Survey assessing obesity policies for assisted reproductive technology in the United States

Capsule:
We discuss the different policies of centers regarding obesity and access to assisted reproductive technology.

Authors:
Leah Kaye, M.D., Carolina Sueldo, M.D., Lawrence Engmann, M.D., John Nulsen, M.D., Claudio Benadiva, M.D., H.C.L.D.

Volume 105, Issue 3, Pages 703-706

Abstract:

Objective:
To determine what assisted reproductive technologies (ART) policies, if any, have been instituted in response to an increasingly overweight and obese patient population.

Design:
Cross-sectional survey.

Setting:
University-affiliated IVF clinic.

Patient(s):
Women in the overweight and obese body mass index (BMI) categories seeking ART treatments.

Intervention(s):
Anonymous survey sent to medical directors at 395 IVF centers listed in Society for Assisted Reproductive Technology database.

Main Outcome Measure(s):
Assessment of recommendations, policies, and restrictions for patients who are overweight/obese and who desire treatment for infertility, including in IVF, IUI, and donor egg cycles.

Result(s):
Seventy-seven anonymous responses were received (19.5% response rate): 64.9% of centers have a formal policy for obesity, and 84% of those have a maximum BMI at which they will perform IVF, while 38% of those have a maximum BMI for performing IUI; 64.6% of respondents reported anesthesia requirements/concerns as the primary criteria for patient exclusion. Other primary considerations included safety during ongoing pregnancy and ART outcomes.

Conclusion(s):
Centers that have policies regarding obesity and access to ART consider efficacy, procedural safety, safety in pregnancy, and overall health status. Policies vary widely. The patient’s autonomy must be balanced with nonmaleficence and the avoidance of interventions that may be unsafe both immediately and long term.

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