Doctors discuss denying obese women fertility treatment
// Claire Temple

Imagine if women were forced to undergo a rigorous medical examination before they were permitted to get pregnant. The test would screen for health problems, hereditary disease, and mental and financial stability, in addition to core values. It's a scenario more likely found in dystiopian fiction than real life. However, a proposed ban on in-vitro fertilization (IVF) for obese women is arguably this hypothetical scenario in reality.

During a conference in Toronto last week, fertility doctors discussed whether to put in place a nation-wide ban on IVF for women who are considered obese. Obesity is clinically diagnosed when a person's body mass index (BMI), a measurement of weight relative to height, is greater than or equal to 30. Many doctors in the world already refuse to give IVF treatment to women who have a BMI of over 35, due to potential health risks and complications to the mother and the baby.

“We’ve had many angry patients say to us, ‘This is discriminatory,’ and I say, ‘Yes, it is.’ But I still won’t do it,” says Arthur Leader, co-founder of the Ottawa Fertility Centre, in an interview with the Globe and Mail. “A patient doesn’t have the right to make a choice that’s going to be harmful to them.”

And yet, the fertility treatment can be potentially harmful to anyone looking to have a baby, no matter how fit the woman might be. IVF gives a woman a 1 in 4 chance of having twins, compared to a 1 in 80 chance with natural conception. Multiple-baby pregnancies increase a woman's chance of having a miscarriage, as well as her chances of getting diabetes. Also, the fertility drugs used to stimulate egg production can have severe side effects such as insomnia, blurred vision, irritability, and weight gain. All these potential complications of IVF are increased if the patient is obese. Research shows that severely overweight women require higher doses of fertility drugs for ovulation, increasing the risk of side effects.

However, Anthony Cheung, a fertility expert at the University of British Columbia and Grace Fertility Centre, stands against the motion. At the meeting in Toronto, Cheung argued that studies also show IVF does not pose unacceptable risks for heavy women, and that BMI alone is not a good measure of obesity in the first place. Age, he said, is “by far the strongest indicator” of potential complications due to IVF. “We don’t say, ‘Oh sorry, you smoke, so we can’t treat you – it could result in pre-eclampsia, or small babies,’” said Cheung to the Globe and Mail. “It doesn’t mean we have this blanket policy where we say we can’t treat [smokers].” There are many factors that contribute to the success of IVF, so why is obesity the only one being targeted?

“If you are more than 100 pounds overweight, that issue must be addressed before you start a family,” says Beverly Hanck, executive director of the Infertility Awareness Association of Canada. “Get off ... 50 pounds or so and exercise, and then see where your fertility is at. A woman can lose 20 pounds and conceivably become pregnant … It could take a year, but it could result in getting pregnant naturally and save thousands of dollars.”

In some cases, losing weight is not possible, whether it be for physical or medical reasons. In these cases, a woman's chances of having a baby are incredibly small. Obesity in itself is already a barrier to conceiving naturally.

“It may be for some women that [not conceiving] is wise advice … but it’s ethically troubling,” said the University of Manitoba’s Arthur Schafer. “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?”

The decision could set a dangerous precedent. If the reproductive rights of obese women are taken away, what about other “imperfect” women? There are many genetic flaws that have a high risk of being passed down from mother to child, from grandmother to grandson: Asthma, Autism, ADD, ADHD, Alzheimer’s, Down’s Syndrome, colour blindness, Dwarfism, Treacher Collins Syndrome, and diabetes, just to name a few. All of these are undesirable, and yet are they so undesirable that it would be better if these people weren't born at all? Nobody is perfect; if we start putting restrictions on who can have babies, one must wonder where we will draw the line.

// Claire Temple, Write
// Illustration by Shannon Elliott

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