End ‘unjust’ fertility treatment ban for obese women: report

A new paper published today in the Australian and New Zealand Journal of Obstetrics and Gynaecology has called for an end to ‘unjust’ guidelines restricting obese Australian women’s access to assisted fertility treatment such as IVF.

Its lead author, Flinders University’s Professor Kelton Tremellen, said the guidelines were overly restrictive given that IVF success rates in obese women were only marginally reduced compared to their lean counterparts, and far superior than success rates in women older than 40 years of age, where access to treatment is allowed.

He also said the guidelines unfairly penalise obese women’s male partners from becoming parents and made little biological sense when IVF is the only treatment likely to produce pregnancy, as is the case with blocked fallopian tubes or poor sperm quality.

“These prohibitions by the Royal Australian and New Zealand College of Gynaecology fly in the face of statistics showing that success rates for obese women are much higher than those observed for many older women who are allowed access to IVF,” said Professor Tremellen.

“Furthermore, as obesity is significantly more common in women of low socioeconomic status, a group that struggles to get access to high quality food and supervised exercise programs, this policy could even be considered as discriminatory.”

Professor Tremellen said pregnancy for obese women does pose increased risk but that the absolute magnitude of risks to mother or child is relatively small.

“The role of the doctor should be to educate women about these risks and how they can be reduced by weight loss, but allow women to make the final decision regarding whether they access IVF,” he said.

“As such, we believe the RANZCOG ban on severely obese women’s access to assisted reproductive treatment is unwarranted and should be revised.

“We would suggest that the RANZCOG statement make reference to the overall health of obese women, not merely their BMI, when deciding on delaying access to ART.”

Up to a third of women with a BMI exceeding 35 are “metabolically healthy” and for this group there is minimal evidence that pregnancy poses significant risks to either themselves or their child.

The new paper also argued that prohibiting access to fertility treatment on the basis of obesity made no more sense that prohibiting adults from engaging in dangerous sports.

Fast facts:

  • Guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m 2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF
  • Even in the most extreme cases (BMI > 50 kg/m 2 ) the live birth rate is still 21.2% – just one third less than lean individuals
  • The New Zealand government has adopted a policy limiting access to public funding for in vitro  fertilisation (IVF) to women with a BMI under 32 kg/m 2
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