Canadians are missing out on IVF because of their weight, and they want to know why: 'It honestly doesn't make any sense to me'

An OBGYN says complications for overweight people trying to access IVF is "rare," and yet body mass index cutoffs can prevent people from accessing treatment

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Why does BMI play a factor in IVF? (Image via Getty Images)
Why does BMI play a factor in IVF? (Image via Getty Images)

Kate Adams is at risk of losing her spot on the in vitro fertilization (IVF) waitlist because of her weight. With a body mass index (BMI) exceeding 40, she was told by her doctor that if she doesn’t lose weight, they won’t be able to move forward with IVF due to fears about putting her under general anesthesia.

To Adams, this can feel like “walking without a purpose,” not knowing if she has to financially plan for maternity leave, if she and her husband can book any trips and if she’ll be able to grow her family like she’s wanted. Even moreso, she wonders if it’s really her weight that’s preventing her from having a child, or if it’s a failure of the healthcare system and weight bias.

“It’s taking a toll,” Adams said. “I feel like when you’re fat, your weight is the first thing people point to as an explanation.”

It all seems like a massive mountain.Kate Adams

What confuses Adams is that she was able to have her first child with assisted reproductive technology, specifically cycle monitoring, but when she tried to have her second child, nothing worked. While doctors said it was because of her weight, Adams said she felt she was under a lot of stress.

Why is weight a barrier to in vitro fertilization? (Image via Getty Images)
Why is weight a barrier to in vitro fertilization? (Image via Getty Images)

"It honestly doesn't make any sense to me. My weight never came up when I was pregnant with [my daughter]," Adams said. She also has had two colonoscopies and her gallbladder removed in the past few years—both of which she was under general anesthesia. "And they never questioned that...It's baffling because I think that people who tend to struggle with fertility also have weight-related issues. It all seems like a massive mountain."

Adams's experience is not singular. Many Canadian women are denied IVF treatments due to their BMI — a marker sometimes used as a hard cutoff in certain fertility clinics, or a number that can vary in each province due to different regulating bodies.

Yahoo Canada recently spoke to experts in the fertility field about people with obesity seeking IVF and if BMI cutoffs are preventing people from expanding their families.

How does having a high BMI impact IVF?

BMI is common metric used in healthcare, including fertility clinics, to assess weight relative to height. A “normal weight” is a BMI that sits between 18.5 to 24.9. Being “overweight” means your BMI is between 25 to 29.9. Anything 30 and above is considered “obese.”

According to the Canadian Fertility and Andrology Society, women with obesity might require higher doses of hormones or medications and there is a decline in pregnancy rates for those with a BMI of 40 and higher.

Dr. Michael Dahan, an OBGYN and an reproductive endocrinology and infertility specialist at the McGill University Health Centre said it’s important to understand that even with lower pregnancy rate, it doesn’t mean someone can’t get pregnant. “Many people that are overweight will conceive who have a BMI above 40 with IVF.”

What role does BMI play when it comes to IVF? (Image via Getty Images)
What role does BMI play when it comes to IVF? (Image via Getty Images)

Regardless of someone’s BMI, Dahan starts with treatment first, assessing if there could be any complications, rather than denying IVF. For example, one complication that might arise if someone is overweight is the inability to see the ovaries ultrasonographically, which would prevent an egg collection.

“But it’s also extremely unlikely,” said Dahan, adding that in over two decades of practice, he has only seen this happen a few times out of thousands of patients.

Another concern for people with higher BMIs is going under general anesthesia. During an egg retrieval, people who are overweight might face breathing problems or low oxygen levels.

Dahan said for patients who are at risk for sleep apnea, a hospital setting could help manage potential complications more than a private clinic could, considering their resources and the ability to resuscitate. “And if someone is concerned about this happening to a patient I think at least, they’d refer them to a place they could get treatment.”

Also, for patients who are overweight and have an airway that’s likely to collapse, Dahan said that can be assessed beforehand.

“We haven’t seen a high rate of complications among patients with higher BMI and [egg] collection. Even with anesthesia complications, we don’t see a lot,” Dahan said. “And with the rate of obesity increasing internationally and in Canada, you gain some comfort as you treat more overweight patients and realize these risks aren’t necessarily there. Or they are there, but they’re so rare.”

No standard BMI in Canada

Dahan is able to provide this quality of care for his patients because he works in a hospital setting, as well as in Quebec, where IVF is publicly funded. There is no hard cut off for him when it comes to BMI and receiving treatment.

BMI cutoffs, however, do exist in many settings in Canada when it comes to fertility treatments. These numbers can vary in hospitals and clinics, and across different provinces due to differences in protocols, healthcare regulations and interpretations of medical guidelines.

In a 2015 survey of Canadian IVF directors, the median upper BMI limit for allowing IVF was 38. Meanwhile, in the U.S. a survey of IVF clinics showed that the upper BMI cutoffs range from 35 to 50.

Sonja Swanson, the clinic manager at Generation Fertility in Waterloo, Ont., said most fertility clinics in Ontario — which are classified as an out-of-hospital premise —which she said have to follow the College of Physicians and Surgeons of Ontario's (CPSO) regulations and guidelines. However the CSPO confirmed in a statement to Yahoo Canada that it does "not provide information regarding BMI cutoffs."

BMI cut offs for in vitro fertilization vary across Canada. (Image via Getty Images)
BMI cut offs for in vitro fertilization vary across Canada. (Image via Getty Images)

“Our clinic and a lot of clinics provide conscious sedation versus general anesthesia. And with that, you don’t require an anesthesiologist and you’re not fully going into sleep, so it’s a lower BMI than what could be accommodated at a hospital,” Swanson said.

She adds that it is quite common for people to come in with a BMI over 35. Weight management strategies are discussed, and people are referred to nutrition specialists so they can get into the BMI range allotted for an IVF procedure. “It is a struggle for people," she said.

Other provinces, like B.C., have published guidelines for obesity and IVF procedures. The College of Physicians and Surgeons of British Columbia recommends that a physician must consult with a medical director before proceeding with any procedure on a patient with a BMI of 45 or greater. Also, for patients with a BMI of 40 or greater, there must be an anesthesia consultation before the procedure.

The College of Physicians and Surgeons of Alberta cutoff for egg retrievals performed under conscious sedation is a BMI of 40.

Is BMI an outdated model?

Critics challenge BMI cutoffs as overly simplistic and potentially discriminatory considering BMI as a sole determinant of health and fertility can overlook individual complexities. Factors such as metabolic health, lifestyle habits, and underlying medical conditions can influence fertility outcomes independently of BMI.

Every patient that comes to see me wishes they were pregnant yesterday.Dr. Michael Dahan

Dahan said denying people of treatment until they’ve lost weight can be “extremely counterproductive.”

“Because you're saying to somebody ‘You have to go and lose weight, and it will probably take you years.’ Right? And think about the effect of those years on their fertility, because as we get older, particularly women's fertility goes down,” said Dahan, adding that although weight loss might result in less complications in pregnancy, the ability might also go down in that time period. “Every patient that comes to see me wishes they were pregnant yesterday. And at this point they are in their late 30s or early 40s and they don't have years to wait to make their embryos.”

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