A debate is simmering in the medical profession over the issue of obesity and in-vitre insemination.
Is it discrimination to deny an obese woman fertility treatment, or is it a medical decision due to concerns of health risks?
Dr Carl Laskin is a founding partner of the LifeQuest centre for reproductive medicine, and associate professor in the Departments of Medicine, and Obstetrics and Gynecolgy at the University of Toronto
ListenIt’s a fairly recent issue, in that in-vitro fertilization, has become more popular in the last several years.
But also during that time, the issue of being overweight and even obese, has been increasing in the general population.
Now, for many medical personnel involved in fertility treatment, the issue of helping obese women get pregnant is a fine line.
A recent study by the Ottawa Hospital of births between December 2008 and March 2010 was published by the National Centre for Biotechnological Information.
Using body-mass index, (BMI) they classed some 6,674 women into normal, overweight, and obese categories, according to World Health Organization classes.
The finding indicated that the heavier a woman was the greater her risk of complications. This includes preeclampsia, which is a potentially life-threatening increase in blood pressure, gestational diabetes, and a higher incidence of emergency caesarean sections.
There were also increased risks to the baby, from stillbirth, to premature birth, to increased risk of defects, including spinal abnormalities.
Dr Jason Min, is chairman of the clinical practice guidelines committee of the Canadian Fertility and Andrology Society. He is quoted in the National Post newspaper saying, “Right now, many of us are confused as to whether or not we should restrict treatment by weight”
Dr. Laskin sets his upper limit at a BMI of 35, which he says is generous as in other countries, England and Europe for example, an upper limit of 33 or even 30 BMI is common. He adds that in his opinion it is purely a medical issue. He says obese women in pregnancy have a three times higher risk of high blood pressure and toxemia than do average weight mothers-to-be, while risk of diabetes increases by four times, and the need for caesarean sections is doubled.
Dr Laskin says an official guideline should be established but adds it may take time as it’s still a controversial debate.
In Australia, a new study by the University of Melbourne is underway at seven Victoria hospitals. It will involve some 15,000 births to obese women and examine the effect of a mother’s BMI on caesarian time, pregnancy complications and their newborn child’s health. It should be completed by the end of the year.
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