OBESE women are being unfairly penalised when it comes to IVF treatment, an Oxford Uni specialist claims.
Dr Rebecca Brown has called women who fall outside the "healthy" BMI boundaries "easy targets" for trusts looking to cut costs.
Writing in the journal Health Care Analysis, she's criticises Clinical Commission Groups (CCGs) in England who ration free IVF cycles based on a person’s BMI.
Dr Brown said that there was little evidence to suggest that IVF is any less effective in obese women than their slimmer peers – and that as a result, overweight women were being unfairly stigmatised because of a "blame culture".
Dr Brown says: "I have advocated a sceptical stance towards ‘evidence-based’ justifications for excluding obese people from NHS-funded IVF treatment.
“I have argued that the lack of high-quality evidence regarding the effectiveness of IVF in both obese and non-obese populations.
“Claims that the evidence is of sufficient clarity to make decisive cost-effectiveness cut-offs appropriate is disingenuous."
Instead, she suggests that trusts are trying to save money and using pseudo-science to cover up anti-obesity bias and budget cuts.
“My claim is not that it is cost-effective to provide IVF to obese women, but that there is insufficient evidence to show that it is significantly less cost-effective than to provide it to non-obese women," she says.
“To claim that evidence relating to the cost-efficiency of IVF allows for fine-grained distinctions between different points on the BMI scale when so little is known about numerous aspects of the effectiveness of IVF is at best naive, and at worst, intentionally misleading.”
NHS IVF funding has fallen dramatically
Between 2013 and 2017, the number of Clinical Commission Groups in England offering the recommended three cycles of IVF to those who met all criteria halved, from 24 per cent to 12 per cent.
Twenty-three per cent of CCGs offered just two cycles, 61 per cent one cycle, and four per cent – or seven in total – none.
Back in January, Oldham's CCG became the latest body to announce that it was cutting the number of cycles from three to one, saving £147,500 a year.
The National Institute for Health and Care Excellence (Nice) guidelines suggest that "women who have a body mass index (BMI) of 30 or over should be informed that they are likely to take longer to conceive".
Its guidance has prompted many CCGs to only provide free cycles to women who have a BMI of between 19 and 29.9.
Obesity is still a risk factor
That's not to say that obesity isn't a risk factor for reduced fertility.
There is some evidence to suggest that being overweight can increase the risk of pregnancy complications.
But Dr Brown insists that it's wrong to described IVF treatment as "futile" in obese women.
She points to an American study which has found that the live birth rates in morbidly obese women aren't that much lower than in those who are a healthy weight.
And she's not alone in her thoughts.
But age is the main issue
Dr Hana Visnova, medical director at the IVF Cube clinic, who treat many British and Irish patients each year, says: "Obesity is seen by many health professionals as a factor in the chances any woman has of becoming pregnant, but clearly there are many slender people who also fail to conceive.
Risks of being obese
While obesity may not be as much of a risk factor for obesity as some authorities might claim, obesity can cause other huge health problems.
The NHS estimates that around one in four Brits are obese and one in five kids are also dangerously overweight.
It can increase your risk of:
- type 2 diabetes
- coronary heart disease
- high cholesterol
- sleep apnoea
- liver and kidney disease
- gestational diabetes
- many types of cancer increasing womb, bowel and breast
“Age is the main factor which plays a role in the likelihood of pregnancy, and that is why IVF treatment on the NHS in England and Wales is not offered to women aged over 42.
“The reasons for this include the fact that egg quality starts to decrease after the age of 30 and after 35 both egg quality and quantity are significantly reduced.
“But here are many other reasons why a woman may struggle to conceive, including ovary malfunction endometriosis, and hormonal malfunction, premature menopause, and blocked tubes – NOT just their weight.
“National health bodies such as the UK’s NHS have had to make cost savings due to financial pressures, and sadly IVF treatment is one area where this has happened.
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“Other reasons for limiting IVF may remain contentious and subject to debate, but Dr Brown’s analysis is interesting.”
Dr Brown even goes further to suggest anti-obesity is linked to a warped belief that people who are responsible for their ill health should eb less of a priority for treatment than those who are supposedly not responsible.
She adds: "Given the highly stigmatised nature of obesity, the ambiguity around the status of subfertility as a ‘disease’, and the confusion around the methodologies used to assess its cost-effectiveness, she says it is unsurprising that CCGs have chosen to deny IVF treatment to the overweight.”
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