Wednesday, September 21, 2011

Denial of Treatment to the Obese

I heard this on the news this morning: Canadian infertility doctors are considering adopting a policy that would prevent obese women from obtaining fertility treatments. (See: Globe and Mail Article: Canadian MDs consider denying fertility treatments to obese women)

Some studies suggest obese women need more fertility drugs to produce enough eggs during an IVF cycle. This can obviously sometimes result in adverse reactions and side-effects to the drugs required.

Some studies also suggest that obese women are more prone to complications during pregnancy, such as gestational diabetes, high blood pressure (and thus possibly strokes) which would negatively affect the pregnancy.

However, others are arguing that, for example, treatment isn't denied to smokers, who statistically are more prone to having pre-eclampsia during the pregnancy or underweight babies at birth.

Those of you who know me in person, yes, I am obese. My BMI would present a problem for many fertility clinics. However...

  • My blood pressure is fine.

  • I do not have diabetes.

  • I do have long-term thyroid issues.

  • I have PCOS. (Both this and the thyroid have contributed to higher weight and a difficulty in losing weight.)

  • I do go to the gym between 3 and 5 times per week (for 1+ hours at a time).

  • According to my doctor, I am perfectly healthy.

  • I confess, I would like to lose between 20 and 50 pounds. But that will still see me with a BMI that is "obese."

And yet... our first IVF worked. I had no problems during the pregnancy. My blood pressure remained great. I had no problems with gestational diabetes. I made sure my thyroid levels were good during the pregnancy. The entire 40 weeks were completely unremarkable in fact. I only gained 9 pounds.

The only time I had trouble in the pregnancy was because of a gall bladder attack, and that is not specific to obese women; it occurs with a large percentage of women who are pregnant. My gall bladder has since been removed.

So should I, by definition be denied treatment? No. I don't believe so. I believe in evaluating the individual, individually. I don't believe that blanket statements or policies which don't take into consideration underlying causes or lifestyle factors is beneficial for the population as a whole.

If Canadian infertility doctors had already adopted this policy, I would never have had the opportunity to be a mommy the first time. I would never know the joy of my little girl. Never feel her kisses or hear her laughter. Never know the fun of experiencing life through her eyes.

If Canadian infertility doctors adopt this policy, I will never have the opportunity to have a second child. And I weigh less now than I did when I did our first IVF.

I'm troubled by this sort of thinking. I am cognizant of the fact that yes, many women can benefit from losing weight before infertility treatments. Absolutely. But I don't necessarily think that denial of treatment simply based on BMI is the right way to go. Not at all.

This saddens me. Many couples and women in this country can be great mothers, and weight has nothing to do with how well (or poorly) they treat their children.

In Canada, another factor comes into play: money. The almighty dollar. For in most provinces, my own included, fertility treatments are not covered by the health care system. So if patients are knowledgeable and aware of the risks, the treatment, the cost, as well as the issues that obesity brings to the table, in the end, it is THEIR money. They should be permitted some determination on how to spend it, should they not? Essentially, a doctor would be restricting a patient from trying, even though the cost of trying is burdened solely by the patient. I suppose there's also the cost of caring for the patient in the event of complications though; that is covered by the health care system so maybe that is why this comes into play.

All in all, a very tricky path to be on. For if treatments are restricted and unavailable to the obese or those with a body mass determined to be too high, where do we stop? Do we then ban treatment for smokers? For those with chronic diseases? For those who drink 'too much'? What about incomes? Can we study the bank accounts of those who walk into infertility clinics?

When are we taking it too far?

1 comment:

marilyn said...

good point!! I think it is absurd. Also, they have created fear for me the whole time, i was trying to get pregnant, ivf, and now pregnant. They said I was pre pre diabetic. What the heck does that mean. What about the women who are so skinny, they look anorexic are they getting any reprimand from health insurance. I was so worried because they said when you are obese, IVF does not always work. It worked and I have been fine. I have also got hypothyroidism and my thyroid is actually increasing the last month and i have to double the levothroid every three days. I have to admit, I have been feeling more anxious and emotional since increasing the meds.