On last night’s episode of This Is Us, Kate and Toby decide to pursue in-vitro fertilization (IVF) treatments to have a baby. Eager to get started on the process due to her "ticking clock," Kate and Toby visit a new doctor, only to be told that the doctor can’t take Kate on as a patient.
"At your weight, the chances of a successful pregnancy are very slim, even if you go through in-vitro," the doctor tells her.
Visibly crestfallen, Kate says that she knows, doesn't care, and wants to try anyways. "I admire that, but egg retrieval is invasive," the doctor says. "At your BMI, going under anesthesia for an elective procedure is not advised." Kate reiterates that she is willing to take her chances, and the doctor tells her that due to liability issues, she can’t accept her. "I fear you’ll be hard-pressed to find anyone who will," the doctor says.
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This scenario is an unfortunate reality for many prospective IVF patients. For patients who are classified as overweight or obese, there tend to be more risks associated with IVF treatments. For example, egg retrieval can be more difficult in obese patients because it's harder to see the ovaries, going under anesthesia can be riskier for people who are obese, and someone who is obese may not respond as well to IVF medications, Mindy Christianson, MD, assistant professor of obstetrics and gynecology specializing in fertility at Johns Hopkins University of Medicine told Refinery29. Additionally, obese people may be at an increased risk of miscarriage, and pregnancy conditions such as pre-eclampsia and gestational diabetes.
For this reason, many fertility clinics will only accept patients who fall within a certain body mass index (BMI) range. Although BMI is not the best indicator of someone's health, in general, live birth rates decrease with a BMI that's greater than 35-40, Dr. Christianson said. But that doesn't mean that people with a BMI higher than 40 can't get IVF at all. Some clinics will suggest that patients lose weight before treatments, or go through additional consultations to ensure that the procedures will be safe, she said. But every person and every clinic is different: Depending on other factors such as age or egg quality, some doctors may not be able to delay fertility treatments in time for someone to lose weight.
Although this was just one episode and one fictional story, it paints a larger picture of the very real weight bias that obese and overweight patients experience from their doctors and healthcare providers. Research has shown that when people experience weight discrimination from doctors, they are more likely to delay or stop going to the doctor. It will be interesting to see how Kate's fertility story develops over the course of this season of This Is Us. Hopefully, she'll end up finding a doctor who hears her concerns, respects her decisions, and is willing to help her.