hey because you are high risk you do not get to have a baby until you are no longer high risk………

Of course not, because if we did this with all high risk individuals than a number of people would be refused services and this would be considered discrimination. The Mayo clinic (retrieved from http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/high-risk-pregnancy/art-20047012 ) lists high risk pregnancy factors can include age, lifestyle choices, diabetes, high blood pressure, epilepsy, and anemia just to name a few. So with the logic of some of these ladies than we would need to refuse fertility treatment to those who carry any of these risk factors too, after all they pose a risk to both mother and child. Of course to do so would be ridiculous and possibly grounds for a law suit. So than why is it right to discriminate due to BMI?

Some in this same thread even gave personal examples of loved ones who lost their baby due to weight, but wait it wasn’t just weight, factors also included age, high blood pressure, and diabetes. And didn’t I just read the Mayo Clinic said all those items make a pregnancy high risk, oh yeah that’s right I did. So had she not been over weight would this individual still been a high risk pregnancy, yes indeed she would have.

Ok so I’ve beat that section to a dead horse now, I’m sure you get it, just being overweight/obese is not the only option out there that can make you a high risk. Let’s now look at other areas such as fertility treatment outcomes.

In this same thread many of these young ladies stated that you have less of a chance of having your treatment be successful when you are obese. And to their credit they are partially correct. I say partially because there is more that goes into factors of outcomes, however, they are often over looked as many studies do not tease apart other risk factors that a woman may have in conjunction with obesity.

 In fact there is research to suggest that type 2 diabetes in some of the obese can skew the results (Davenport, 2012). Furthermore, research even has shown that poor success rates of treatment to be unsubstantiated as there is not enough evidence to link BMI to reduction of births (Pandey, Maheshwari, & Bhattacharya, 2010; Davenport, 2012).

Now Dr. Simckes (2015) reports that there is some past studies that point to a 7% decrease in success rates in the very obese while other studies showed no difference. Dr. Simckes(2015) further explains that even looking at that 7% decrease there are studies that show Asians have this same percentage in decrease based solely on race. Dr. Simckes (2015) questions “Can you imagine the uproar if you denied Asian women access to fertility treatments based on race?” So if we refuse to discriminate against other risk factors and race, than why are so many still doing it with size?

Even the American Society for Reproductive Medicine (ASRM)(2015) states that fertility treatment should not be denied to obese woman (Simckes, 2015; CORM, 2015). The ASRM (2015) suggests postponing treatment in order to obtain weight loss should be viewed against the risk of declining fertility of an individual’s age. Dr. Simckes (2015) suggests that a patient should meet with a high risk obstetrician in order to fully understand the risks in the pregnancy and to start them on weight loss plan that could include medication to lose some weight (even if it is a temporary weight loss.) while working on treatment planning.

So point being if we, obese PCOS women, are looking for an RE we need to ask some questions prior to our visit and know that you have found a RE that truly cares if they offer you options, listen to what you have to say, looks at you as an individual and not a number, and develops a plan together. The blanket statement of lose x amount and come back is not giving you options, is not looking at you the individual, but at obesity in general.

It is discrimination to restrict access from treatment based on size. PCOS takes so much from women already, having an RE take away the option of having a family just further hurts those of us who are suffering from this disorder. If losing weight was as simple as flipping a switch, well dog gone it I think we all would have did that a long time ago, I know I would have.

RE Suggestion that does not limit treatment based on size:

(Disclaimer:  While I am listing an RE I am not a patient of his, nor do I work for him, heck I don’t even live in his state, I have however talked with his office and through email)



Dr. Simckes is the medical director of the Fertility Partnership in Saint Peters Missouri and has been in Reproductive medicine for over 20 years. He wishes that all individuals could experience the love of a child. You can contact his clinic at 636-441-7770. Physical address is:

 5401 Veterans Memorial Parkway ste 201

St Peters, MO 63376

http://fertilitypartnership.com/



You-tube video about the practice and Dr. Simckes. https://www.youtube.com/watch?v=4gwot59HyNU

References

American Society of Reproductive Medicine. (2015). Obesity and reproduction:  A committee opinion. Practice Committee of the American Society of Reproductive Medicine, 104(5), 1116-1126.

CORM. (2015). How obesity impacts fertility treatment. Retrieved from https://infertilitytexas.com/infertility-texas/how-obesity-impacts-fertility-treatment/

Davenport, D. (2012). Should obese women be banned from in vitro fertilization?. Retrieved from https://creatingafamily.org/infertility-category/obese-women-banned-vitro-fertilization/

Pandey, S., Maheshwari, A., & Bhattachary, S. (2010). Should access to fertility treatment be determined by female body mass index?. Human Reproduction, 25(4), 815-820. doi:10.1093/humrep/deq013.

Simckes, E. (2015). Obesity and fertility. Retrieved from http://fertilitypartnership.com/obesity-fertility/

Simckes, E. (2015). Pcos: Polycystic ovarian syndrome or what is wrong with my body?. Retrieved from http://fertilitypartnership.com/pcos-polycystic-ovarian-syndrome-wrong-body/