Sally Engelhart | Too fat for reproduction?
Scientifically Blonde | Withholding in vitro fertilization from the obese can be medically justified
October 13, 2011, 12:37 am·
This past long weekend, I was back home in Canad-i-a catching up on some Canadian news (yes, we have newspapers too!) and I came across a troubling article about Canadian doctors debating whether or not to ban obese women from receiving fertility treatments.
At the recent annual meeting of the Canadian Fertility and Andrology Society, Canadian doctors were debating joining Britain and New Zealand in banning women with a body mass index over 35 from receiving in vitro fertilization. I found myself unable to move past this story. The idea of banning certain people from receiving fertility treatments really got to me. And it should get to you too.
Although getting pregnant and having kids seems like a way distant future for most of us (knock on wood), the number of college students suffering from obesity is on the rise. In 1993, 5 percent of college students were obese; in 1999, 8.5 percent were. Now one in 10 college students is obese — meaning that, chances are, you or someone you know would be affected by any fertility treatment policy changes for the obese.
Banning obese women from receiving fertility treatment not only sounds a whole lot like blossoming eugenics (this is a whole other story), but more notably the discussion has sparked a heated debate over whether obese women have the same reproductive rights as their thinner counterparts.
After digging a little deeper, I found this issue to be a lot less cut-and-dry than I first thought and realized it was loaded with medical, moral and social concerns. My first thought was, “WTF! They can’t do that. That’s discrimination.” But now I’m starting to think, “Okay … maybe they can.”
The question at the center of this debate is: can doctors really refuse to help women above a certain weight threshold to get pregnant?
Well, from a medical standpoint: yes. When obese women get pregnant, it’s dangerous business. Looking at it from a health perspective, highly obese women getting pregnant is “suboptimal,” said Christos Coutifaris, laboratory director and chief of the Division of Reproductive Endocrinology and Infertility at Penn Medicine.
He explained that there are several potential complications, for both the mother and the baby, when highly obese women get pregnant.
“Gestational diabetes is a major concern because it has a lot of metabolic effects,” he explained. “There is also trouble giving birth because of these women’s size, and soft tissue interference. And this can lead to a cesarean section,” which is not only more difficult to do on obese patients but also puts these women at much higher risks.
Because of the problems associated with obese women getting pregnant, the standard protocol for doctors is to advise highly obese women to lose weight before trying to get pregnant.
“On the medical side, [withholding fertility treatment from highly obese women] is justified, and it’s an appropriate medical standard of care to advise patients when they come in and say that it would be a good idea to lose weight before trying fertility treatments,” Coutifaris said.
But making the jump from medical reality to policy is not that simple. The situation is definitely different somewhere like Canada or Britain where there is mandated coverage for fertility treatments. In these places, as insensitive as it may seem, there’s just not enough resources to go around. When taxpayer money is going toward paying for infertility treatments, sometimes you need cutoffs.
But in the United States, there is no legislated protocol for doctors to follow regarding giving fertility treatment to obese patients. Instead the issue becomes one of the push and pull of respecting the reproductive rights of the patient and a doctor’s obligation to do no harm.
When I first read this story, I was flooded by thoughts of individual rights and equality. But after hearing the medical perspective, I have to say the Canadian doctors’ ban seems justified and rational.
For now, in the United States, if you’re obese and struggling to get pregnant, it’s ultimately up to you whether or not you want to risk your health and undergo fertility treatment. But with insurance companies increasingly restricting what treatments they will and wont cover under certain circumstances, that decision might someday be taken away.
It’s a tricky thing, when social and moral concerns come to a crossroads with medical considerations. But in this case, I’m going to have to say: doctor knows best.
Sally Engelhart is a College senior from Toronto. Her email address is email@example.com. Scientifically Blonde appears every other Thursday.