A Weighty Issue: IVF, Miscarriage, and Obesity
I want to start with a question: what was the purpose of this study? It was reported recently that women who are overweight have a higher rate of miscarriage after IVF, results found in research conducted at Guy's and St Thomas' Hospital in London. Out of the 300 women followed in the study (all of whom had a five-day transfer),
More than a third of overweight and obese women had a miscarriage compared with one in five of normal weight women ... In women with a BMI of over 25 there was a 35% miscarriage rate. This compared with 21% in women with a BMI less than 25.
The BBC article goes on to point out that obesity has been tied to other health risks connected to pregnancy such as an increased risk of preeclampsia and diabetes. And the leader of the study cautions that "women undergoing IVF should be advised of the risks if they are overweight."
I am certainly taking the findings of the study seriously, and any information that can help women curb their chance of experiencing a miscarriage should be taken to heart. But at the end of the day, just as an enormous bias towards people experiencing obesity exists within the general population, the same bias is there ten-fold within the fertility community. And in a population already saturating themselves in self-reproach, does a study laying blame do more to help or hurt?
After all, the British Fertility Society already issued new guidelines a few years back stating that obese women should be denied access to fertility treatments, a stance that was reiterated again this year by the European Society of Human Reproduction and Embryology, despite the fact that fertility is a time-sensitive issue and the time used to lose weight could be creating new age-related fertility issues.
David Kreiner, a doctor at East Coast Fertility, writes about the enormous bias against overweight women in United States fertility clinics. He states,
The most shocking thing I’ve experienced in my 30 year career in Reproductive Endocrinology has been the consistent "resistance" among specialists to treat women with obesity. This "resistance" has felt at times to both me and many patients to be more like a prejudice ... Closing the door to fertility treatment is what most women in this condition experience.
Bloggers often relay negative experiences of trying to navigate treatments while overweight. The Life of a Husband and a Wife wrote back in June about a visit to her RE where he told the couple to lose weight or fertility treatments would be pointless:
Before he really started, RCW and I both said we were well aware that we were overweight and could stand to lose some pounds. Dr. H. continued with "until you each lose at least 50 pounds IF treatment will be pointless, unless you jump right into IVF". He suggested Weight Watchers or Atkins. He then made us aware that if we couldn't or wouldn't lose weight on our own, he would recommend LapBand surgery. The weight conversation didn't bother me too much; again, we aren't in denial about needing to lose weight, but LapBand. Wow, really? Isn't that a bit invasive and drastic? He continued and in hindsight, I should have been counting, but the phrase 'whistling in the wind' was used numerous times as in until you are skinny, ANY form of IF treatment would be like whistling in the wind.
Sell Crazy Someplace Else -- who is currently in the second trimester of her pregnancy -- still has one of the best posts about the enormous bias against overweight women in the infertility world. While the writer has no known fertility issues, her husband's male factor diagnosis led them to use donor insemination. She writes,
I too have been told that I would need to lose weight in order to build my family. Not because I am not active enough to keep up with children, but because my clinic's insurance is worried about the possible side effects to anesthesia in obese people. Not because I would be a bad parent, but because an insurance company is more concerned about an amorphous risk. I call this "amorphous" because we are using IUIs, which don't require anesthesia, so these rules are simply there to prevent me, someone with no infertility factors, from being able to determine when and how I will build my family.
The public is already well-versed in the health problems associated with obesity. There have already been studies that have shown an increased risk of miscarriage associated with obesity within unassisted pregnancies. Nor do I believe that if this study had shown that obese women lower their chance of a miscarriage by using IVF would fertility clinics have started to welcome more obese women into the gynecological stirrups.
No one is denying that it is healthier to have a BMI under 25, or that being obese carries more risks when it comes to miscarriage. Which brings me back to my original question -- why dedicate the manpower, the journal space, and the conference time to discussing the risk of miscarriage after IVF in regards to those with a BMI higher than 25?
Personally, I think it stops being about finding useful information that could curb miscarriage and becomes more about placing responsibility on women for their losses. It is about assigning blame, about finding concrete reasons for fertility clinics to continue with weight bias. With 21% of women still experiencing miscarriages even with a BMI lower than 25, I would rather see more work being done to study how to prevent all miscarriages than finding more places to set blame.
What are your thoughts?