In 2013 Gina Balzano for the first time in her life was told that she was too fat to become pregnant. She was 32, weighed 144 kilograms and had been trying to get pregnant since her marriage with Nick a couple of years back.

She didn’t have any of the health conditions often associated with obesity. Her blood pressure and cholesterol levels were normal, she didn’t have any signs of diabetes or other chronic diseases. “It because of your weight”, said a reproductive endocrinologist during the first appointment at a large fertility clinic in Boston. Balzano was confused to hear such an outright statement before undergoing any of the tests. Her husband went furious. “I know plenty of larger women who have been pregnant without any problems. It doesn’t make sense what you’re saying”, he screamed.

It turned out that the majority of the clinics in the US have policy against providing in vitro fertilization (IVF) to women with a body mass index (BMI) above 50, which corresponds to a 167-centimeter tall woman weighting 137 kilograms. Balzano didn’t know anything about such a policy and felt humiliated.

Interestingly, BMI is not regulated by health authorities and is established individually by clinics. In some it can be as low as 30. It was the case for Chelsea Ritchie, who is now a mother of twins, when she was told by a nurse that before seeing a doctor she should lose 10 kilograms.

BMI was adopted by the World Health Organization in 1995 and is seen by many specialists as outdated. According to the scale, BMI higher than 30 is classified as “obese”. The thing is this index doesn’t factor in gender, age or muscle mass, it simply measures how one’s height corresponds to one’s weight, body composition and overall health are out of the equation.

Many specialists and scientific societies are now questioning the use of BMI in fertility treatment. For instance, American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology have never established any guidelines on whether fertility treatment should be declined on the basis of patient’s weight. 

“The belief that obesity is responsible for all the fertility problems is highly outdated”, says Dr. Richard S. Legro, a professor of public health services and chair of obstetrics and gynecology at Penn State University. “In 1952 a pair of physicians have conducted a study about the relation of obesity to menstrual disturbances. They surveyed 100 women between the ages of 16 and 40 who had been experiencing menstrual disorders and compared their weights with a group of women with no health issues. The results showed that 43 per cent of the patients with menstrual disorders weighted 20 per cent or more that women in the control group. Based on this observation, physicians concluded that obesity causes infertility.”

Many doctors think that the benefits of preconception weight are overexaggerated. In some cases for success rates the time is more important, the time that would be lost on losing those 10 kilograms that will not make any difference at the end. In addition to that, losing weight is associated with a very high stress for the body and it is usually comes back within five years.

Other doctors prefer not to work with obese patients as they see real health risks when performing certain operations on them. For example, retrieving eggs requires sedation of the patient and the use of an ultrasound probe to identify and extract eggs. With obese women ultrasound is not very efficient, doctors usually have to go through abdomen instead of vagina, which results in retrieving fewer eggs and exposing a patient to a higher risk.

To find a way out of this controversial situation many clinics implement “informed consent” process. They educate their patients on the risks associated with performing IVF treatment with obesity and start the treatment only after the patient has given her full consent.

Gina lives in Boston where insurance covers IVF only after three attempts to conceive with artificial insemination. The couple was skeptical about this procedure. The first attempt failed, as they expected, but the second round had worked and Gina became pregnant. She gave birth to a healthy daughter and is now busy with changing diapers. 

 

Photos by New York Times
Based on the article by New Yor Times

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