Session: Ethical Issues in Reproductive and Fertility Care
Ethical Considerations and Patient Experiences with BMI Restrictions on Fertility Care
Saturday, October 14, 2023
1:15 PM – 2:30 PM ET
Location: Dover C (Third Floor)
Approximately 40% of reproductive-aged women in the U.S. have obesity, including women who experience infertility for reasons associated with, and independent of, weight status. Two-thirds of U.S. fertility clinics have policies limiting egg retrieval or other procedures for patients with high body mass index (BMI), citing anesthesia and procedural risks, as well as the increased likelihood of adverse pregnancy outcomes. Such policies have been criticized as overly protectionist, infringing upon reproductive autonomy, and biased against persons with obesity. To understand patient experiences, we conducted a qualitative interview study with 40 women with a BMI ≥35 seeking fertility services. Most participants indicated that they understood the medical justification of BMI restrictions, although described disappointment and frustration that it was an a priori contraindication to fertility care. Denial of fertility services was often received in the context of lifelong experiences with medical and social weight bias; some internalized the BMI policy as implying unworthiness of motherhood. Several participants expressed that a model where individual risk was assessed as part of shared decision-making with their provider would be more respectful of reproductive autonomy. In addition to the emotional distress associated with BMI restrictions, other clinical and ethical factors (e.g., unlikelihood of weight loss in a narrow reproductive window; parity with other high-risk groups) support a reevaluation of strict policies limiting fertility care for women with high BMI. We argue that personalized health assessment and engagement on risk tolerance is more ethically appropriate than a blanket policy limiting fertility care based on BMI alone.
Sean Phelan, PhD – Division of Health Care Delivery Research – Mayo Clinic; Chandra Shenoy, MD – Department of Obstetrics & Gynecology – Mayo Clinic; Megan Allyse, PhD – Biomedical Ethics Research Program – Mayo Clinic