“It may be for some women that this is wise advice … but it’s ethically troubling,” said the University of Manitoba’s Arthur Schafer, director of the Centre for Professional and Applied Ethics. “In our society, the decision to procreate is left to the individual – so why would it be appropriate for the doctors to usurp those rights for women who are obese?”
Doctors would only be justified, he says, if they could “honestly, hand-on-heart say,” that the safety risks are so great “that no reasonable fat woman would want to conceive a baby in this way.”
”I’m not sure the fertility industry or association can really defend a blanket exclusion on obese women having access to assisted reproduction.”
Research has shown women who are severely overweight require higher doses of fertility drugs to spur ovulation – increasing the risk of side effects. As well, obese women face a greater risk of developing high blood pressure, which can trigger strokes, and gestational diabetes, which can pose risks to mother and baby.
While these risks during pregnancy apply to obese women even if they conceive naturally, Carl Laskin, president of the CFAS, believes fertility doctors have a responsibility to address them if a woman wants to conceive with medical help.
“If you don’t think a woman should become pregnant for medical reasons, you have no business helping her to become pregnant. … But it’s a tough, tough message to deliver … there’s usually lots of tears,” said Dr. Laskin, adding that he asks the women to return every three months to evaluate their weight loss.
For Dr. Leader, a major concern is that the “conscious sedation” used on patients while retrieving their eggs could disrupt breathing, but inserting a breathing tube into a patient who is morbidly obese is tricky and risky – “the patient could choke.”
“If that person then dies on my table – how good would I feel?” said Dr. Leader, who asks that women bring their BMI below 35 to receive treatment. He knows some clinics won’t treat women with a BMI of 30 – “30,” he said, “is a bit extreme.”
High BMI is a problem, Dr. Cheung agrees, but with no consensus around what the BMI cut off for treatment should be, no one knows where to draw the line - “32, 35, 40?”
(BMI can be influenced by bone structure and ethnicity)
“If you adhere to BMI blindly or uncritically…you may have people with low risk and still be denying them treatment.”
Arya Sharma, a leading expert on obesity at the University of Alberta, doesn’t agree that technical risks should exclude women from access to fertility treatments since “obese people undergo surgeries and all sorts of procedures all the time.” But he does feel obese women should try to lose weight before turning to IVF to conceive, since it is a risky and costly procedure they have to pay for themselves: “Why take the risks or spend the money, if you don’t need it?”
