Rethinking BMI Restrictions in IVF: A Call for Inclusive and Individualized Care

The prevalence of obesity among reproductive-age adults in the United States has doubled over the past 40 years, with projections suggesting that nearly half of the population may have obesity by 2030. This trend has significant implications for fertility treatment, particularly in vitro fertilisation (IVF). A recent review challenges the common practice of using body mass index (BMI) restrictions for IVF treatment and calls for a more individualised approach to patient care.

Key Points:

1. Obesity and Infertility: Obesity is associated with a two to threefold increase in infertility, mainly due to anovulation. Patients with obesity are more likely to require assisted reproductive technologies to conceive.
2. Current Practices: Many IVF centres have policies restricting treatment based on BMI thresholds, ranging from 35 to 45 kg/m². The primary reasons for these restrictions include anaesthesia safety concerns, pregnancy rates, and equipment limitations.
3. Safety of Oocyte Retrieval: Recent studies have shown that oocyte retrieval can be safely performed as an outpatient procedure in patients with class III obesity (BMI > 40 kg/m²) when proper precautions are taken.
4. Weight Bias in Reproductive Medicine: The review highlights the presence of explicit and implicit weight bias among healthcare providers, which may contribute to inequitable access to fertility treatments.
5. Individualised Risk Assessment: Instead of relying solely on BMI, the authors recommend individualised preoperative evaluations that consider available resources, equipment, and patient-specific factors.
6. Best Practices for Inclusive Care: The review outlines several strategies for creating an inclusive IVF treatment environment, including respectful communication, size-inclusive equipment, and modified procedural techniques.
7. Anesthesia and Procedural Modifications: The authors describe various anaesthesia options and procedural modifications that can be employed to ensure safe and effective oocyte retrieval and embryo transfer in patients with obesity.

Implications for IVF Centers:

1. Reevaluate BMI Restrictions: IVF centres should reconsider strict BMI cutoffs in favor of more comprehensive, individualized patient assessments.
2. Crucial Addressing Weight Bias: Healthcare providers should be educated about weight bias and encouraged to use empathetic, unbiased language when discussing weight and fertility.
3. Vital Adaptation of Equipment and Procedures: Centers should invest in size-inclusive equipment and train staff on modified techniques for patients with larger bodies.
4. Improve Access to Care: IVF centers can provide timely access to safe and effective fertility treatments for a broader range of patients by adopting more inclusive practices.

As the prevalence of obesity continues to rise, IVF centres must adapt their practices to meet the needs of a changing patient population. By moving beyond BMI restrictions and adopting a more individualised, inclusive approach to care, we can ensure that patients with obesity have equitable access to fertility treatments. This shift aligns with the principles of patient-centred care. It reflects the latest evidence on the safety and efficacy of IVF procedures in patients with higher BMIs.

The future of reproductive medicine lies in our ability to provide compassionate, evidence-based care that addresses each patient's unique needs, regardless of their body size. By embracing these changes, we can work towards a more inclusive and practical approach to helping individuals and couples achieve their dreams of parenthood.

By combining cutting-edge medical expertise with a deeply compassionate approach, Newlife IVF Greece stands at the forefront of inclusive fertility care. Our commitment to providing high-quality, individualised treatment to patients across the BMI spectrum reflects a broader shift in the field towards more equitable and patient-centred reproductive medicine.