Plus-size and trying to get pregnant through IVF? Here's why the process can be especially challenging.
"We have anti-fat bias baked into our medical systems and research," says one activist.
If for whatever reason, a hopeful parent can’t get pregnant through sex, an option they may consider is in vitro fertilization, also known as IVF. In a nutshell, IVF entails retrieving eggs from the ovaries, fertilizing them with sperm in a lab, then transferring the resulting embryo to the uterus. Unfortunately, IVF isn’t a simple (or cheap) process, to understate it. The average cost of one cycle is $12,400, and a study in JAMA showed 65.3% of women achieved a live birth by the sixth cycle.
According to a fertility expert, getting pregnant as a plus-size woman can be even more difficult. “In general, elevated BMI [body mass index] contributes to a myriad of chronic health conditions,” says Dr. Tia Jackson-Bey, an ob-gyn and specialist at RMA of New York. As examples, she lists mechanisms needed for reproduction (such as ovulation, egg quality, menstrual patterns and ability to conceive) as well as negative impacts on reproductive outcomes (such as decreased embryo implantation, increased risk of miscarriage, lower testosterone levels in men and less response to fertility medications).
Jackson-Bey also points to the heightened risks that come with anesthesia, which is needed for egg retrieval. “Most clinics perform these surgical procedures in ambulatory settings where more advanced anesthesia monitoring and airway resuscitation is not present,” she says.
However, at least some issues (if not most) associated with people in larger bodies can be seen in people who have smaller bodies, too. “For example, it is possible obese patients may simply not have a long enough implantation period to sustain a pregnancy, which is also common in patients with a normal BMI,” notes Dr. Aimee Eyvazzadeh, an ob-gyn and medical advisor for Proov. “The issue may be fixed by supplemental progesterone after confirmed ovulation.”
She adds a couple of other possible limitations, such as a patient’s insurance requirements (which can include BMI) and needing a higher dose and longer duration of medication that induces ovulation, if needed, which “leads to an increased risk of cycle cancellation, whether it is for timed intercourse, intrauterine insemination (IUI) or IVF.”
How anti-fat bias comes into play
But weight bias, or the stigmatization, bullying, prejudice and discrimination against people in larger bodies based on their weight and appearance, is also baked into the notion that fat people can’t get pregnant. It’s well-documented that many people in larger bodies receive inferior health care, from doctors flat-out ignoring their pain to giving them one treatment option — weight loss — regardless of their presenting problem.
To help individuals meet their goals regardless of their size, one thing advocate Jen McLellan does is encourage people to ask about absolute risk versus relative risk. “As shocking as it sounds, some plus-size women are told they can undergo IVF, but only if they do not receive anesthesia during the egg retrieval,” the certified childbirth educator tells Yahoo Life. “This is because there are increased risks for those with a higher BMI receiving anesthesia, but the overall risk is still very low. And that’s also the case for increased risks during pregnancy.”
Nicola Salmon, a fat-positive fertility coach and author, agrees that the idea that plus-size people struggle to get pregnant with IVF is layered. The first layer, she tells Yahoo Life, is general anti-fat bias, or the assumption that fat people are always unhealthy and will, as a result, struggle to get pregnant.
The second is how “due to these foundational biases … we have anti-fat bias baked into our medical systems and research.” It raises the issue of equality versus equity. “If we treat all bodies the same and give them the same medication, then fatter bodies will respond less well,” she explains. “If we treat people as individuals and give people the medication dose that they need based on how their body responds — the trend is that fat folks tend to need higher doses — folks with higher BMIs respond in the same way as their smaller counterparts.”
The final layer she mentions: risk. “IVF is seen as riskier for fat folks even though the evidence does not support this,” she says. One example study she points to, published in Human Reproduction, found no evidence of “obesity” increasing the risk of complications after assisted reproductive technologies. “The real risks are that fat folks are put under huge physiological stress due to the way they are treated in this process, which does have an impact on their health." She also worries about the risks that might come from doctors being inexperienced in performing IVF for plus-size patients.
Eyvazzadeh agrees BMI isn’t a sole determinant in whether someone can get pregnant. While many reproductive clinics have a BMI cut-off between 30 and 50 for IVF, “even clinics with a cut-off of 50 can have very high success rates,” she says, adding, “I would never turn away the patient for a consultation based solely on weight.” After all, many factors play a role in the success someone can have with IVF, ranging from their age to the number of embryos transferred and more.
How plus-size people can advocate for themselves at the doctor’s office
Plus-size people who are curious about IVF may be met with weight stigma at the doctor’s office or fertility clinic. Dr. Rebecca Berens, an anti-diet family physician at Vida Family Medicine in Houston, offers suggestions for avoiding that scenario.
Find a trustworthy doctor.
While many medical professionals express weight discrimination and judgment, not all of them do. Finding the right doctor will be worth the time and research. “Get recommendations from friends and family, read their bios and training on their websites and follow their social media channels if they have them so you can have a sense of their approach to care and whether they will be a good fit for you,” Berens ells Yahoo Life.
For example, does their site mention they practice the Health at Every Size (HAES) approach to care? Does their Instagram bio include the term “anti-diet”? Which providers have fellow plus-size loved ones or acquaintances gone to, and did they have good experiences?
Additionally, for lists of size-friendly care providers, check out McLellan’s resource and Salmon’s resource.
Make an appointment specifically for this conversation.
Don’t try to cram questions about conception into the “free” yearly physical. “Annual physicals are only ‘free’ when they cover very specific screening tests that they must cover, and any discussion of a concern, such as infertility, will make the visit no longer ‘free,’” Berens explains, noting this is an insurance mandate rather than a doctor’s decision.
She adds that by scheduling an appointment for the sole purpose of discussing reproductive options, patients "will be able to have your doctor’s undivided attention” and “the entire appointment can be dedicated to it.” (Anyone who’s been to the doctor and felt rushed out knows how valuable this is.)
Prepare with inspiration and information.
Reading lots of fat-positive content for extra encouragement can be beneficial, too. A couple of great Instagram accounts include Fat Positive Fertility, run by Salmon, and Plus Size Birth, run by McLellan. These platforms can help people figure out what they need to find out at their appointment, as well as serve as inspiration and validation.
Don’t forget the usual best practices when visiting the doctor, too. Berens says to note family history of gynecological problems, reproductive health history and general health history, how long the person has been trying to conceive and a list of medications and their respective dosages. This helps ensure the doctor has all the information they need.
Prepare questions and ask them freely.
No matter someone’s size, they should receive quality health care. “You deserve to have all the information you need to understand your health and make informed choices,” Berens emphasizes. “There is no such thing as too many questions.” Some questions she recommends asking include:
Which tests are being ordered and why
A full explanation of the results
If a medication is recommended: why, what it will do, any possible side effects, the cost and alternatives (both medicinal and non-medicinal)
Listen to gut feelings.
No one deserves or needs to sit there and be treated with disrespect. Easier said than done, yes, but remember it’s more than fair to try out different providers. “At the end of the day, what you choose is up to you,” Berens says. “You do not have to agree to anything that you don’t feel comfortable with. You always have the right to ask more questions or get another opinion before deciding on a course of action.”
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