2B - Women with a BMI over 40 Should Be Refused Fertility Treatment

Summary

Treatment, or denial of treatment, for infertility to women of advanced weight is not based on evidence, but rather ignorance and biases of care givers and public health systems. The association between obesity and subfertility is real, but much smaller than recognised. Obesity is not a personal choice, but the result of a complex disease and one that is generally resistant to most treatments. The hypothalamus holds onto weight as the miser holds onto gold. Long-term maintenance of significant weight loss is the exception and not the rule of the treatment of obesity. Further there is no evidence that weight loss prior to pregnancy in women with obesity improves live birth rates or lowers maternal morbidity during pregnancy. In fact, the data suggest taking time to lose weight results in a delayed time to delivery and potentially other adverse events such as increased early pregnancy loss. We should stop advising women with obesity to lose weight prior to conception, because obesity per se is a marginal issue in subfertility; effective therapies to achieve the recommended weight loss are lacking, and even if achieved, there may be no benefit to it.