How dangerous is it to go through IVF for Overweight Women?
his season's television show "This Is Us" focuses on the issue of obesity and fertility.
This season's television show "This Is Us" focuses on the issue of obesity and fertility.
In its first two seasons, the television show "This Is Us" took on a lot of emotional issues, not the least of which was husband and father Jack's death.
This season, another controversial, important topic—obesity and fertility—is addressed by the popular drama series.
"This Is Us" follows the lives of five family members—including Kate, a woman who has been obese throughout her life and faced weight-related stigma.
Kate and her husband visit a fertility specialist in the initial episodes of this season to discuss the possibility of in vitro fertilization (IVF). The couple hopes that IVF will help Kate get pregnant again after struggling to overcome an emotionally devastating miscarriage in season two.
But in the beginning, the fertility specialist refuses to accept Kate as a patient. "The chances of a successful pregnancy are very slim at your weight, even if you're going through in vitro," says Kate, the specialist.
"It is not advisable to go under anaesthesia at your BMI for an elective procedure," she added while discussing the risks of egg retrieval sedation. Finally, the specialist changes her mind and agrees to treat Kate. But in real life, in women of the size of the television character, many clinics may be less willing to conduct IVF.
"Most clinics will use some form of sedation during the egg recovery process," said Dr Amanda Kallen, Assistant Professor of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine and Chair of the Connecticut Section of the American Congress of Obstetricians and Gynecologists.
"These medicines are generally considered less safe for someone who is overweight because there is more chance of breathing problems during the procedure," she continued, "so many clinics have a weight reduction due to this safety concern".
Excess weight affects fertility
Before visiting a fertility specialist, Kate is diagnosed with a condition known as polycystic ovary syndrome (POS). PCOS can cause irregular periods of menstruation and make pregnancy more difficult. In fact, in couples seeking treatment, the condition accounts for up to 30 per cent Trusted Source of infertility cases.
While more research is needed to understand the weight-to-PCOS relationship, up to 80% of women with the condition are obese.
Research suggests that excess weight could also have a negative impact on egg quality trusted Source, which even with IVF reduces the chances of a successful pregnancy. "We know that obese women may need higher doses of medication to stimulate the growth of eggs," said Kallen.
"Studies suggest that the rate of embryo implantation, the likelihood that an embryo that is put back into the body will stick, is lower," she continued, "and the likelihood of pregnancy with live birth, of actually taking a baby home at the end of the day, is lower."
According to a systematic review published in 2012Trusted Source, women with excess weight are 10% less likely to take a baby home.
They also have a higher risk of complications associated with pregnancy, including premature birth, preeclampsia, and gestational diabetes.
While informing patients about these risks is important for healthcare providers, too many of them do so in a way that contributes to weight-related stigma, he told Healthline Sharon Bernicki DeJoy, Ph.D., MPH, an associate professor of public health at West Chester University in Pennsylvania.
"Providers tend to have a standard script for 'the fat person' speaking," said DeJoy. "Providers also tend to conflate an increased risk of a condition with that condition's inevitability," she continued.
"What some women heard was, 'you're fat, so you're going to get gestational diabetes, or you're going to have blood pressure problems, or you're going to need a C-section that's going to endanger your baby.'"
Stereotypes put patients at risk When health care providers make health-related assumptions or habits based on their size alone, they may overlook problems or other risk factors.
This may prevent patients from receiving the care or assistance they need. Some patients may also be traumatized and their trust in doctors eroded.
To stop this from happening, it is important to avoid stereotyping and stigmatizing patients with larger bodies for doctors and other healthcare providers, DeJoy said.
A common attitude among the participants in her research was: "Look, we're not dumb. We know that there are risks. So just say what those risks are in a neutral matter-of-fact way: 'You're at increased risk for X because of your BMI, so I'd like to monitor you by doing Y and Z.'" Kallen also stressed the importance of providing individualized and non-judgmental care.
"I see a lot of patients struggling with weight and they have often tried many of the things that people suggest out there.
They're often already counting calories, they're already watching their diets, or they've been trying their entire lives and watching other people eat whatever they want while they don't have the same weight-like ease," Kallen said. "So, I think it sounds trite and simple, but it really sounds like hearing what the patient tells you, what they've tried so far, and reassuring them that you're going to be there for them and support them throughout the process," she added.
"Even if I have a patient above our cut-off, where I can't provide IVF, it doesn't mean I can't provide any other support," she continued.
"It doesn't mean we can't talk about how to make the body as healthy for pregnancy as possible."
Bottom line In a recent episode of the TV show "This Is Us," Kate visits a fertility specialist who initially refuses to treat her within Vitro fertilization because of her weight concerns.
Excess weight reduces the chances of pregnancy for women and increases the risk of sedation during fertility treatments.
It is important for health care providers to offer non-stigmatizing, non-judgmental, and individualized care to effectively support large-scale women.