Infertility and The Overweight Woman
Posted on 10. Feb, 2010 by David Kreiner, MD in Obesity, PCOS
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. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.
A new article appearing in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggests that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.
The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.
Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view. Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.
Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.
We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.
Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.
What right do we have to deny these women the right to build their families?
It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.
Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.
Marna Gatlin
Mar 16th, 2010
Hi Dr. Kreiner — This was something that needed to be written and thank you for addressing these issues.
You know when struggled through infertility, my journey began when I wasn’t over weight. I was height and weight appropriate. It wasn’t until I lost my first pregnancy and began the trek through the infertilty jungle, taking medication after medication in a vain attempt to conceive that the weight began to pile on. And pile on it did.
Nine lost pregnancy later and many pounds later I found myself morbidly obese and no chance in hell of having a child.
Thankfully my RE Dr. John Hesla took a chance on me. He partnered with me. He didn’t make me feel embarrassed, ashamed about my extra weight.
He was kind, honest, and genuine. He told me what could and couldn’t happen to women who were obese. All because I said “Please tell it to me straight.”
Thankfully I conceived my child through egg donation. Did I struggle through my pregnancy? Yes, yes I did. Do I think my struggles were directly weight related. Yes, yes I do.
But the point is I had caring, understanding and extremely talented care providers who helped me through the entire process.
Knowing what I do now, would I attempt a pregnancy again being obese?
Not on your life. I had no many “A-ha” moments during my pregnancy and understood now why physicians get a little nervous when they treat obese Mom’s during pregnancy.
With all that being said I think the patient should make the choice to seek treatment regardless of weight and thank you for supporting all of we big girls:)
Warmly,
Marna Gatlin
PVED
Kelly Anderson
Jun 25th, 2010
I am battling this same thing right now. I have PCOS and it is hard for me to lose the weight I have been trying for over a year with eating properly and I am still turned away by all Dr.’s.
I am lost and discouraged. No one wants to help the “obese” woman with her journey to having a child. I feel this is an unfair thing.
Are you aware of any Dr in the southern area that are willing to do IVF for an overweight woman? If so, please let me know.
Gwen
Mar 1st, 2011
Thank you, thank you, thank you!! I thought it was just me being over sensitive that the doctor I was working with kept coming back to my weight as my infertility issue. I already have a beautiful 3 year old girl who came into this world without any of the problems everyone kept telling me I would have. This second time around things just weren’t happening and so we are talking with the professionals about it. But they seem to forget that I’ve done this before at a very similar weight and keep harping on it. I swear they were marketing bariatric surgery!
Thank you for putting this information out there. Even if the rest of the medical field is not ready to hear it, I am glad that someone is looking at us as people and not just as patients. Thank you.
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