Plus-size people are often subjected to many types of anti-fat bias at the doctor's office, whether it's being brushed off about their physical pain or getting long speeches about weight-related health risks. Unfortunately, this can extend to fertility settings, too, in which plus-size patients are told they need to lose weight before going through IVF.
In a recent article for Yahoo Life, Dr. Tia Jackson-Bey, an OB-GYN and specialist at RMA of New York, explained that this is because higher BMIs contribute to various chronic health conditions related to reproductive success. A few examples she listed are problems with egg quality, menstrual pattern, and increased risk of miscarriage. Additionally, she warned about the heightened risks that come with anesthesia, and a lack of properly advanced anesthesia monitoring. According to Dr. Aimee Eyvazzadeh, an OB-GYN and medical advisor for Proov, plus-size patients may also have too short of an implantation period for the pregnancy. She noted that people of all BMIs can have this problem, however, and that supplemental progesterone can help.
All the while, there is hope: Plus-size women have been able to get pregnant and have kids through IVF, despite the anti-fat bias they've experienced at doctor's offices. Yahoo Life spoke to women — both moms and those who hope to conceive themselves — about their journeys.
“He even tried to convince me that having a baby at my weight would be cruel to the child.”
When Nicole Phillips, a 40-year-old mom of a 6-year-old daughter, was ready to explore fertility treatments, she struggled to find a respectful, compassionate doctor. The first one she saw made assumptions about her based on her body. “He even tried to convince me that having a baby at my weight would be cruel to the child," she says. She tells Yahoo Life that the doctor was also forceful with the speculum before telling her it wouldn’t fit inside someone with a plus-size body. Phillips left in tears, feeling defeated — until she heard the clinic hired a new doctor they thought she’d like.
“She was like light after darkness,” the Los Angeles-based mom tells Yahoo Life. “Every interaction with her was kind and met with compassion. Instead of assuming my weight was the cause of us not getting pregnant, she started her work and we started to get the tests we needed to find out what the causes were.”
Phillips adds that this second physician, Dr. Sanaz Ghazal, handled the topic of her weight with grace and empathy. “She explained to me that there would likely be tests, limitations and hurdles I may have to jump through because of my weight, but she never made me feel like this was a fault or flaw,” she recalls. “Instead of treating my weight, my doctor treated the issues. This made me feel like she saw me.”
“The entire initial consultation with this provider was geared toward weight loss."
Leslie DeSha, 37, has a 3-year-old son and another IVF baby on the way. She’s experienced many roadblocks, from access to care, to insurance coverage, to weight bias. As a woman with PCOS who also had an ovary removed due to a complex cyst, she says she was in panic mode trying to have her first baby.
While meeting with the first of two fertility providers in her town, she experienced what she perceived to be weight bias. “The entire initial consultation with this provider was geared toward weight loss for both my husband and I, all while this provider gave examples about how he personally lost weight," she shares. Anxious to start the process of having a baby, DeSha says she "sought out unhealthy ways to lose weight. I felt that the faster I lost weight, the faster I could have a successful pregnancy.”
She realized how unhelpful those steps were, however, and also sought a second opinion — which entailed no weight discussion. “In the journey to IVF, weight wasn’t found to be an issue with this second provider because I had the eggs in my body and the use of ICSI [an intracytoplasmic sperm injection] for creating the embryos,” she says. DeSha adds that going to a local hospital, rather than a smaller clinic, may have helped as well, as they had the equipment needed to serve her as a plus-size person.
“The total time from [the] start of treatments to the birth of our first child was approximately three years,” she says. “We know that we are extremely lucky, and that it can take a lot longer for other individuals.” Now, she leads a local infertility support group through Resolve.org, which is part of the National Infertility Association.
"Any issues I have, whether it’s fertility or something else, is always met with ‘if you lose weight.'"
J.K., a woman in her late 30s who asked to go by her initials out of fear of retaliation, started her IVF journey three years ago. As a health care worker, she had to go to a specific fertility clinic for her insurance to pay the highest rate. When she saw the doctor, she felt immediately blown off.
After undergoing several rounds of IUI, a doctor told her she needed IVF. After reaching out, a nurse emailed her saying her BMI was over the limit, and that she needed to lose weight. “From the beginning I was over the BMI limit, and was never told this,” she says. “As I questioned the staff about the lack of communication throughout this process, I was met with attitude. … I feel as though this office wasted two and a half years of my life, and I have spent over $12,000 out of pocket for nothing.” The experience left her feeling bullied.
Since then, she says she hasn’t been able to get IVF at a new clinic because of weight bias. “It seems all IVF clinics around me have a BMI requirement,” she says. The barriers don't stop there, either. “I do feel that people who are not plus-sized are talked to differently,” she adds. “As a plus-size person, any issues I have, whether it’s fertility or something else, is always met with ‘if you lose weight.’”
She encourages self-advocacy in the doctor’s office, and going to a different doctor if an experience with one feels wrong. “Poor treatment and being bullied by medical personnel is not acceptable," she says.
“They would not be moving forward with an egg retrieval until I lost more weight."
Diana Zucknick’s story — and the questions that have lingered — have been weighing on her mind, she tells Yahoo Life. She was 29 years old when her fertility journey started, and she’s 40 now.
The Austinite recalls being asked to step on a scale on her way out of one appointment. “That afternoon, a nurse called to tell me over the phone what she was too timid to say to my face: They would not be moving forward with an egg retrieval until I lost more weight,” Zucknick shares. She felt devastated, and determined to lose weight.
“I even researched medical tourism and considered traveling to a foreign country to get parts of my digestive system amputated just to lose enough weight so that I could have access to the treatment that we desperately needed,” she says. She now feels like she's lost a decade of her life — time that could have been spent undergoing fertility treatments — to fixating on being the appropriate weight. Now, given her age, doctors are worried her eggs are “too old” and “poor quality.”
“I remember sobbing after I woke up from my first egg retrieval, after realizing that there was absolutely nothing special about my body at 39 versus my body at 29," says Zucknick. "I should have been able to do this 10 years prior! And if we would have, would our outcomes be different? Would I be a mother by now?”
The weight bias has cost her in many ways. “It has cost us money, since we now travel out of state to access care that isn’t easily available in our home state,” she shares. “But, most of all, it has cost us time, which is more valuable than anything.”
She urges other plus-size individuals to seek out clinics that don't have age or BMI requirements — she's worked with CNY Fertility and Rejuvenating Fertility Center — that are further afield rather than waiting.
“You do not have to put off this time-sensitive treatment,” she emphasizes. “Fat people have successful pregnancies all of the time and have throughout human history.”
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